SanteChoraleV4, Main, Exploration, bibRecord, 000161

Impact of higher hemoglobin targets on blood pressure and clinical outcomes: a secondary analysis of CHOIR.

Identifieur interne : 000161 ( Main/Exploration ); précédent : 000160; suivant : 000162

Impact of higher hemoglobin targets on blood pressure and clinical outcomes: a secondary analysis of CHOIR.

Auteurs : Jula K. Inrig [États-Unis] ; Shelly Sapp ; Huiman Barnhart ; Uptal D. Patel ; Donal Reddan ; Ajay Singh ; Robert M. Califf ; Lynda Szczech

Source :

Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association [ 1460-2385 ] ; 2012.

RBID : pubmed:22573238

Descripteurs français

KwdFr :
- Antianémiques (administration et posologie), Débit de filtration glomérulaire (MeSH), Facteurs de risque (MeSH), Femelle (MeSH), Humains (MeSH), Hémoglobines (administration et posologie), Hémoglobines (métabolisme), Insuffisance rénale chronique (complications), Maladies cardiovasculaires (métabolisme), Maladies cardiovasculaires (traitement médicamenteux), Maladies cardiovasculaires (étiologie), Mâle (MeSH), Pression sanguine (effets des médicaments et des substances chimiques), Pression sanguine (physiologie), Pronostic (MeSH), Sujet âgé (MeSH), Études de suivi (MeSH).
MESH :
- administration et posologie : Antianémiques, Hémoglobines.
- effets des médicaments et des substances chimiques : Pression sanguine.
- métabolisme : Hémoglobines, Maladies cardiovasculaires.
- physiologie : Pression sanguine.
- traitement médicamenteux : Maladies cardiovasculaires.
- étiologie : Maladies cardiovasculaires.
- complications : Débit de filtration glomérulaire, Facteurs de risque, Femelle, Humains, Insuffisance rénale chronique, Mâle, Pronostic, Sujet âgé, Études de suivi.

English descriptors

KwdEn :
- Aged (MeSH), Blood Pressure (drug effects), Blood Pressure (physiology), Cardiovascular Diseases (drug therapy), Cardiovascular Diseases (etiology), Cardiovascular Diseases (metabolism), Female (MeSH), Follow-Up Studies (MeSH), Glomerular Filtration Rate (MeSH), Hematinics (administration & dosage), Hemoglobins (administration & dosage), Hemoglobins (metabolism), Humans (MeSH), Male (MeSH), Prognosis (MeSH), Renal Insufficiency, Chronic (complications), Risk Factors (MeSH).
MESH :
- chemical , administration & dosage : Hematinics, Hemoglobins.
- complications : Renal Insufficiency, Chronic.
- drug effects : Blood Pressure.
- drug therapy : Cardiovascular Diseases.
- etiology : Cardiovascular Diseases.
- metabolism : Cardiovascular Diseases, Hemoglobins.
- physiology : Blood Pressure.
- Aged, Female, Follow-Up Studies, Glomerular Filtration Rate, Humans, Male, Prognosis, Risk Factors.

Abstract

BACKGROUND

Targeting a higher hemoglobin in patients with chronic kidney disease leads to adverse cardiovascular outcomes, yet the reasons remain unclear. Herein, we sought to determine whether changes in erythropoiesis-stimulating agent (ESA) dose and in hemoglobin were predictive of changes in blood pressure (BP) and whether these changes were associated with cardiovascular outcomes.

METHODS

In this secondary analysis of 1421 Correction of Hemoglobin and Outcomes in Renal Disease (CHOIR) participants, mixed model analyses were used to describe monthly changes in ESA dose and hemoglobin with changes in diastolic BP (DBP) and systolic BP (SBP). Poisson modeling was performed to determine whether changes in hemoglobin and BP were associated with the composite end point of death or cardiovascular outcomes.

