Anemia normalization in patients with type 2 diabetes and chronic kidney disease: results of the NEPHRODIAB2 randomized trial

Villar, Emmanuel; Lièvre, Michel; Kessler, Michèle; Lemaı̂tre, V.; Alamartine, Éric; Rodier, M.; François, Maud; Zaoui, Philippe; Moranne, Olivier; Choukroun, Gabriel; Guerraoui, A.; Jolivot, Anne; Janin, G.; Branger, B.; Heng, Anne-Élisabeth; Boudray, Catherine; Bissery, Alvine; Rabilloud, Muriel; Pouteil‐Noble, Claire

doi:10.1016/j.jdiacomp.2011.03.003

Cited by 22 publications

(28 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Full-text assessment of 319 potentially relevant articles resulted in the identification of 19 eligible trials enrolling a total of 8,129 patients [10,11,13,14,15,22,23,24,25,26,27,28,29,30,31,32,33,34,35] (fig. 1).…”

Section: Resultsmentioning

confidence: 99%

“…Four studies reported the decline in renal function or progression of renal disease as the primary endpoint [10,14,15,26]. Only one study reported early termination due to safety issues [30].…”

Section: Resultsmentioning

confidence: 99%

“…They did not, however, focus on or report conclusive information on the impact of anemia treatment on renal function over time. Since some recent studies [13,14,15] have suggested that anemia treatment has a beneficial impact on renal function, we decided to perform a systematic analysis of the existing literature in order to establish if different degrees of anemia correction (low or high Hb targets) by ESAs may have different impact on renal function trajectories in CKD patients. …”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Erythropoiesis-Stimulating Agents (ESA) for Preventing the Progression of Chronic Kidney Disease: A Meta-Analysis of 19 Studies

et al. 2014

View full text Add to dashboard Cite

Background: The effect of anemia correction on kidney function in chronic kidney disease (CKD) patients remains unclear. As 19-40% of patients with CKD receive an erythropoiesis-stimulating agent (ESA), this is a potentially important consideration. Summary: We conducted a systematic review and meta-analysis of randomized trials to January 1, 2014 in adult patients with CKD stages 1 to 4. Selection criteria for studies: randomized controlled trials of at least 2 months duration. Patients were allocated to ESA versus placebo, no treatment, or different ESA doses with the purpose of achieving a higher versus a lower hemoglobin target. The analyzed outcomes were the need for renal replacement therapy, doubling of serum creatinine, change in GFR (ml/min), mortality and withdrawal of treatment due to adverse events. A total of 19 trials (n = 8,129 participants with CKD stage 1-4) were reviewed. There was no difference in the risk of end-stage kidney disease (RR, 0.97 [CI 0.83-1.20], 17 trials, 8,104 participants), change in GFR (Mean Difference [MD] -0.45 [-2.21, 1.31], 9 trials, 1,848 participants) or withdrawal of treatment due to adverse events (RR, 1.18 [CI 0.77-1.81], 10 trials, n = 1,958 participants) for patients at higher hemoglobin (Hb) targets. Furthermore, no statistically significant differences in mortality (Risk Ratio [RR] 1.10 [CI 0.90-1.35], 16 trials, n = 8,082 participants) were observed. Key Messages: There is no evidence that ESA treatment affects renal function in patients with CKD. Use of these agents should not therefore be influenced by considerations about influencing CKD progression.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Erythropoiesis-Stimulating Agents (ESA) for Preventing the Progression of Chronic Kidney Disease: A Meta-Analysis of 19 Studies

et al. 2014

View full text Add to dashboard Cite

show abstract

“…However, the effects of ESA on the progression of renal function are controversial. Some studies showed that after starting ESA therapy and correction of anemia, renal function declines at a slower rate, delaying the need for dialysis in pre-dialysis patients [52][53][54]; in opposition, other studies reported that ESA do not significantly affect renal function [55,56].…”

Section: Erythropoiesis-stimulating Agents In Ckd-anemiamentioning

confidence: 99%

The HIF System Response to ESA Therapy in CKD‐Anemia

Ribeiro¹,

Belo²,

Reis³

et al. 2017

Hypoxia and Human Diseases

View full text Add to dashboard Cite

Anemia is a common complication of chronic kidney disease (CKD) associated with disease progression and increased mortality. This anemia is mainly due to inadequate production of erythropoietin (EPO) by the failing kidneys, resulting from the reduction in renal EPO-producing cells (REPC) or from dysregulation of the hypoxia-inducible factor (HIF) system that regulates several genes related to hypoxia, angiogenesis, fibrosis and glucose metabolism, among others. In this chapter, we present a review on the HIF system in CKD-anemia, the HIF response to erythropoiesis-stimulating agents (ESA) therapy and its potential involvement in the development of ESA resistance by enhancing kidney fibrosis and inflammation. Due to concerns related to ESA use, new drugs to correct anemia are under study, being the prolyl hydroxylase inhibitors the most promising candidates.

