Maintaining high hemoglobin levels improved the left ventricular mass index and quality of life scores in pre-dialysis Japanese chronic kidney disease patients.
BACKGROUND
Anemia is common among patients with chronic kidney disease (CKD). The introduction of erythropoietin treatment has changed anemia management, but the therapeutic hemoglobin (Hb) target is still under debate, and clinical evidence for its effect on cardiac functions and QOL is sparse.


METHODS
A 16-week dose-response study and a 32-week follow-Up study were combined. After correcting anemia of less than 10 g/dl in pre-dialysis Japanese CKD patients, a higher Hb target (12-13 g/dl) by darbepoetin alfa (DPO) was compared with the conventional Hb target by epoetin alfa (EPO). Outcomes were anemia correction, management of the left ventricular mass index (LVMI) and QOL scores.


RESULTS
No significant difference was seen in Hb at baseline and week 16, but a significant difference was recorded at week 34 (12.34 +/- 0.93 g/dl for DPO and 10.43 +/- 0.90 g/dl for EPO). In both groups, LVMI decreased similarly until week 16, but the decrease of EPO was retarded, and a significant difference between LVMI was seen only in DPO at week 34 (100.7 +/- 16.6 g/m(2) for DPO and 110.9 +/- 25.2 g/m(2) for EPO). Relationships between Hb and LVMI change at week 34 were examined by stratifying Hb into four groups (Hb <10 g/dl, 10 g/dl < or = Hb <11 g/dl, 11 g/dl < or = Hb <12 g/dl and 12 g/dl < or = Hb), and a decrease of LVMI was prominent in the 12 g/dl < or = Hb group. Correction of anemia to 11 g/dl or more led to improved QOL scores. No safety difference was observed among the treatments.


CONCLUSIONS
Targeting a higher Hb around 12 g/dl was more beneficial than targeting conventional Hb in terms of reduction of LVMI and QOL. Further studies to determine the appropriate Hb target are necessary.
Hirakata
Hideki
H
Fukuoka Red Cross Hospital, 3-1-1 Ogusu Minami-ku, Fukuoka, Fukuoka, 815-8555, Japan. hhirakata@fukuoka-med.jrc.or.jp
Tsubakihara
Yoshiharu
Y
Gejyo
Fumitake
F
Nishi
Shinichi
S
Iino
Yasuhiko
Y
Watanabe
Yuzou
Y
Suzuki
Masashi
M
Saito
Akira
A
Akiba
Takashi
T
Inaguma
Daijo
D
Fukuhara
Shunichi
S
Morita
Satoshi
S
Hiroe
Michiaki
M
Hada
Yoshiyuki
Y
Suzuki
Makoto
M
Akaishi
Makoto
M
Aonuma
Kazutaka
K
Akizawa
Tadao
T
D000328:Adult; D000368:Aged; D044466:Asian People; D000068256:Darbepoetin alfa; D004305:Dose-Response Relationship, Drug; D064420:Drug-Related Side Effects and Adverse Reactions; D000068817:Epoetin Alfa; D004921:Erythropoietin / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000033:anatomy & histology* / Q000187:drug effects; D006454:Hemoglobins / Q000187:drug effects / Q000378:metabolism*; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000188:drug therapy; D007564:Japan; D007676:Kidney Failure, Chronic / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D011994:Recombinant Proteins
D006454:Hemoglobins; D011994:Recombinant Proteins; D004921:Erythropoietin; D000068256:Darbepoetin alfa; D000068817:Epoetin Alfa