An update on the controversies in anemia management in chronic kidney disease: lessons learned and lost.
Identifieur interne : 000151 ( Main/Corpus ); précédent : 000150; suivant : 000152An update on the controversies in anemia management in chronic kidney disease: lessons learned and lost.
Auteurs : Geoffrey Teehan ; Robert L. BenzSource :
- Anemia [ 2090-1275 ] ; 2011.
Abstract
Background. Erythropoietin deficiency and anemia occur in Chronic Kidney Disease (CKD) and may be treated with Erythropoietin Stimulating Agents (ESAs). The optimal hemoglobin, in non-End Stage Renal Disease CKD, is controversial. Methods. We review three recent randomized trials in anemia in CKD: CHOIR, CREATE, and TREAT. Results. CHOIR (N = 1432) was terminated early with more frequent death and cardiovascular outcomes in the higher Hb group (HR 1.34: 95% C.I. 1.03-1.74, P = .03). CREATE (N = 603) showed no difference in primary cardiovascular endpoints. Stroke was more common in the higher Hb group (HR 1.92; 95% C.I. 1.38-2.68; P < .001) in TREAT (N = 4038). Conclusions. There is no benefit to an Hb outside the 10-12 g/dL range in this population. To avoid transfusions and improve Quality of Life, ESAs should be used cautiously, especially in patients with Diabetes, CKD, risk factors for stroke, and ESA resistance.
DOI: 10.1155/2011/623673
PubMed: 21541213
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">An update on the controversies in anemia management in chronic kidney disease: lessons learned and lost.</title><author><name sortKey="Teehan, Geoffrey" sort="Teehan, Geoffrey" uniqKey="Teehan G" first="Geoffrey" last="Teehan">Geoffrey Teehan</name><affiliation><nlm:affiliation>Department of Medicine, Division of Nephrology, Lankenau Medical Center, Suite 130 MOBW, 100 Lancaster Avenue, Wynnewood, PA 19096, USA.</nlm:affiliation></affiliation></author><author><name sortKey="Benz, Robert L" sort="Benz, Robert L" uniqKey="Benz R" first="Robert L" last="Benz">Robert L. Benz</name></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2011">2011</date><idno type="RBID">pubmed:21541213</idno><idno type="pmid">21541213</idno><idno type="doi">10.1155/2011/623673</idno><idno type="wicri:Area/Main/Corpus">000151</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Corpus" wicri:corpus="PubMed">000151</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">An update on the controversies in anemia management in chronic kidney disease: lessons learned and lost.</title><author><name sortKey="Teehan, Geoffrey" sort="Teehan, Geoffrey" uniqKey="Teehan G" first="Geoffrey" last="Teehan">Geoffrey Teehan</name><affiliation><nlm:affiliation>Department of Medicine, Division of Nephrology, Lankenau Medical Center, Suite 130 MOBW, 100 Lancaster Avenue, Wynnewood, PA 19096, USA.</nlm:affiliation></affiliation></author><author><name sortKey="Benz, Robert L" sort="Benz, Robert L" uniqKey="Benz R" first="Robert L" last="Benz">Robert L. Benz</name></author></analytic><series><title level="j">Anemia</title><idno type="eISSN">2090-1275</idno><imprint><date when="2011" type="published">2011</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Background. Erythropoietin deficiency and anemia occur in Chronic Kidney Disease (CKD) and may be treated with Erythropoietin Stimulating Agents (ESAs). The optimal hemoglobin, in non-End Stage Renal Disease CKD, is controversial. Methods. We review three recent randomized trials in anemia in CKD: CHOIR, CREATE, and TREAT. Results. CHOIR (N = 1432) was terminated early with more frequent death and cardiovascular outcomes in the higher Hb group (HR 1.34: 95% C.I. 1.03-1.74, P = .03). CREATE (N = 603) showed no difference in primary cardiovascular endpoints. Stroke was more common in the higher Hb group (HR 1.92; 95% C.I. 1.38-2.68; P < .001) in TREAT (N = 4038). Conclusions. There is no benefit to an Hb outside the 10-12 g/dL range in this population. To avoid transfusions and improve Quality of Life, ESAs should be used cautiously, especially in patients with Diabetes, CKD, risk factors for stroke, and ESA resistance.</div></front></TEI><pubmed><MedlineCitation Status="PubMed-not-MEDLINE" Owner="NLM"><PMID Version="1">21541213</PMID><DateCompleted><Year>2011</Year><Month>07</Month><Day>14</Day></DateCompleted><DateRevised><Year>2020</Year><Month>03</Month><Day>06</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">2090-1275</ISSN><JournalIssue CitedMedium="Internet"><Volume>2011</Volume><PubDate><Year>2011</Year></PubDate></JournalIssue><Title>Anemia</Title><ISOAbbreviation>Anemia</ISOAbbreviation></Journal><ArticleTitle>An update on the controversies in anemia management in chronic kidney disease: lessons learned and lost.