title: Positive outcomes of high hemoglobin target in patients with chronic kidney disease not on dialysis: a randomized controlled study.
abstract: Correcting anemia in patients with chronic kidney disease (CKD) to higher hemoglobin (Hb) levels may be associated with increased risk. No optimal target for Hb has been established. This controlled study examined 321 patients with CKD who were not on dialysis, had a Hb level of <10g/dL, and a serum creatinine of 2.0 to 6.0mg/dL. They were randomized into two target Hb groups: 161 to high Hb (11.0-13.0g/dL) to receive darbepoetin alfa and low Hb to 160 (9.0-11.0g/dL) to receive recombinant erythropoietin. The study lasted 48weeks. Of 154 and 153 patients with adverse events, cardiovascular adverse events developed in 42 and 51 patients in the high and low Hb groups, respectively, with no significant difference in the incidence. All quality of life scores improved in the high Hb group and vitality improved significantly more with high Hb (P=0.025). The left ventricular mass index (LVMI) remained stable in the low Hb group, but there was a significant decrease in LVMI in the high group (P<0.001). There were no safety concerns with targeting a higher Hb level during the 48weeks of this study. Patients with a higher Hb target had comparatively better outcomes with respect to quality of life and LVMI.
authors.affiliation: Showa University School of Medicine Nippon Medical School Hospital Tokyo, Japan. akizawa@med.showa-u.ac.jp
authors.forename: Tadao
authors.initials: T
authors.lastname: Akizawa
authors.forename: Fumitake
authors.initials: F
authors.lastname: Gejyo
authors.forename: Shinichi
authors.initials: S
authors.lastname: Nishi
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Iino
authors.forename: Yuzou
authors.initials: Y
authors.lastname: Watanabe
authors.forename: Masashi
authors.initials: M
authors.lastname: Suzuki
authors.forename: Akira
authors.initials: A
authors.lastname: Saito
authors.forename: Takashi
authors.initials: T
authors.lastname: Akiba
authors.forename: Hideki
authors.initials: H
authors.lastname: Hirakata
authors.forename: Shunichi
authors.initials: S
authors.lastname: Fukuhara
authors.forename: Satoshi
authors.initials: S
authors.lastname: Morita
authors.forename: Michiaki
authors.initials: M
authors.lastname: Hiroe
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Hada
authors.forename: Makoto
authors.initials: M
authors.lastname: Suzuki
authors.forename: Makoto
authors.initials: M
authors.lastname: Akaishi
authors.forename: Manabu
authors.initials: M
authors.lastname: Iwasaki
authors.forename: Yoshiharu
authors.initials: Y
authors.lastname: Tsubakihara
mesh_terms: D000368:Aged; D000740:Anemia / Q000188:drug therapy* / Q000209:etiology; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology; D003404:Creatinine / Q000097:blood; D000068256:Darbepoetin alfa; D004921:Erythropoietin / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D005260:Female; D006352:Heart Ventricles / Q000187:drug effects / Q000473:pathology; D006397:Hematinics / Q000009:adverse effects / Q000627:therapeutic use; D006454:Hemoglobins / Q000187:drug effects* / Q000378:metabolism; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D016896:Treatment Outcome
chemical_list: D006397:Hematinics; D006454:Hemoglobins; D004921:Erythropoietin; D000068256:Darbepoetin alfa; D003404:Creatinine