RESULTS

Monthly average DBP, but not SBP, was higher in participants in the higher hemoglobin arm. Increases in ESA doses and in hemoglobin were significantly associated with linear increases in DBP, but not consistently with increases in SBP. In models adjusted for demographics and comorbid conditions, increases in ESA dose (>0 U) and larger increases in hemoglobin (>1.0 g/dL/month) were associated with poorer outcomes [event rate ratio per 1000 U weekly dose per month increase 1.05, (1.02-1.08), P = 0.002 and event rate ratio 1.70 (1.02-2.85), P = 0.05, respectively]. However, increasing DBP was not associated with adverse outcomes [event rate ratio 1.01 (0.98-1.03), P = 0.7].

CONCLUSION

Among CHOIR participants, higher hemoglobin targets, increases in ESA dose and in hemoglobin were associated both with increases in DBP and with higher event rates; however, increasing DBP was not associated with adverse outcomes.

DOI: 10.1093/ndt/gfs123
PubMed: 22573238
PubMed Central: PMC3433928

Affiliations:

Links toward previous steps (curation, corpus...)

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Le document en format XML

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<term>Blood Pressure (physiology)</term>
<term>Cardiovascular Diseases (drug therapy)</term>
<term>Cardiovascular Diseases (etiology)</term>
<term>Cardiovascular Diseases (metabolism)</term>
<term>Female (MeSH)</term>
<term>Follow-Up Studies (MeSH)</term>
<term>Glomerular Filtration Rate (MeSH)</term>
<term>Hematinics (administration & dosage)</term>
<term>Hemoglobins (administration & dosage)</term>
<term>Hemoglobins (metabolism)</term>
<term>Humans (MeSH)</term>
<term>Male (MeSH)</term>
<term>Prognosis (MeSH)</term>
<term>Renal Insufficiency, Chronic (complications)</term>
<term>Risk Factors (MeSH)</term>
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<keywords scheme="KwdFr" xml:lang="fr"><term>Antianémiques (administration et posologie)</term>
<term>Débit de filtration glomérulaire (MeSH)</term>
<term>Facteurs de risque (MeSH)</term>
<term>Femelle (MeSH)</term>
<term>Humains (MeSH)</term>
<term>Hémoglobines (administration et posologie)</term>
<term>Hémoglobines (métabolisme)</term>
<term>Insuffisance rénale chronique (complications)</term>
<term>Maladies cardiovasculaires (métabolisme)</term>
<term>Maladies cardiovasculaires (traitement médicamenteux)</term>
<term>Maladies cardiovasculaires (étiologie)</term>
<term>Mâle (MeSH)</term>
<term>Pression sanguine (effets des médicaments et des substances chimiques)</term>
<term>Pression sanguine (physiologie)</term>
<term>Pronostic (MeSH)</term>
<term>Sujet âgé (MeSH)</term>
<term>Études de suivi (MeSH)</term>
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<keywords scheme="MESH" type="chemical" qualifier="administration & dosage" xml:lang="en"><term>Hematinics</term>
<term>Hemoglobins</term>
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<term>Hémoglobines</term>
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<keywords scheme="MESH" qualifier="drug therapy" xml:lang="en"><term>Cardiovascular Diseases</term>
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<keywords scheme="MESH" qualifier="effets des médicaments et des substances chimiques" xml:lang="fr"><term>Pression sanguine</term>
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<keywords scheme="MESH" qualifier="etiology" xml:lang="en"><term>Cardiovascular Diseases</term>
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<keywords scheme="MESH" qualifier="metabolism" xml:lang="en"><term>Cardiovascular Diseases</term>
<term>Hemoglobins</term>
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<term>Maladies cardiovasculaires</term>
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<keywords scheme="MESH" qualifier="physiology" xml:lang="en"><term>Blood Pressure</term>
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<keywords scheme="MESH" qualifier="traitement médicamenteux" xml:lang="fr"><term>Maladies cardiovasculaires</term>
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<term>Female</term>
<term>Follow-Up Studies</term>
<term>Glomerular Filtration Rate</term>
<term>Humans</term>
<term>Male</term>
<term>Prognosis</term>
<term>Risk Factors</term>
</keywords>
<keywords scheme="MESH" qualifier="complications" xml:lang="fr"><term>Débit de filtration glomérulaire</term>
<term>Facteurs de risque</term>
<term>Femelle</term>
<term>Humains</term>
<term>Insuffisance rénale chronique</term>
<term>Mâle</term>
<term>Pronostic</term>
