Effect of hemoglobin levels in hemodialysis patients with asymptomatic cardiomyopathy

Foley, Robert N.; Parfrey, Patrick S.; Morgan, J.G.; Barré, Paul E.; Campbell, Patricia; Cartier, P; Coyle, Doug; Fine, Adrian; Handa, Paul; Kingma, Iris; Lau, Cathy; Levin, Adeera; Mendelssohn, David C.; Muirhead, Norman; Murphy, Brendan; Plante, Richard K.; Posen, Gerald A.; Wells, George A.

doi:10.1046/j.1523-1755.2000.00289.x

Cited by 369 publications

(225 citation statements)

References 26 publications

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“…Small studies among dialysis patients also demonstrated benefits of [Hb] normalization on sleep (42), neurologic function (43), exercise capacity, and well being (44,45). Quality of life has also been demonstrated, in a variety of controlled and uncontrolled studies, to be related to [Hb] among dialysis patients (20,45,46). The fact that we were unable to observe a difference in quality of life between groups in this study is likely to be related to the small overall difference in [Hb], rather than an intrinsic difference between dialysis and nondialysis patients.…”

Section: Discussionmentioning

confidence: 97%

Effects of Early and Late Intervention with Epoetin α on Left Ventricular Mass among Patients with Chronic Kidney Disease (Stage 3 or 4)

Roger¹,

McMahon²,

Clarkson³

et al. 2004

Journal of the American Society of Nephrology

197

115

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Abstract. It is not known whether prevention of anemia among patients with chronic kidney disease would affect the development or progression of left ventricular (LV) hypertrophy. A randomized controlled trial was performed with 155 patients with chronic kidney disease (creatinine clearance, 15 to 50 ml/min), with entry hemoglobin concentrations ([Hb]) of 110 to 120 g/L (female patients) or 110 to 130 g/L (male patients). Patients were monitored for 2 yr or until they required dialysis; the patients were randomized to receive epoetin ␣ as necessary to maintain [Hb] between 120 and 130 g/L (group A) or between 90 and 100 g/L (group B). [Hb] increased for group A (from 112 Ϯ 9 to 121 Ϯ 14 g/L, mean Ϯ SD) and decreased for group B (from 112 Ϯ 8 to 108 Ϯ 13 g/L) (P Ͻ 0.001, group A versus group B). On an intent-to-treat analysis, the changes in LV mass index for the groups during the 2-yr period were not significantly different (2.5 Ϯ 20 g/m 2 for group A versus 4.5 Ϯ 20 g/m 2 for group B, P ϭ NS). There was no significant difference between the groups in 2-yr mean unadjusted systolic BP (141 Ϯ 14 versus 138 Ϯ 13 mmHg) or diastolic BP (80 Ϯ 6 versus 79 Ϯ 7 mmHg). The decline in renal function in 2 yr, as assessed with nuclear estimations of GFR, also did not differ significantly between the groups (8 Ϯ 9 versus 6 Ϯ 8 ml/min per 1.73 m 2 ). In conclusion, maintenance of [Hb] above 120 g/L, compared with 90 to 100 g/L, had similar effects on the LV mass index and did not clearly affect the development or progression of LV hypertrophy. The maintenance of [Hb] above 100 g/L for many patients in group B might have been attributable to the relative preservation of renal function.Chronic kidney disease (CKD) is widespread in the community, with a prevalence far exceeding previous estimates (1). Many studies examining mortality and morbidity rates among patients with CKD have identified high rates of cardiovascular events. When even mild renal insufficiency is associated with other risk factors for cardiovascular disease, the risk of subsequent cardiovascular events is significantly increased (2-10). The effect of mild renal insufficiency (serum creatinine levels of Ͼ124 M) on cardiovascular risk is possibly also independent of other known risk factors and treatment (11)(12)(13)(14)(15). For patients established on dialysis, cardiovascular disease is responsible for up to 50% of the all-cause mortality rate (16,17). It is therefore important to attempt to reduce the incidence of cardiovascular events with risk factor modification before the onset of dialysis.Left ventricular (LV) hypertrophy (LVH) is recognized as a powerful independent predictor of death and morbidity in the dialysis population, together with anemia, hypertension, malnutrition, hyperparathyroidism, and an elevated calcium-phos-

