Peginesatide for Anemia in Patients with Chronic Kidney Disease Not Receiving Dialysis

Macdougall, Iain C.; Provenzano, Robert; Sharma, Amit; Spinowitz, Bruce; Schmidt, Rebecca J.; Pèrgola, Pablo E.; Zabaneh, Raja; Tong-Starksen, Sandra; Mayo, Martha; Tang, Hong; Polu, Krishna; Duliegè, Anne-Marie; Fishbane, Steven; Groups, Pearl Study

doi:10.1056/nejmoa1203166

Cited by 110 publications

(63 citation statements)

References 27 publications

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“…Prespecified analyses according to population (patients undergoing hemodialysis and patients not undergoing dialysis) were performed; results in the population not undergoing dialysis are reported separately. 14 …”

Section: Study End Pointsmentioning

confidence: 99%

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Peginesatide in Patients with Anemia Undergoing Hemodialysis

et al. 2013

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confidence: 99%

“…Data specific to the cohort that did not undergo dialysis (the PEARL studies cohort) are reported by Macdougall et al elsewhere in this issue of the Journal. 14 …”

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Peginesatide in Patients with Anemia Undergoing Hemodialysis

et al. 2013

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“…However, recommendations regarding optimal hemoglobin (Hb) levels in CKD continuously evolve, and results from randomized controlled trials of corrective strategies continue to be mixed. Although partial anemia correction with erythropoiesis-stimulating agents (ESAs) provides benefits (14)(15)(16)(17)(18)(19)(20)(21)(22)(23), using ESAs to normalize Hb levels is associated with cardiovascular and cancer risks. As a result, ESAs are now used less frequently than before.…”

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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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“…Current adjuvant therapies, including intravenouslyadministered iron, erythropoiesis-stimulating agents, and erythrocyte transfusions, have limited efficacy and important side effects. [5][6][7] Research has focused on the development of new therapeutic agents targeting hepcidin, 8 including inhibitors of hepcidin synthesis. Among them, LDN-193189, a BMP type I receptor inhibitor that is a derivative of dorsomorphin, has been reported to increase hemoglobin levels in animal models of AI.…”

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confidence: 99%