</ArticleTitle><Pagination><MedlinePgn>623673</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1155/2011/623673</ELocationID><Abstract><AbstractText>Background. Erythropoietin deficiency and anemia occur in Chronic Kidney Disease (CKD) and may be treated with Erythropoietin Stimulating Agents (ESAs). The optimal hemoglobin, in non-End Stage Renal Disease CKD, is controversial. Methods. We review three recent randomized trials in anemia in CKD: CHOIR, CREATE, and TREAT. Results. CHOIR (N = 1432) was terminated early with more frequent death and cardiovascular outcomes in the higher Hb group (HR 1.34: 95% C.I. 1.03-1.74, P = .03). CREATE (N = 603) showed no difference in primary cardiovascular endpoints. Stroke was more common in the higher Hb group (HR 1.92; 95% C.I. 1.38-2.68; P < .001) in TREAT (N = 4038). Conclusions. There is no benefit to an Hb outside the 10-12 g/dL range in this population. To avoid transfusions and improve Quality of Life, ESAs should be used cautiously, especially in patients with Diabetes, CKD, risk factors for stroke, and ESA resistance.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Teehan</LastName><ForeName>Geoffrey</ForeName><Initials>G</Initials><AffiliationInfo><Affiliation>Department of Medicine, Division of Nephrology, Lankenau Medical Center, Suite 130 MOBW, 100 Lancaster Avenue, Wynnewood, PA 19096, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Benz</LastName><ForeName>Robert L</ForeName><Initials>RL</Initials></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2011</Year><Month>04</Month><Day>10</Day></ArticleDate></Article><MedlineJournalInfo><Country>Egypt</Country><MedlineTA>Anemia</MedlineTA><NlmUniqueID>101536021</NlmUniqueID><ISSNLinking>2090-1267</ISSNLinking></MedlineJournalInfo></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="received"><Year>2010</Year><Month>09</Month><Day>08</Day></PubMedPubDate><PubMedPubDate PubStatus="accepted"><Year>2011</Year><Month>01</Month><Day>27</Day></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2011</Year><Month>5</Month><Day>5</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2011</Year><Month>5</Month><Day>5</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2011</Year><Month>5</Month><Day>5</Day><Hour>6</Hour><Minute>1</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">21541213</ArticleId><ArticleId IdType="doi">10.1155/2011/623673</ArticleId><ArticleId IdType="pmc">PMC3085324</ArticleId></ArticleIdList><ReferenceList><Reference><Citation>J Am Soc Nephrol. 2009 Dec;20(12):2651-60</Citation><ArticleIdList><ArticleId IdType="pubmed">19850955</ArticleId></ArticleIdList></Reference><Reference><Citation>Am J Kidney Dis. 1995 Apr;25(4):548-54</Citation><ArticleIdList><ArticleId IdType="pubmed">7702049</ArticleId></ArticleIdList></Reference><Reference><Citation>N Engl J Med. 2006 Nov 16;355(20):2085-98</Citation><ArticleIdList><ArticleId IdType="pubmed">17108343</ArticleId></ArticleIdList></Reference><Reference><Citation>Kidney Int. 2008 Nov;74(10):1237-40</Citation><ArticleIdList><ArticleId IdType="pubmed">18596731</ArticleId></ArticleIdList></Reference><Reference><Citation>Arch Intern Med. 2002 Jun 24;162(12):1401-8</Citation><ArticleIdList><ArticleId IdType="pubmed">12076240</ArticleId></ArticleIdList></Reference><Reference><Citation>J Am Soc Nephrol. 1999 Jun;10 Suppl 13:S292-6</Citation><ArticleIdList><ArticleId IdType="pubmed">10425612</ArticleId></ArticleIdList></Reference><Reference><Citation>World Health Organ Tech Rep Ser. 1968;405:5-37</Citation><ArticleIdList><ArticleId IdType="pubmed">4975372</ArticleId></ArticleIdList></Reference><Reference><Citation>Am J Kidney Dis. 1991 Jul;18(1):50-9</Citation><ArticleIdList><ArticleId IdType="pubmed">2063855</ArticleId></ArticleIdList></Reference><Reference><Citation>N Engl J Med. 2009 Nov 19;361(21):2019-32</Citation><ArticleIdList><ArticleId IdType="pubmed">19880844</ArticleId></ArticleIdList></Reference><Reference><Citation>J Clin Oncol. 2005 Sep 1;23(25):5960-72</Citation><ArticleIdList><ArticleId IdType="pubmed">16087945</ArticleId></ArticleIdList></Reference><Reference><Citation>J Am Soc Nephrol. 2005 Jun;16(6):1803-10</Citation><ArticleIdList><ArticleId IdType="pubmed">15857925</ArticleId></ArticleIdList></Reference><Reference><Citation>N Engl J Med. 2006 Nov 16;355(20):2071-84</Citation><ArticleIdList><ArticleId IdType="pubmed">17108342</ArticleId></ArticleIdList></Reference><Reference><Citation>Kidney Int Suppl. 2002 May;(80):35-8</Citation><ArticleIdList><ArticleId IdType="pubmed">11982810</ArticleId></ArticleIdList></Reference><Reference><Citation>Lancet. 1987 Nov 28;2(8570):1227-9</Citation><ArticleIdList><ArticleId IdType="pubmed">2890852</ArticleId></ArticleIdList></Reference><Reference><Citation>Lancet. 2009 May 2;373(9674):1532-42</Citation><ArticleIdList><ArticleId IdType="pubmed">19410717</ArticleId></ArticleIdList></Reference><Reference><Citation>Am J Kidney Dis. 1999 Dec;34(6):1089-95</Citation><ArticleIdList><ArticleId IdType="pubmed">10585319</ArticleId></ArticleIdList></Reference><Reference><Citation>Kidney Int. 2001 Nov;60(5):1875-84</Citation><ArticleIdList><ArticleId IdType="pubmed">11703606</ArticleId></ArticleIdList></Reference><Reference><Citation>Am J Kidney Dis. 1994 Jul;24(1 Suppl 1):S2-9; 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