BACKGROUND AND OBJECTIVES: Optimal hemoglobin targets for chronic kidney disease patients receiving erythropoiesis-stimulating agents remain controversial. The effects of different hemoglobin targets on blood transfusion requirements have not been well characterized, despite their relevance to clinical decision-making. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Five hundred ninety-six incident hemodialysis patients without symptomatic cardiac disease were randomly assigned to hemoglobin targets of 9.5 to 11.5 g/dl or 13.5 to 14.5 g/dl for 96 wk using epoetin alfa as primary therapy and changes in left ventricular structure as the primary outcome (previously reported). Patients were masked to treatment assignment. Blood transfusion data were prospectively collected at 4-wk intervals. RESULTS: The mean age and prior duration of dialysis therapy of the study population were 50.8 and 0.8 yr, respectively. Previously reported mortality was similar in low and high-target subjects, at 4.7 (95% confidence interval 3.0, 7.3) and 3.1 (1.8, 5.4) per hundred patient years, respectively. Transfusion rates were 0.66 (0.59, 0.74) units of blood per year in low and 0.26 (0.22, 0.32) in high-target subjects (P < 0.0001). Hemoglobin level at transfusion (7.7 [7.5, 7.9]) versus 8.1 [7.6, 8.5] g/dl) were similar with both groups. High hemoglobin target was a significant predictor of time to first transfusion independent of baseline associations (hazard ratio = 0.42; 95% confidence interval = 0.26-0.67). CONCLUSIONS: In hemodialysis patients with comparatively low mortality risks, normal hemoglobin targets may reduce the need for transfusions.
RCT Entities:
BACKGROUND AND OBJECTIVES: Optimal hemoglobin targets for chronic kidney diseasepatients receiving erythropoiesis-stimulating agents remain controversial. The effects of different hemoglobin targets on blood transfusion requirements have not been well characterized, despite their relevance to clinical decision-making. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Five hundred ninety-six incident hemodialysis patients without symptomatic cardiac disease were randomly assigned to hemoglobin targets of 9.5 to 11.5 g/dl or 13.5 to 14.5 g/dl for 96 wk using epoetin alfa as primary therapy and changes in left ventricular structure as the primary outcome (previously reported). Patients were masked to treatment assignment. Blood transfusion data were prospectively collected at 4-wk intervals. RESULTS: The mean age and prior duration of dialysis therapy of the study population were 50.8 and 0.8 yr, respectively. Previously reported mortality was similar in low and high-target subjects, at 4.7 (95% confidence interval 3.0, 7.3) and 3.1 (1.8, 5.4) per hundred patient years, respectively. Transfusion rates were 0.66 (0.59, 0.74) units of blood per year in low and 0.26 (0.22, 0.32) in high-target subjects (P < 0.0001). Hemoglobin level at transfusion (7.7 [7.5, 7.9]) versus 8.1 [7.6, 8.5] g/dl) were similar with both groups. High hemoglobin target was a significant predictor of time to first transfusion independent of baseline associations (hazard ratio = 0.42; 95% confidence interval = 0.26-0.67). CONCLUSIONS: In hemodialysis patients with comparatively low mortality risks, normal hemoglobin targets may reduce the need for transfusions.
Authors: Nicole Casadevall; Joelle Nataf; Beatrice Viron; Amir Kolta; Jean-Jacques Kiladjian; Philippe Martin-Dupont; Patrick Michaud; Thomas Papo; Valerie Ugo; Irene Teyssandier; Bruno Varet; Patrick Mayeux Journal: N Engl J Med Date: 2002-02-14 Impact factor: 91.245
Authors: R N Foley; P S Parfrey; J Morgan; P E Barré; P Campbell; P Cartier; D Coyle; A Fine; P Handa; I Kingma; C Y Lau; A Levin; D Mendelssohn; N Muirhead; B Murphy; R K Plante; G Posen; G A Wells Journal: Kidney Int Date: 2000-09 Impact factor: 10.612
Authors: S W Murphy; R N Foley; B J Barrett; G M Kent; J Morgan; P Barré; P Campbell; A Fine; M B Goldstein; S P Handa; K K Jindal; A Levin; H Mandin; N Muirhead; R M Richardson; P S Parfrey Journal: Kidney Int Date: 2000-04 Impact factor: 10.612
Authors: A Besarab; W K Bolton; J K Browne; J C Egrie; A R Nissenson; D M Okamoto; S J Schwab; D A Goodkin Journal: N Engl J Med Date: 1998-08-27 Impact factor: 91.245
Authors: Suetonia C Palmer; Valeria Saglimbene; Dimitris Mavridis; Georgia Salanti; Jonathan C Craig; Marcello Tonelli; Natasha Wiebe; Giovanni F M Strippoli Journal: Cochrane Database Syst Rev Date: 2014-12-08
Authors: Olga Dmitrieva; Simon de Lusignan; Iain C Macdougall; Hugh Gallagher; Charles Tomson; Kevin Harris; Terry Desombre; David Goldsmith Journal: BMC Nephrol Date: 2013-01-25 Impact factor: 2.388