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
The efficacy and economic evaluation of roxadustat treatment for anemia in patients with kidney disease not receiving dialysis
TL;DR: For the treatment of anemia in Chinese patients with CKD ND, roxadustat is much more effective than a placebo; moreover, it is cost-effective at conventional WTP thresholds.
Journal ArticleDOI
Achievement of renal anemia KDIGO targets by two different clinical strategies - a European hemodialysis multicenter analysis.
Maciej Drozdz,André Weigert,Fatima Silva,João M. Frazão,Abdulkareem Alsuwaida,Mahesh Krishnan,Werner Kleophas,Szymon Brzosko,Fredrik K. Johansson,Stefan H. Jacobson +9 more
TL;DR: Administration of high doses of IV iron in routine clinical HD practice may not be associated with considerable harm and the odds for Hb within guidelines increased significantly, but large randomized controlled trials are needed to provide absolute evidence of iron safety.
Journal ArticleDOI
Mirtazapine-Associated Hyponatremia in an Elderly Patient:
TL;DR: validated the effectiveness of the CPOE rule by demonstrating a high percentage (>94%) of ESA orders prevented and utilizing theride functionality was utilized in only one caseuring the analysis.
Journal ArticleDOI
Decline of kidney function during the pre-dialysis period in chronic kidney disease patients: a systematic review and meta-analysis.
Cynthia J. Janmaat,Merel van Diepen,Cheyenne C. E. van Hagen,Joris I. Rotmans,Friedo W. Dekker,Olaf M. Dekkers +5 more
TL;DR: In this paper, a systematic review and meta-analysis was performed to compare the kidney function decline during pre-dialysis in CKD stage 3-5 patients, in these two different study types.
Journal ArticleDOI
Cardiorenal anemia syndrome: do erythropoietin and iron therapy have a place in the treatment of heart failure?
Efstathios D. Pagourelias,Charalambos Koumaras,Anna I. Kakafika,Konstantinos Tziomalos,Konstantinos Tziomalos,Paraskevi G. Zorou,Vasilios G. Athyros,Asterios Karagiannis +7 more
TL;DR: Results suggest that EPO treatment might be beneficial in CHF, but more studies are needed and certain issues should be resolved, particularly the optimal hemoglobin level, before EPO can become part of the treatment of patients with CHF.
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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