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<front><div type="abstract" xml:lang="en"><p><b>BACKGROUND</b>
</p>
<p>Targeting a higher hemoglobin in patients with chronic kidney disease leads to adverse cardiovascular outcomes, yet the reasons remain unclear. Herein, we sought to determine whether changes in erythropoiesis-stimulating agent (ESA) dose and in hemoglobin were predictive of changes in blood pressure (BP) and whether these changes were associated with cardiovascular outcomes.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>METHODS</b>
</p>
<p>In this secondary analysis of 1421 Correction of Hemoglobin and Outcomes in Renal Disease (CHOIR) participants, mixed model analyses were used to describe monthly changes in ESA dose and hemoglobin with changes in diastolic BP (DBP) and systolic BP (SBP). Poisson modeling was performed to determine whether changes in hemoglobin and BP were associated with the composite end point of death or cardiovascular outcomes.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>RESULTS</b>
</p>
<p>Monthly average DBP, but not SBP, was higher in participants in the higher hemoglobin arm. Increases in ESA doses and in hemoglobin were significantly associated with linear increases in DBP, but not consistently with increases in SBP. In models adjusted for demographics and comorbid conditions, increases in ESA dose (>0 U) and larger increases in hemoglobin (>1.0 g/dL/month) were associated with poorer outcomes [event rate ratio per 1000 U weekly dose per month increase 1.05, (1.02-1.08), P = 0.002 and event rate ratio 1.70 (1.02-2.85), P = 0.05, respectively]. However, increasing DBP was not associated with adverse outcomes [event rate ratio 1.01 (0.98-1.03), P = 0.7].</p>
</div>
<div type="abstract" xml:lang="en"><p><b>CONCLUSION</b>
</p>
<p>Among CHOIR participants, higher hemoglobin targets, increases in ESA dose and in hemoglobin were associated both with increases in DBP and with higher event rates; however, increasing DBP was not associated with adverse outcomes.</p>
</div>
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<Abstract><AbstractText Label="BACKGROUND" NlmCategory="BACKGROUND">Targeting a higher hemoglobin in patients with chronic kidney disease leads to adverse cardiovascular outcomes, yet the reasons remain unclear. Herein, we sought to determine whether changes in erythropoiesis-stimulating agent (ESA) dose and in hemoglobin were predictive of changes in blood pressure (BP) and whether these changes were associated with cardiovascular outcomes.</AbstractText>
<AbstractText Label="METHODS" NlmCategory="METHODS">In this secondary analysis of 1421 Correction of Hemoglobin and Outcomes in Renal Disease (CHOIR) participants, mixed model analyses were used to describe monthly changes in ESA dose and hemoglobin with changes in diastolic BP (DBP) and systolic BP (SBP). Poisson modeling was performed to determine whether changes in hemoglobin and BP were associated with the composite end point of death or cardiovascular outcomes.</AbstractText>
<AbstractText Label="RESULTS" NlmCategory="RESULTS">Monthly average DBP, but not SBP, was higher in participants in the higher hemoglobin arm. Increases in ESA doses and in hemoglobin were significantly associated with linear increases in DBP, but not consistently with increases in SBP. In models adjusted for demographics and comorbid conditions, increases in ESA dose (>0 U) and larger increases in hemoglobin (>1.0 g/dL/month) were associated with poorer outcomes [event rate ratio per 1000 U weekly dose per month increase 1.05, (1.02-1.08), P = 0.002 and event rate ratio 1.70 (1.02-2.85), P = 0.05, respectively]. However, increasing DBP was not associated with adverse outcomes [event rate ratio 1.01 (0.98-1.03), P = 0.7].</AbstractText>
<AbstractText Label="CONCLUSION" NlmCategory="CONCLUSIONS">Among CHOIR participants, higher hemoglobin targets, increases in ESA dose and in hemoglobin were associated both with increases in DBP and with higher event rates; however, increasing DBP was not associated with adverse outcomes.</AbstractText>
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<ForeName>Jula K</ForeName>
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Impact of higher hemoglobin targets on blood pressure and clinical outcomes: a secondary analysis of CHOIR.

Impact of higher hemoglobin targets on blood pressure and clinical outcomes: a secondary analysis of CHOIR.

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