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
Association of anemia and erythropoiesis stimulating agents with inflammatory biomarkers in chronic kidney disease.
Sai Ram Keithi-Reddy,Francesco Addabbo,Tejas V. Patel,Bharati V. Mittal,Michael S. Goligorsky,Ajay K. Singh +5 more
TL;DR: The study found that the anemia of chronic kidney disease was associated with up regulation of TNF-alpha, and possibly IL-6 and IL-8 along with increased levels of these proinflammatory cytokines in patients treated with epoetin.
Journal ArticleDOI
Low testosterone and anaemia in men with type 2 diabetes
Mathis Grossmann,Sianna Panagiotopolous,Ken Sharpe,Richard J MacIsaac,Sophie Clarke,Jeffrey D Zajac,George Jerums,Merlin C. Thomas,Merlin C. Thomas +8 more
TL;DR: It is hypothesized that low testosterone levels are also associated with anaemia in men with type 2 diabetes, over the effects of chronic kidney disease.
Journal ArticleDOI
Pattern of resistance to erythropoietin-stimulating agents in chronic kidney disease
TL;DR: To minimize the harmful consequences of EPO resistance, surveillance programs must replenish nutrient stores, minimize oxidative hemolysis, control hyperparathyroidism, avoid catheter infection, and optimize uremic clearance.
Journal ArticleDOI
Recent progresses in layer-by-layer assembled biogenic capsules and their applications
TL;DR: This review summarizes the recent progress made in the fabrication of pure natural materials such as biogenic capsules, which have been developed as smart materials for guest molecule encapsulation and delivery in the last two decades.
Journal ArticleDOI
Safety of Intravenous Iron in Dialysis: A Systematic Review and Meta-Analysis
Ingrid Hougen,David Collister,David Collister,Mathieu Bourrier,Thomas W. Ferguson,Thomas W. Ferguson,Laura Hochheim,Paul Komenda,Paul Komenda,Claudio Rigatto,Claudio Rigatto,Navdeep Tangri +11 more
TL;DR: Higher-dose intravenous iron does not seem to be associated with higher risk of mortality, infection, cardiovascular events, or hospitalizations in adult patients on dialysis, a finding limited by small numbers of participants and events in the randomized, controlled trials and statistical heterogeneity in observational studies.
References
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Journal ArticleDOI
Correction of Anemia with Epoetin Alfa in Chronic Kidney 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
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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