Background Treatment with erythropoietin is well established for anemia in chronic kidney disease patients but not well studied in acute kidney injury. Methods This is a multicenter, randomized, pragmatic controlled clinical trial. It included 134 hospitalized patients with anemia defined as hemoglobin < 11 g/dL and acute kidney injury defined as an increase of serum creatinine of ≥ 0.3 mg/dL within 48 h or 1.5 times baseline. One arm received recombinant human erythropoietin 4000 UI subcutaneously every other day (intervention; n = 67) and the second received standard of care (control; n = 67) during the hospitalization until discharge or death. The primary outcome was the need for transfusion; secondary outcomes were death, renal recovery, need for dialysis. Results There was no statistically significant difference in transfusion need (RR = 1.05, 95%CI 0.65,1.68; p = 0.855), in renal recovery full or partial (RR = 0.96, 95%CI 0.81,1.15; p = 0.671), in need for dialysis (RR = 11.00, 95%CI 0.62, 195.08; p = 0.102) or in death (RR = 1.43, 95%CI 0.58,3.53; p = 0.440) between the erythropoietin and the control group. Conclusions Erythropoietin treatment had no impact on transfusions, renal recovery or mortality in acute kidney injury patients with anemia. The trial was registered on ClinicalTrials.gov (NCT03401710, 17/01/2018).
Background Treatment with erythropoietin is well established for anemia in chronic kidney disease patients but not well studied in acute kidney injury.MethodsThis is a multicenter, randomized, pragmatic controlled clinical trial. It included 134 hospitalized patients with anemia defined as hemoglobin <11 g/dL and acute kidney injury defined as an increase of serum creatinine of 0.3 mg/dL within 48 hours or 1.5 times baseline. One arm received recombinant human erythropoietin 4000 UI subcutaneously every other day (intervention; n=67) and the second received standard of care (control; n=67) during the hospitalization until discharge or death. The primary outcome was the need for transfusion; secondary outcomes were death, renal recovery, need for dialysis.ResultsThere was no statistically significant difference in transfusion need (RR=1.05, 95%CI 0.65,1.68; p=0.855), in renal recovery full or partial (RR=0.96, 95%CI 0.81,1.15; p=0.671), in need for dialysis (RR=11.00, 95%CI 0.62, 195.08; p=0.102) or in death (RR=1.43, 95%CI 0.58,3.53; p=0.440) between the erythropoietin and the control group. ConclusionsErythropoietin treatment had no impact on transfusions, renal recovery or mortality in acute kidney injury patients with anemia. The trial was registered on ClinicalTrials.gov (NCT03401710, 17/01/2018).
Background. Hemodialysis (HD) patients have a high prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and mortality, but they may have a weak response to coronavirus disease 2019 (COVID-19) vaccines.Objectives. This study aimed to evaluate factors predictive of humoral response in HD patients vaccinated against SARS-CoV-2 infection. Materials and methods. This is a 2-center observational study including HD patients who received the BNT162b2 mRNA vaccine followed by serological measurements 20 days and 4 weeks after the 1 st and 2 nd dose, respectively. Healthy controls were included. Anti-spike antibody was measured using the chemiluminescent immunoassay (CLIA) method. The quantile regression analysis was performed to assess factors associated with anti-spike antibody titers.Results. Seventy-two HD patients and 22 healthy controls were included. Mean age of dialysis patients and controls was 72.5 ±11.5 years and 45.7 ±17.4 years, respectively. In the HD group, median levels of anti-spike antibody were 3 (interquartile range (IQR): 0.5−26) UI/mL and 391 (IQR: 55−1642) UI/mL after the 1 st and 2 nd dose, respectively, with response rates of 62.5% and 96.7%. The median level of the anti-spike antibody after the 1 st dose in previously infected patients was 8571 (IQR: 2586−19147) UI/mL. There was a significant correlation between anti-spike antibody levels after the 2 nd dose and age and anti-hepatitis B surface (HBs) antibody and serum albumin levels (Spearman's rho: r = −0.289, p < 0.001; r = 0.357, p = 0.027; r = 0.317; p = 0.026, respectively). The regression analysis showed a significant association of previous infection and anti-Hbs antibody level with anti-spike antibody level after the 1 st dose of vaccine (p < 0.001). After a 5-month follow-up, 2 vaccinated patients contracted COVID-19.Conclusions. This study showed a response rate of 96.7% to 2 doses of BNT162b2 mRNA vaccine in HD patients and 100% to a single dose in previously infected patients. The level of anti-spike antibody can be predicted by age, anti-Hbs antibodies, serum albumin, and previous infection. Despite the immunization of patients, preventive measures should be maintained in all dialysis units.
BACKGROUND AND AIMS Treatment with erythropoietin (EPO) is well established for anemia in chronic kidney disease patients but not well studied in acute kidney injury (AKI). This study aims to assess the transfusion need, renal recovery and all-cause mortality of AKI patients with anemia whether treated or not with EPO. METHOD This is a multicenter, randomized, pragmatic controlled clinical trial. It included 134 hospitalized patients with anemia [hemoglobin (Hb) <11 g/dL] and AKI [serum creatinine (Scr) of 0.3 mg/dL in 48 h or 1.5 times baseline]. Patients with active bleeding were excluded. Patients received EPO 4000 UI every other day (n = 67) or standard of care (control; n = 67) during the hospitalization until discharge or death. The study got the approval of the ethics committee of Saint-Joseph University number CE-HDF1115. The trial is registered on ClinicalTrials.gov (NCT03401710). RESULTS The general characteristics of both groups are summarized in Table 1. There was no statistically significant difference in transfusions, renal recovery or mortality between the treated group and the control (Table 2). A conditional regression analysis found phosphate, Hb on admission, CRP at the end of the hospitalization, the need for transfusions, the absence of renal recovery and inotrope use as factors associated with mortality (OR = 1.34, 95% CI 1.09–1.63; P = 0.004; OR = 0.61, 95% CI 0.41–0.92; P = 0.018; OR = 1.014, 95% CI 1.005–1023; P = 0.003; OR = 4.48, 95% CI 1.53–13.07; P = 0.006; OR = 22.1, 95% CI 6.36–76.74; P < 0.001; OR = 9.16, 95% CI 2.89–28.99; P < 0.001, respectively). CONCLUSION EPO treatment in patients with AKI and anemia has no significant impact on transfusion need, renal recovery or death.
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