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
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
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Journal ArticleDOI
Design of the Blood Pressure Goals in Dialysis pilot study.
Ambreen Gul,Antonia Harford,Bruce Horowitz,Edward J. Bedrick,Dana C. Miskulin,Jennifer J. Gassman,Joline Chen,Susan Paine,John W. Kusek,Mark Unruh,Mark Unruh,Philip G. Zager,Philip G. Zager +12 more
TL;DR: This is the first study to randomize hemodialysis patients to 2 different predialysis systolic BP targets and will determine the feasibility and safety and inform the design of a full-scale trial, powered for hard outcomes, which may require 2000 participants.
Journal ArticleDOI
Effect of facility-level hemoglobin concentration on dialysis patient risk of transfusion.
Allan J. Collins,Keri L. Monda,Julia T. Molony,Suying Li,David T. Gilbertson,Brian D. Bradbury +5 more
TL;DR: In this article, the authors examined anemia management trends in hemodialysis patients and risk of red blood cell (RBC) transfusion according to dialysis facility-level hemoglobin concentration.
Journal ArticleDOI
Continuous EPO receptor activator therapy of anemia in children under peritoneal dialysis
Francisco Cano,Claudia Alarcon,Marta Azocar,Carolina Lizama,Ana Maria Lillo,Angela Delucchi,Mariluz Gonzalez,Patricia Arellano,Iris Delgado,Maria Teresa Droguett +9 more
TL;DR: CERA is an effective and safe therapy for maintaining hemoglobin levels when administered twice, up to once a month, in PD children, and Doses required to reach target Hb were higher than published experiences in adult populations.
Journal ArticleDOI
The incidence, predictors and management of anaemia and its association with virological response in HCV / HIV coinfected persons treated with long-term pegylated interferon alfa 2a and ribavirin
TL;DR: Aliment Pharmacol Ther 2011; 33: 1234–1244.
Journal ArticleDOI
Defining, Treating, and Understanding Chronic Kidney Disease--A Complex Disorder.
Dean Campbell,Matthew R. Weir +1 more
TL;DR: Treatment of patients with CKD should focus on mitigating risk factors, as well as common comorbidities such as cardiovascular disease, anemia, and bone mineral disease.
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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
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