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
Recent advances and clinical application of erythropoietin and erythropoiesis-stimulating agents
Tetsuhiro Tanaka,Masaomi Nangaku +1 more
TL;DR: The clinical benefit of normalization of anemia in pre-dialysis CKD by EPO therapy is controversial and recent large-scale, randomized-controlled trials do not favor normalization byEPO in improving cardiovascular as well as renal outcomes.
Journal ArticleDOI
Roxadustat for anemia in patients with end-stage renal disease incident to dialysis.
Robert Provenzano,Evgeny Shutov,Liubov Eremeeva,Svitlana Korneyeva,Lona Poole,Gopal Saha,Charles Bradley,Meraf Eyassu,Anatole Besarab,Robert Leong,Cameron Liu,Thomas B. Neff,Lynda A. Szczech,Kin-Hung Peony Yu +13 more
TL;DR: The HIMALAYAS trial as mentioned in this paper evaluated the efficacy and safety of roxadustat versus epoetin alfa for the treatment of chronic kidney disease-related anemia in patients new to dialysis.
Journal ArticleDOI
Changes in anemia management and hemoglobin levels following revision of a bundling policy to incorporate recombinant human erythropoietin
Takeshi Hasegawa,Takeshi Hasegawa,Jennifer L. Bragg-Gresham,Ronald L. Pisoni,Bruce M. Robinson,Shunichi Fukuhara,Takashi Akiba,Akira Saito,Kiyoshi Kurokawa,Tadao Akizawa +9 more
TL;DR: This bundling policy was associated with reduced rHuEPO doses, increased intravenous iron use, and stable hemoglobin levels in Japanese patients receiving hemodialysis.
Journal ArticleDOI
Economic and quality of life burden of anemia on patients with CKD on dialysis: a systematic review.
Bruce Spinowitz,Roberto Pecoits-Filho,Wolfgang C. Winkelmayer,Pablo E. Pergola,Samuel Rochette,Philippe Thompson-Leduc,Patrick Lefebvre,Gigi Shafai,Ana Bozas,Myrlene Sanon,Holly B Krasa +10 more
TL;DR: ESA-treated patients undergoing dialysis incurred lower costs, lower HRU, and had better HRQoL relative to ESA-untreated patients, however, treatment to higher Hb targets led to modest HRZoL improvements compared to lower HB targets.
Journal ArticleDOI
Differential HIF and NOS responses to acute anemia: defining organ-specific hemoglobin thresholds for tissue hypoxia
Albert K. Y. Tsui,Philip A. Marsden,C. David Mazer,John G. Sled,Keith M. Lee,R. Mark Henkelman,Lindsay S. Cahill,Yu-Qing Zhou,Neville Chan,Elaine Liu,Gregory M. T. Hare,Gregory M. T. Hare +11 more
TL;DR: Observations suggest that each organ expresses a different threshold for cellular HIF/NOS hypoxia responses, which may help define the mechanism(s) by which the brain and kidney maintain oxygen homeostasis during anemia.
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.
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