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
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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
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Journal ArticleDOI
Emerging strategies to preserve renal function.
Hélène François,Antoine Jacquet,Séverine Beaudreuil,Alexandre Seidowsky,Hadia Hebibi,Bernard Charpentier,Antoine Durrbach +6 more
TL;DR: The role of other current therapies being used during CKD, including statins, vitamin D and erythropoiesis-stimulating agents, will be discussed, as these may also exert nephroprotective effects.
Journal ArticleDOI
Hematologic manifestations of kidney disease.
TL;DR: The failure of the kidney to clear toxins from the body can result in alteration involving hemostasis, as well as leukocyte function and survival, which can lead to anemia and polycythemia.
Journal ArticleDOI
Coronary artery disease in chronic kidney disease: highlights from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference.
TL;DR: The KDIGO Clinical Practice Guideline for Anemia in Chronic Kidney Disease and Prolyl hydroxylase domain inhibitors as a novel therapeutic approach against anemia in chronic kidney disease are guidelines for patients undergoing long-term dialysis.
Journal ArticleDOI
Early versus delayed erythropoietin for the anaemia of end-stage kidney disease.
Jorge Coronado Daza,Arturo J Martí-Carvajal,Amaury Ariza García,Joaquín Rodelo Ceballos,Nancy Yomayusa González,Carol Páez-Canro,César Loza Munarriz,Gerard Urrútia +7 more
TL;DR: No evidence is found to assess the benefits and harms of early versus delayed EPO for the anaemia of ESKD, especially among older people whose life expectancy is limited, but in whom EPO therapy may improve quality of life.
Journal ArticleDOI
Management of anaemia in haemodialysis and peritoneal dialysis patients (chapter 8).
TL;DR: A higher proportion of HD patients than PD patients receive ESA therapy (88% vs 76%).
References
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The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection.
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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.
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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.
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