show abstract

“…However, studies looking at normalization of haemoglobin levels in CKD and anaemia such as the CREATE, (204) TREAT,(205) NEPHRODIAB2 (206) and CHOIR(207) studies, have found that correcting haemoglobin to normalized levels (130-150g/L) did not improve mortality outcome and moreover may be detrimental to cardiovascular health. The avoidance of prescribing erythropoietin stimulating agents to CKD patients is due in part to exacerbation of hypertension and subsequent increase in events of stroke and mortality.…”

Section: Determinants Of Higher Intensity Exercisementioning

confidence: 99%

Exercise and lifestyle intervention and high intensity interval training in patients with chronic kidney disease

Beetham¹

View full text Add to dashboard Cite

Chronic kidney disease (CKD) patients have a shorter life expectancy than healthy individuals, from the premature development of cardiovascular disease due to traditional and non-traditional risk factors. It is therefore pertinent that management of CKD be aimed at modifying these cardiovascular disease risk factors. Exercise therapy, in particular aerobic exercise, in the end stage kidney disease population has been shown to decrease cardiovascular disease risk factors and subsequent cardiovascular disease. However, Section 2 contains the second trial that investigated the feasibility and efficacy of a 12 week HIIT program in CKD patients. Recruitment for the HIIT study was through participants who had completed the LM3 study.Chapter 1 provides an introduction to the studies, including the aims of the thesis. Topics reviewed include; pathophysiology of CKD, exercise capacity, autonomic dysfunction, haemoglobin, muscle atrophy, oxidative stress, inflammation, blood lipids and HIIT. Section 1 starts with the detailed methods of the LM3 study (Chapter 2). Further methods applicable to specific studies are reported in the relevant chapter.Chapter 3 investigates the determinants of reduced muscle strength at baseline through a cross-sectional analysis of the LM3 study. This study identified the association of oxidative 3 stress with low muscle strength and reduced lean mass. The relationship was independent of known influences on muscle mass and strength.The feasibility and determinants of the LI group participating in higher intensity exercise training in the first 12 months of the LM3 study was investigated in Chapter 4. The findings identified that higher intensity exercise training was indeed feasible in the CKD cohort, with the number of participants reporting higher intensity exercise increasing from 20% to 43%.Reported higher intensity exercise during the LI was also associated with the greatest exercise capacity at 12 months. Furthermore, the analysis identified haemoglobin to be the greatest predictor of individuals reporting higher intensity exercise.Chapter 5 investigates the agreement between creatinine and cystatin-C estimated glomerular filtration rate (eGFR) measurements in patients completing 12 months of the LM3 study. This chapter explores whether discrepancies in the CKD Epidemiology Collaboration (CKD-EPI)cystatin-C, CKD-EPIcreatinine and modification of diet in renal disease (MDRD) eGFR equations occur after an exercise intervention. It was identified that cystatin-C based eGFR measurements were considerably lower than creatinine based eGFR measurements. Despite this discrepancy at baseline, the agreement between the different GFR estimates did not change after exercise training.Chapter 6 contains the main study from LM3, which investigates the changes in cardiorespiratory fitness, exercise capacity, functional capacity, blood biochemistry, anthropometry measures and other cardiovascular disease risk factors after 3 years of LI compared to the control group. The primary finding from this...

show abstract

Anemia normalization in patients with type 2 diabetes and chronic kidney disease: results of the NEPHRODIAB2 randomized trial

Cited by 22 publications

References 31 publications

Erythropoiesis-Stimulating Agents (ESA) for Preventing the Progression of Chronic Kidney Disease: A Meta-Analysis of 19 Studies

Erythropoiesis-Stimulating Agents (ESA) for Preventing the Progression of Chronic Kidney Disease: A Meta-Analysis of 19 Studies

The HIF System Response to ESA Therapy in CKD‐Anemia

Exercise and lifestyle intervention and high intensity interval training in patients with chronic kidney disease

Contact Info

Product

Resources

About