<i>Summary and Comment</i>: CHOIR, CREATE, and Anemia Treatment in Patients with CKD

Berns, Jeffrey S.; Fishbane, Steven

doi:10.1111/j.1525-139x.2007.00290.x

Seminars in Dialysis

2007

DOI: 10.1111/j.1525-139x.2007.00290.x

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Summary and Comment: CHOIR, CREATE, and Anemia Treatment in Patients with CKD

Jeffrey S. Berns

Steven Fishbane

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Cited by 6 publications

(3 citation statements)

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“…Treatment with erythropoiesis stimulating agents (ESA) has been a landmark achievement of modern nephrology, and this treatment is of unquestionable benefit in CKD patients with severe anemia. However, recent studies have shown that full anemia correction in stage 3 to 4 CKD patients may be harmful (1,2). Such an effect is currently attributed to the deleterious action of high doses of erythropoietin imposed by erythropoietin resistance in patients with systemic illness and inflammation (3).…”

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confidence: 99%

The Relationship between Hemoglobin Levels and Endothelial Functions in Diabetes Mellitus

Sönmez

Yılmaz²,

Sağlam³

et al. 2010

Clinical Journal of the American Society of Nephrology

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Background and objectives: Hemoglobin (Hb) is the main carrier and buffer of nitric oxide. Evidence has been produced that Hb concentration is inversely related with endothelial function in human diseases. Testing whether this association exists also in diabetic patients stage 1 to 2 chronic kidney disease (CKD) is important because anemia in these patients starts at an earlier stage than in other renal diseases. The relationship was investigated between Hb and flow-mediated dilation (FMD) levels of the patients with diabetic nephropathy in a cross-sectional design.Design, setting, participants, & measurements: Eighty-nine diabetics with mild to moderate proteinuria and normal to mildly reduced GFR who were normotensive, nondyslipidemic, and cardiovascular-events free were enrolled. None of the patients was taking metformin or renin-angiotensin system blockers.Results: FMD was inversely related with Hb levels. Furthermore, there was an inverse link between proteinuria and FMD. However, further analysis of this association showed that the FMD-proteinuria link was confined to patients with proteinuria exceeding 150 mg/d, while no such association existed in patients with proteinuria <150 mg/d. Adjustment of the Hb-FMD relationship for pertinent Framingham risk factors, proteinuria, homeostasis model assessment (HOMA) index, and GFR levels had a modest influence on this association, which remained significant.Conclusions: Endothelial function is inversely associated with Hb levels in diabetic patients with stage 1 to 2 CKD, and proteinuria is an effect modifier of this association. Overall, the observations of this study generate the hypothesis that proteinuria exposes a situation wherein Hb may limit the endothelium-mediated vasoregulation in diabetes.

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confidence: 99%

The Relationship between Hemoglobin Levels and Endothelial Functions in Diabetes Mellitus

Sönmez

Yılmaz²,

Sağlam³

et al. 2010

Clinical Journal of the American Society of Nephrology

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“…Clinical trials have suggested adverse consequences if the hemoglobin (Hb) is too high (1)(2)(3)(4) or too low (5). Additionally, erythropoiesis-stimulating agents (ESAs) are expensive drugs, warranting judicious use.…”

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Determining Optimum Hemoglobin Sampling for Anemia Management from Every-Treatment Data

Gawęda

Nathanson

Jacobs

et al. 2010

Clinical Journal of the American Society of Nephrology

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“…2 Full correction of anemia may do more harm than good in chronic kidney disease (CKD). 3,4 This phenomenon has been attributed to the adverse effect of erythropoietin in patients with systemic illness and inflammation. 5 However, our recent data showed a direct association between Hb concentration and endothelial function in patients with chronic kidney disease (CKD stage 3-4), who are not under treatment with erythropoietin 6 , or in diabetic patients with proteinuria.…”

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confidence: 99%

Relationship between hemoglobin and CD40 ligand in prediabetes

Kutlu¹,

Sönmez²,

Genç³

et al. 2009

CIM

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Clin Invest Med 2009; 32 (6): E244-E250. AbstractPurpose: Hemoglobin (Hb) regulates the endothelial function by modulating the bio-availability of NO at the tissue level. A significant direct relationship is present between the Hb levels and endothelial functions in patients with Type 2 diabetes. Testing whether this association also exists in subjects with prediabetes is important because prediabetes is associated with an increased risk of cardiovascular disease and mortality. Therefore, we investigated the association of Hb both with the classical cardiac risk factors and the markers for endothelial dysfunction and inflammation, in subjects with impaired glucose tolerance (IGT). Methods: We enrolled 69 normotensive, and cardiovascular events free subjects with IGT (M=40, age=45.50±6.8 yr). Plasma insulin, hsCRP, soluble CD40L, vonWillebrand factor, p-selectin levels were measured. The parameters given according to the higher and lower median Hb values of the subjects were compared. Results: Subjects with the higher Hb levels exhibited lower HDL-C (46.68±10.8 mg/dl vs 51.5±8.9mg/dl; P=0.04) and higher systolic (122.57±6.2mmHg vs 1 1 6 . 1 7 ± 7 . 4 m m H g ; p < 0 . 0 0 1 ) a n d d i a s t o l i c (79.14±3.73mmHg vs 75.58±6.1mmHg; P=0.005) blood pressures and sCD40L (7.9±3.8ng/ml vs 6.07±2.1 ng/ml; P=0.02) levels. Hb levels were correlated to the HDL cholesterol, sCD40L, systolic and diastolic blood pressures and waist circumference (r=-0.28, P=0.02; r=0.29, P=0.02; r=0.53, P<0.001; r=0.41, P=0.001; r=0.42, P<0.001 respectively). According to the multiple logistic regression analysis, Hb was the determinant of sCD40L levels (β=0.437, P<0.001). Conclusion:These results indicate that there may be a link with higher Hb values and cardiovascular risk factors in patients with IGT. Further investigation is warranted to understand the clinical implications of these findings in subjects with prediabetes.

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Summary and Comment: CHOIR, CREATE, and Anemia Treatment in Patients with CKD

Cited by 6 publications

References 16 publications

The Relationship between Hemoglobin Levels and Endothelial Functions in Diabetes Mellitus

The Relationship between Hemoglobin Levels and Endothelial Functions in Diabetes Mellitus

Determining Optimum Hemoglobin Sampling for Anemia Management from Every-Treatment Data

Relationship between hemoglobin and CD40 ligand in prediabetes

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