Journal ArticleDOI
Normalization of Hemoglobin Level in Patients with Chronic Kidney Disease and Anemia
Tilman B. Drüeke,Francesco Locatelli,Naomi Clyne,Kai-Uwe Eckardt,Iain C. Macdougall,Dimitrios Tsakiris,Hans-Ulrich Burger,Armin Scherhag +7 more
Reads0
Chats0
TLDR
In patients with chronic kidney disease, early complete correction of anemia does not reduce the risk of cardiovascular events and there was no significant difference in the combined incidence of adverse events between the two groups.Abstract:
BACKGROUND Whether correction of anemia in patients with stage 3 or 4 chronic kidney disease improves cardiovascular outcomes is not established. METHODS We randomly assigned 603 patients with an estimated glomerular filtration rate (GFR) of 15.0 to 35.0 ml per minute per 1.73 m 2 of body-surface area and mild-to-moderate anemia (hemoglobin level, 11.0 to 12.5 g per deciliter) to a target hemoglobin value in the normal range (13.0 to 15.0 g per deciliter, group 1) or the subnormal range (10.5 to 11.5 g per deciliter, group 2). Subcutaneous erythropoietin (epoetin beta) was initiated at randomization (group 1) or only after the hemoglobin level fell below 10.5 g per deciliter (group 2). The primary end point was a composite of eight cardiovascular events; secondary end points included left ventricular mass index, quality-of-life scores, and the progression of chronic kidney disease. RESULTS During the 3-year study, complete correction of anemia did not affect the likelihood of a first cardiovascular event (58 events in group 1 vs. 47 events in group 2; hazard ratio, 0.78; 95% confidence interval, 0.53 to 1.14; P = 0.20). Left ventricular mass index remained stable in both groups. The mean estimated GFR was 24.9 ml per minute in group 1 and 24.2 ml per minute in group 2 at baseline and decreased by 3.6 and 3.1 ml per minute per year, respectively (P = 0.40). Dialysis was required in more patients in group 1 than in group 2 (127 vs. 111, P = 0.03). General health and physical function improved significantly (P = 0.003 and P<0.001, respectively, in group 1, as compared with group 2). There was no significant difference in the combined incidence of adverse events between the two groups, but hypertensive episodes and headaches were more prevalent in group 1. CONCLUSIONS In patients with chronic kidney disease, early complete correction of anemia does not reduce the risk of cardiovascular events. (ClinicalTrials.gov number, NCT00321919.)read more
Citations
More filters
Journal ArticleDOI
Anemia of critical illness.
TL;DR: Although several therapeutic options are available to treat anemia, critically ill patients often receive a transfusion, and yet, most recent studies indicate that blood transfusions in critical ill patients are associated with worse outcomes, including higher morbidity and mortality.
Journal ArticleDOI
Quality of life among patients with moderate to advanced chronic kidney disease in Ghana - a single centre study
Elliot Koranteng Tannor,Betty Norman,Kwame K. Adusei,Fred Stephen Sarfo,Mogamat Razeen Davids,George Bedu-Addo +5 more
TL;DR: Patients with moderate to advanced CKD had low- Income status, presented with advanced disease and had poor QOL, and Anaemia and low-income status were significantly associated with poorQOL.
Journal Article
Clinical use of erythropoietin in chronic kidney disease: outcomes and future prospects.
TL;DR: Until future studies are able to clarify the multiple beneficial or unfavorable effects of Epo, it is advisable to remain prudent in its administration, yet optimistic about its possible contribution in a number of pathologic conditions.
Journal ArticleDOI
Maintaining high hemoglobin levels improved the left ventricular mass index and quality of life scores in pre-dialysis Japanese chronic kidney disease patients
Hideki Hirakata,Yoshiharu Tsubakihara,Fumitake Gejyo,Shinichi Nishi,Yasuhiko Iino,Yuzou Watanabe,Masashi Suzuki,Akira Saito,Takashi Akiba,Daijo Inaguma,Shunichi Fukuhara,Satoshi Morita,Michiaki Hiroe,Yoshiyuki Hada,Makoto Suzuki,Makoto Akaishi,Kazutaka Aonuma,Tadao Akizawa +17 more
TL;DR: Targeting a higher Hb around 12 g/dl was more beneficial than targeting conventional Hb in terms of reduction of LVMI and QOL scores and further studies to determine the appropriate Hb target are necessary.
Journal ArticleDOI
Prevention of Chronic Kidney Disease and Subsequent Effect on Mortality: A Systematic Review and Meta-Analysis
TL;DR: A systematic review of randomized controlled trials to determine whether prevention or slowing of progression of chronic kidney disease would translate into improved mortality, and if so, the attributable risk due to CKD itself on mortality.
References
More filters
Journal ArticleDOI
The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection.
John E. Ware,Cathy D. Sherbourne +1 more
TL;DR: A 36-item short-form survey designed for use in clinical practice and research, health policy evaluations, and general population surveys to survey health status in the Medical Outcomes Study is constructed.
Journal ArticleDOI
The MOS 36-Item Short-Form Health Survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs.
TL;DR: In this article, cross-sectional data from the Medical Outcomes Study (MOS) were analyzed to test the validity of the MOS 36-Item Short-Form Health Survey (SF-36) scales as measures of physical and mental health constructs.
Journal ArticleDOI
Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms.
Nelson B. Schiller,P. M. Shah,Michael H. Crawford,Anthony N. DeMaria,Richard B. Devereux,Harvey Feigenbaum,H. Gutgesell,Nathaniel Reichek,David J. Sahn,Ingela Schnittger +9 more
TL;DR: It is the opinion that current technology justifies the clinical use of the quantitative two-dimensional methods described in this article and the routine reporting of left ventricular ejection fraction, diastolic volume, mass, and wall motion score.
Journal ArticleDOI
Correction of Anemia with Epoetin Alfa in Chronic Kidney Disease
Ajay K. Singh,Lynda A. Szczech,Kezhen L. Tang,Huiman X. Barnhart,Shelly Sapp,Marsha Wolfson,Donal N. Reddan,Abstr Act +7 more
TL;DR: The use of a target hemoglobin level of 13.5 g per deciliter (as compared with 11.3 g perDeciliter) was associated with increased risk and no incremental improvement in the quality of life and the use of epoetin alfa targeted to achieve a level of 11.4 g perdeciliter was not associated with an increased risk.
Journal ArticleDOI
The effects of normal as compared with low hematocrit values in patients with cardiac disease who are receiving hemodialysis and epoetin.
Anatole Besarab,W K Bolton,J K Browne,Joan C. Egrie,Allen R. Nissenson,D M Okamoto,Steve J. Schwab,David A. Goodkin +7 more
TL;DR: In patients with clinically evident congestive heart failure or ischemic heart disease who are receiving hemodialysis, administration of epoetin to raise their hematocrit to 42 percent is not recommended.
Related Papers (5)
A Trial of Darbepoetin Alfa in Type 2 Diabetes and Chronic Kidney Disease
Marc A. Pfeffer,Emmanuel A. Burdmann,Chao-Yin Chen,Mark E. Cooper,Dick de Zeeuw,Kai-Uwe Eckardt,Jan Feyzi,Peter Ivanovich,Reshma Kewalramani,Andrew S. Levey,Eldrin F. Lewis,Janet B. McGill,John J.V. McMurray,Patrick S. Parfrey,Hans-Henrik Parving,Hans-Henrik Parving,Giuseppe Remuzzi,Ajay K. Singh,Scott D. Solomon,Robert D. Toto +19 more