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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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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2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines
Clyde W. Yancy,Mariell Jessup,Biykem Bozkurt,Javed Butler,Donald E. Casey,Mark H. Drazner,Gregg C. Fonarow,Stephen A. Geraci,Tamara B. Horwich,James L. Januzzi,Maryl R. Johnson,Edward K. Kasper,Wayne C. Levy,Frederick A. Masoudi,Patrick E. McBride,John J.V. McMurray,Judith E. Mitchell,Pamela N. Peterson,Barbara Riegel,Flora Sam,Lynne W. Stevenson,W.H. Wilson Tang,Emily J. Tsai,Bruce L. Wilkoff +23 more
TL;DR: In this article, Anderson et al. proposed a new FAHA Chair, Jeffrey L. Anderson, MD, FACC, FAHA, Chair-Elect, Alice K. Jacobs et al., this article and Biykem Bozkurt.
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
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
TL;DR: The use of darbepoetin alfa in patients with diabetes, chronic kidney disease, and moderate anemia who were not undergoing dialysis did not reduce the risk of either of the two primary composite outcomes (either death or a cardiovascular event ordeath or a renal event) and was associated with an increased risk of stroke.
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Clinical Practice Guidelines We Can Trust
TL;DR: Clinical Practice Guidelines The authors Can Trust shows how clinical practice guidelines can enhance clinician and patient decision-making by translating complex scientific research findings into recommendations for clinical practice that are relevant to the individual patient encounter, instead of implementing a one size fits all approach to patient care.
Journal ArticleDOI
Targeting Hypoxia-Inducible Factors for the Treatment of Anemia in Chronic Kidney Disease Patients
TL;DR: Results from clinical studies of a number of HIF prolyl hydroxylase inhibitors are increasingly available and provide support for the continued evaluation of the risk-benefit ratio of this novel therapeutic approach to the treatment of anemia in CKD.
References
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Journal ArticleDOI
Canadian Randomized Trial of Hemoglobin Maintenance to Prevent or Delay Left Ventricular Mass Growth in Patients With CKD
Adeera Levin,Ognjenka Djurdjev,Christopher R. Thompson,Brendan J. Barrett,Jean Ethier,Euan Carlisle,Paul E. Barre,Peter Magner,Norman Muirhead,Sheldon W. Tobe,Paul Tam,Jose Arturo Wadgymar,Joanne Kappel,David C. Holland,Vincent Pichette,Ahmed Shoker,George Soltys,Mauro Verrelli,Joel Singer +18 more
TL;DR: There is strong evidence that the association between Hgb level and LVMI likely is not causal, and large randomized controlled trials with unselected patients, using morbidity and mortality as outcomes, are needed.
Journal ArticleDOI
Cardiovascular effects of recombinant human erythropoietin in predialysis patients
José Portolés,Antonio Torralbo,Piedad Martin,Jose Rodrigo,José Antonio Herrero,Alberto Barrientos +5 more
TL;DR: Ambulatory BP reveals a worse control in some patients who were previously hypertensive and confirms the utility of this technique in the assessment of patients under erythropoietin treatment, and shows the role of anemia among the multiple factors leading to LV hypertrophy in end-stage renal disease (ESRD), and opens therapeutic possibilities.
Journal ArticleDOI
Effects of recombinant human erythropoietin on renal function in chronic renal failure predialysis patients.
David M. Roth,Ronald D. Smith,Gerald Schulman,Theodore I. Steinman,Fred E. Hatch,Michael R. Rudnick,James A. Sloand,Barry I. Freedman,Winfred W. Williams,Craig A. Shadur,Robert L. Benz,Brendan P. Teehan,Dennis A. Revicki,Brenda J. Sarokhan,Robert I. Abels +14 more
TL;DR: It is concluded that r-HuEPO therapy improves anemia in predialysis patients and does not accelerate the rate of progression to end-stage renal disease.
Journal ArticleDOI
Focal segmental glomerulosclerosis in adults
TL;DR: Evidence suggests that timely initiation of epoetin treatment to correct renal anaemia appears to be associated with improved survival of ESRD patients in the first year after start of dialysis and reduced costs of treatment.
Journal ArticleDOI
Effects of haemoglobin normalization on quality of life and cardiovascular parameters in end‐stage renal failure
Lawrence P. McMahon,Kim Mason,Sandford L. Skinner,Caroline M. Burge,Leanne E. Grigg,Gavin J. Becker +5 more
TL;DR: There may be a significant haemodynamic and symptomatic advantage in maintaining a physiological [Hb] in haemodialysis patients, and a substantially higher dose of epoetin is required to maintain this level.
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