Stability of target hemoglobin levels during the first year of epoetin treatment in patients with chronic kidney disease.
OBJECTIVE
Instability of hemoglobin levels during epoetin therapy is a new problem in hemodialysis. We evaluated extent and correlates of time in target, that is, the time spent with hemoglobin > or = 11 g/dl during the first year of epoetin and its association with renal survival.


METHODS
Data were collected in 917 visits for 12.0 mo in 119 patients with chronic kidney disease; thereafter, patients started renal survival analysis for 10.1 mo. At baseline, hemoglobin was 10.0 +/- 0.8 g/dl and GFR was 22.1 +/- 14.2 ml/min per 1.73 m2.


RESULTS
Hemoglobin target, reached in 1.5 mo, was steadily maintained in only 24% of patients. Time in target was not merely due to differences in time to target; after first achievement of target, in fact, a reduction of hemoglobin < 11 g/dl occurred in 51% of patients. At multivariate analysis, male gender, basal GFR and hemoglobin levels, first epoetin dose, and iron supplementation were directly associated with length of time in target. A lower risk for renal death (dialysis n = 53; death n = 8) was detected in the higher tertile of time in target (11.3 mo) versus lower tertile (3.2 mo). This difference persisted at Cox analysis after adjustment for age, gender, GFR, BP, and proteinuria.


CONCLUSIONS
In chronic kidney disease, time in target during the first year of epoetin therapy is frequently short depending not only on time to target but also on post-target hemoglobin reductions, correlates with male gender, timing, and intensity of initial therapy and is coupled with better renal survival.
De Nicola
Luca
L
Nephrology Division, Second University of Naples-Santa Maria del Popolo degli Incurabili Hospital-Azienda Sanitaria Locale Napoli 1, Naples, Italy. luca.denicola@unina2.it
Conte
Giuseppe
G
Chiodini
Paolo
P
Cianciaruso
Bruno
B
Pota
Andrea
A
Bellizzi
Vincenzo
V
Tirino
Giuseppina
G
Avino
Deborah
D
Catapano
Fausta
F
Minutolo
Roberto
R
D000740:Anemia / Q000188:drug therapy* / Q000209:etiology*; D002908:Chronic Disease; D004921:Erythropoietin / Q000627:therapeutic use*; D005260:Female; D006454:Hemoglobins / Q000032:analysis*; D006801:Humans; D007674:Kidney Diseases / Q000097:blood* / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011994:Recombinant Proteins; D013997:Time Factors
D006454:Hemoglobins; D011994:Recombinant Proteins; C103998:epoetin beta; D004921:Erythropoietin