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
Serum Albumin Is Strongly Associated with Erythropoietin Sensitivity in Hemodialysis Patients
TL;DR: Serum albumin concentration is an important predictor of both baseline Hgb and epo sensitivity in chronic hemodialysis patients and factors that improve serum albumin may also improve Hgb in hemodIALysis patients.
Journal ArticleDOI
Medication Safety Principles and Practice in CKD.
TL;DR: This review presents the key issues and threats to safe medication use in kidney disease, with a focus on predialysis CKD, as the scope of medication safety in ESKD and transplantation are unique and deserve their own consideration.
Journal ArticleDOI
Hemoglobin Variability Does Not Predict Mortality in European Hemodialysis Patients
Kai-Uwe Eckardt,Joseph Kim,Florian Kronenberg,Pedro Aljama,Stefan D. Anker,Bernard Canaud,Bart Molemans,Peter Stenvinkel,Guntram Schernthaner,Elizabeth Ireland,Bruno Fouqueray,Iain C. Macdougall +11 more
TL;DR: Although Hb variability is common in European hemodialysis patients, it does not independently predict mortality.
Journal ArticleDOI
Baseline characteristics in the Trial to Reduce Cardiovascular Events With Aranesp Therapy (TREAT).
Marc A. Pfeffer,Emmanuel A. Burdmann,Chao-Yin Chen,Mark E. Cooper,Dick de Zeeuw,Kai-Uwe Eckardt,Peter Ivanovich,Reshma Kewalramani,Andrew S. Levey,Eldrin F. Lewis,Janet B. McGill,John J.V. McMurray,Patrick S. Parfrey,Hans-Henrik Parving,Giuseppe Remuzzi,Ajay K. Singh,Scott D. Solomon,Robert D. Toto,Hajime Uno +18 more
TL;DR: With several-fold more patient years and a placebo arm, TREAT will provide a robust estimate of the safety and efficacy of darbepoetin alfa and generate prospective data regarding the risks of major cardiovascular and renal events in a contemporarily managed cohort of patients with type 2 diabetes, CKD, and anemia.
Journal ArticleDOI
Anemia and iron deficiency among chronic kidney disease Stages 3–5ND patients in the Chronic Kidney Disease Outcomes and Practice Patterns Study: often unmeasured, variably treated
Michelle M.Y. Wong,Charlotte Tu,Yun Li,Rachel L. Perlman,R. Pecoits-Filho,R. Pecoits-Filho,Antonio Alberto Lopes,Ichiei Narita,Helmut Reichel,Friedrich K. Port,Nidhi Sukul,Bénédicte Stengel,Bruce M. Robinson,Ziad A. Massy,Ronald L. Pisoni,CKDopps Investigators +15 more
TL;DR: Hemoglobin and iron stores are measured less frequently than per guidelines, and among all regions, there was a substantial proportion of anemic patients with iron deficiency who were not treated with iron, highlighting an area for practice improvement in CKD care.
References
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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
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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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