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Section: Discussionmentioning

confidence: 97%

Effects of Early and Late Intervention with Epoetin α on Left Ventricular Mass among Patients with Chronic Kidney Disease (Stage 3 or 4)

Roger¹,

McMahon²,

Clarkson³

et al. 2004

Journal of the American Society of Nephrology

197

115

View full text Add to dashboard Cite

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“…However, on balance, among randomized controlled trials of dialysis patients, there has been no demonstration of an impact of normalization of Hgb with ESA on CVD events or survival (20)(21)(22)(23)(24)(25); moreover, many of these studies have raised questions of harm (vascular access thrombosis and stroke), which have not been definitively addressed. Smaller randomized trials among nondialysis patients have also failed to show improvements in surrogate end points for CV outcomes (left ventricular mass index on echocardiography and decline in GFR) among ESA-treated patients (26)(27)(28)(29).…”

Section: Trials Of Hgb Normalization and Cardiovascular Outcomesmentioning

confidence: 99%

Chronic kidney disease, heart failure and anemia

Virani

Khosla

Levin

2008

Canadian Journal of Cardiology

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“…Anemia in CKD is also associated with diminished survival (5)(6)(7)(8)(9)(10). Managing anemia may reduce the need for recurrent blood transfusions and improve patient-reported physical function and exercise tolerance (1,(10)(11)(12)(13). However, recommendations regarding optimal hemoglobin (Hb) levels in CKD continuously evolve, and results from randomized controlled trials of corrective strategies continue to be mixed.…”

Section: Introductionmentioning

confidence: 99%

Clinical Factors and the Decision to Transfuse Chronic Dialysis Patients

Whitman

Shreay

Gitlin

et al. 2013

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Red blood cell transfusion was previously the principle therapy for anemia in CKD but became less prevalent after the introduction of erythropoiesis-stimulating agents. This study used adaptive choice-based conjoint analysis to identify preferences and predictors of transfusion decision-making in CKD.Design, setting, participants, & measurements A computerized adaptive choice-based conjoint survey was administered between June and August of 2012 to nephrologists, internists, and hospitalists listed in the American Medical Association Masterfile. The survey quantified the relative importance of 10 patient attributes, including hemoglobin levels, age, occult blood in stool, severity of illness, eligibility for transplant, iron indices, erythropoiesis-stimulating agents, cardiovascular disease, and functional status. Triggers of transfusions in common dialysis scenarios were studied, and based on adaptive choice-based conjoint-derived preferences, relative importance by performing multivariable regression to identify predictors of transfusion preferences was assessed.Results A total of 350 providers completed the survey (n=305 nephrologists; mean age=46 years; 21% women). Of 10 attributes assessed, absolute hemoglobin level was the most important driver of transfusions, accounting for 29% of decision-making, followed by functional status (16%) and cardiovascular comorbidities (12%); 92% of providers transfused when hemoglobin was 7.5 g/dl, independent of other factors. In multivariable regression, Veterans Administration providers were more likely to transfuse at 8.0 g/dl (odds ratio, 5.9; 95% confidence interval, 1.9 to 18.4). Although transplant eligibility explained only 5% of decision-making, nephrologists were five times more likely to value it as important compared with non-nephrologists (odds ratio, 5.2; 95% confidence interval, 2.4 to11.1).Conclusions Adaptive choice-based conjoint analysis was useful in predicting influences on transfusion decisions. Hemoglobin level, functional status, and cardiovascular comorbidities most strongly influenced transfusion decision-making, but preference variations were observed among subgroups.

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Effect of hemoglobin levels in hemodialysis patients with asymptomatic cardiomyopathy

Abstract: Normalization of hemoglobin does not lead to regression of established concentric LV hypertrophy or LV dilation. It may, however, prevent the development of LV dilation, and it leads to improved quality of life.

Cited by 369 publications

References 26 publications

Effects of Early and Late Intervention with Epoetin α on Left Ventricular Mass among Patients with Chronic Kidney Disease (Stage 3 or 4)

Effects of Early and Late Intervention with Epoetin α on Left Ventricular Mass among Patients with Chronic Kidney Disease (Stage 3 or 4)

Chronic kidney disease, heart failure and anemia

Clinical Factors and the Decision to Transfuse Chronic Dialysis Patients

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