title: Effect of Predialysis Recombinant Human Erythropoietin on Early Survival After Hemodialysis Initiation in Patients With Chronic Kidney Disease: Co-JET Study.
abstract: Progression of anemia in patients with chronic kidney disease (CKD) is associated with an increased risk of death and hospitalization. It is not sufficiently clear whether treating renal anemia with recombinant human erythropoietin (rHuEPO) has a beneficial effect on early survival after hemodialysis (HD) initiation in patients with CKD. The study was an open-label multicenter retrospective cohort study to evaluate the relationship between rHuEPO treatment and early survival after HD initiation in patients with CKD. Predialysis patients with CKD were divided into two groups: an rHuEPO-treated group (rHuEPO group) and a non-treatment group. The primary endpoint was all-cause mortality in the year after HD initiation. A total of 3261 patients were enrolled (2275 in the rHuEPO group and 986 in the non-treatment group). One-year survival was 95.36% in the rHuEPO group and 90.36% in the non-treatment group. The survival rate was significantly higher in the rHuEPO group (P < 0.0001). The results of multivariate analysis confirmed that predialysis treatment with rHuEPO is a predictor for reduced mortality risk (hazard ratio = 0.61, 95% confidence interval: 0.42-0.87, P = 0.006). Risk for the composite event of death/hospitalization was also lower in the rHuEPO group (hazard ratio = 0.88, 95% confidence interval: 0.78-0.98, P = 0.026). The results of this study suggest that treatment with rHuEPO can decrease early mortality risk after initiation of HD in patients with CKD. A prospective study is needed to further investigate early survival after HD initiation.
authors.affiliation: Department of Internal Medicine, Kasugai Municipal Hospital, Kasugai, Aichi, Japan.
authors.forename: Yuzo
authors.initials: Y
authors.lastname: Watanabe
authors.affiliation: Department of Nephrology, Showa University School of Medicine, Shinagawa-ku, Tokyo, Japan.
authors.forename: Tadao
authors.initials: T
authors.lastname: Akizawa
authors.affiliation: Department of Nephrology, Shonan Tobu Sogou Hospital, Chigasaki, Kanagawa, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Saito
authors.affiliation: Niigata University Graduate School of Medicine and Dental Sciences, Chuoku, Niigata, Niigata, Japan.
authors.forename: Fumitake
authors.initials: F
authors.lastname: Gejyo
authors.affiliation: Shinraku-en Hospital, Nishi-ku, Niigata, Niigata, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Suzuki
authors.affiliation: Osaka City University Graduate School of Medicine, Abeno, Osaka, Japan.
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Nishizawa
authors.affiliation: Juntendo University Faculty of Medicine, Bunkyo-ku, Tokyo, Japan.
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Tomino
authors.affiliation: Course of Safety Management in Health Care Sciences, Graduate School of Health Care Sciences, Jikei Institute, Yodogawa-ku, Osaka-shi, Japan.|Osaka, Japan.
authors.forename: Yoshiharu
authors.initials: Y
authors.lastname: Tsubakihara
authors.affiliation: Department of Blood Purification, Kidney Center, Tokyo Women's Medical University, Shinjyuku-ku, Tokyo, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Akiba
authors.affiliation: Department of Nephrology, Fukuoka Red Cross Hospital, Minami-ku, Fukuoka, Fukuoka, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Hirakata
authors.affiliation: Department of Artificial Organs, Tsuchiya General Hospital, Naka-ku, Hiroshima, Hiroshima, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Kawanishi
authors.affiliation: Department of Hematology, Saitama Medical School, Moroyama-cho, Iruma-gun, Saitama, Japan.
authors.forename: Masami
authors.initials: M
authors.lastname: Bessho
authors.affiliation: Pharmacovigilance Department, Chugai Pharmaceutical Co., Ltd., Chuo-ku, Tokyo, Japan.
authors.forename: Yukio
authors.identifier: http://orcid.org/0000-0002-1841-8937
authors.initials: Y
authors.lastname: Udagawa
authors.affiliation: Pharmacovigilance Department, Chugai Pharmaceutical Co., Ltd., Chuo-ku, Tokyo, Japan.
authors.forename: Kotonari
authors.initials: K
authors.lastname: Aoki
authors.affiliation: Biostatistics Division, Clinical Research Support Center, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan.
authors.forename: Yukari
authors.initials: Y
authors.lastname: Uemura
authors.affiliation: Department of Integrated Science and Engineering for Sustainable Society, Chuo University, Bunkyo-ku, Tokyo, Japan.
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Ohashi
mesh_terms: D000368:Aged; D015331:Cohort Studies; D004921:Erythropoietin / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011994:Recombinant Proteins / Q000627:therapeutic use*; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000628:therapy*; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D011994:Recombinant Proteins; D004921:Erythropoietin
keywords: Chronic kidney disease; Erythropoiesis-stimulating agent; Hemodialysis; Mortality