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
Effect of erythropoiesis-stimulating agents on blood pressure in pre-dialysis patients.
Marit M. Suttorp,Tiny Hoekstra,Moshe Mittelman,Ilka Ott,Casper F. M. Franssen,Friedo W. Dekker +5 more
TL;DR: The hypertensive effect of ESA is confirmed, since ESA treated patients received more antihypertensive agents, thus the increase in BP seems to be controlled for by anti Hypertensive medication.
Journal ArticleDOI
Effects of the prospective payment system on anemia management in maintenance dialysis patients: implications for cost and site of care
TL;DR: Inpatient- and emergency-department-administered transfusions increased, providing some evidence for a partial shift in the cost and site of care for anemia management from dialysis facilities to hospitals.
Journal ArticleDOI
Incremental Cost Effectiveness of Pharmacist-Managed Erythropoiesis-Stimulating Agent Clinics for Non-Dialysis-Dependent Chronic Kidney Disease Patients
Sherrie L. Aspinall,Kenneth J. Smith,Chester B. Good,Xinhua Zhao,Roslyn A. Stone,Ivy Q. Tonnu-Mihara,Francesca E. Cunningham +6 more
TL;DR: Pharmacist-managed ESA clinics were less costly and more effective than usual care in patients receiving ESAs for anemia and NDD-CKD.
Journal ArticleDOI
Erythropoietin Reverses Sepsis-Induced Vasoplegia to Norepinephrine Through Preservation of α1D-Adrenoceptor mRNA Expression and Inhibition of GRK2-Mediated Desensitization in Mouse Aorta.
Kannan Kandasamy,Soumen Choudhury,Vishakha Singh,M. Pule Addison,Sazad A. Darzi,Jaya Kiran Kasa,Ramasamy Thangamalai,Jeevan Ranjan Dash,Tarun Kumar,Faheem Sultan,Thakur Uttam Singh,Subhashree Parida,Santosh K. Mishra +12 more
TL;DR: EPO seems to reverse sepsis-induced vasoplegia to NE through the preservation of α1D adrenoceptor mRNA/protein expression, inhibition of GRK2-mediated desensitization, and attenuation of NO overproduction in the mouse aorta.
Journal ArticleDOI
Patient-Centred Outcomes in Anaemia and Renal Disease: A Systematic Review.
Phillip Staibano,Iris Perelman,Iris Perelman,Julia Lombardi,Julia Lombardi,Alexandra Davis,Alan Tinmouth,Alan Tinmouth,Marc Carrier,Marc Carrier,Ciara Stevenson,Elianna Saidenberg,Elianna Saidenberg +12 more
TL;DR: A systematic review of studies that evaluated patient-centred outcomes (PCOs) in renal patients undergoing anaemia treatment found no statistically significant association between improvements in haemoglobin and QOL.
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