Double-Blind Comparison of Full and Partial Anemia Correction in Incident Hemodialysis Patients without Symptomatic Heart Disease

Abstract

It is unclear whether physiologic hemoglobin targets lead to cardiac benefit in incident hemodialysis patients without symptomatic heart disease and left ventricular dilation. In this randomized, double-blind study, lower (9.5 to 11.5 g/dl) and higher (13.5 to 14.5 g/dl) hemoglobin targets were generated with epoetin ␣ over 24 wk and maintained for an additional 72 wk. Major eligibility criteria included recent hemodialysis initiation and absence of symptomatic cardiac disease and left ventricular dilation. The primary outcome measure was left ventricular volume index (LVVI). The study enrolled 596 patients. Mean age, duration of dialysis therapy, baseline predialysis hemoglobin, and LVVI were 50.8 yr, 0.8 yr, 11.0 g/dl, and 69 ml/m 2 , respectively; 18% had diabetic nephropathy. Mean hemoglobin levels in the higher and lower target groups were 13.3 and 10.9 g/dl, respectively, at 24 wk. Percentage changes in LVVI between baseline and last value were similar (7.6% in the higher and 8.3% in the lower target group) as were the changes in left ventricular mass index (16.8 versus 14.2%). For the secondary outcomes, the only between-group difference was an improved SF-36 Vitality score in the higher versus the lower target group (1.21 versus ؊2.31; P ‫؍‬ 0.036). Overall adverse event rates were similar in both target groups; higher (P < 0.05) rates of skeletal pain, surgery, and dizziness were seen in the lower target group, and headache and cerebrovascular events were seen in the higher target group. Normalization of hemoglobin in incident hemodialysis patients does not have a beneficial effect on cardiac structure, compared with partial correction.

Association of Anemia and Iron Parameters With Mortality Among Patients Undergoing Prevalent Hemodialysis in Taiwan: The AIM‐HD Study

“…Anemia is frequently encountered in chronic kidney disease (CKD) and is associated with cardiovascular outcomes in patients with CKD 1. Correcting anemia usually requires erythropoiesis‐stimulating agents (ESAs).…”

Chronic Kidney Disease Mineral Bone Disorder and Health-Related Quality of Life Among Incident End-Stage Renal-Disease Patients

“…8 However, it is less clear that increases in hemoglobin beyond current targets (generally 11 to 12-13 g/dL) will result in any material improvement in health-related quality of life. 9 Moreover, there is some evidence to suggest that strategies aimed to normalize hemoglobin concentrations could be harmful. 10,11 Therefore, other potential strategies to optimize health-related quality of life in the ESRD population must be explored.…”

The efficacy of monthly administration of darbepoetin alfa in Saudi hemodialysis patients

“…Several studies have demonstrated that the correction of anemia in patients with CKD improves the quality of life and exercise tolerance while reducing the need for transfusion. 31 In 2000, a panel of the Kidney Disease Outcomes Quality Initiative of the National Kidney Foundation recommended that the target level of Hgb should be 11.0 to 12.0 g per deciliter in patients with CKD, whether or not they were receiving dialysis. 32 A recent update of guidelines regarding anemia in such patients expanded the target range to 11.0 to 13.0 g per deciliter.…”