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Effect of hemoglobin target on progression of kidney disease: a secondary analysis of the CHOIR (Correction of Hemoglobin and Outcomes in Renal Insufficiency) trial.

Identifieur interne : 000163 ( Main/Exploration ); précédent : 000162; suivant : 000164

Effect of hemoglobin target on progression of kidney disease: a secondary analysis of the CHOIR (Correction of Hemoglobin and Outcomes in Renal Insufficiency) trial.

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

Source :

RBID : pubmed:22537421

Descripteurs français

English descriptors

Abstract

BACKGROUND

Conflicting relationships have been described between anemia correction using erythropoiesis-stimulating agents and progression of chronic kidney disease (CKD). This study was undertaken to examine the impact of target hemoglobin level on progression of kidney disease in the CHOIR (Correction of Hemoglobin and Outcomes in Renal Insufficiency) trial.

STUDY DESIGN

Secondary analysis of a randomized controlled trial.

SETTING & PARTICIPANTS

1,432 participants with CKD and anemia.

INTERVENTION

Participants were randomly assigned to target hemoglobin levels of 13.5 versus 11.3 g/dL with the use of epoetin alfa.

OUTCOMES & MEASUREMENTS

Cox regression was used to estimate HRs for progression of CKD (a composite of doubling of creatinine level, initiation of renal replacement therapy, or death). Interactions between hemoglobin target and select baseline variables (estimated glomerular filtration rate, proteinuria, diabetes, heart failure, and smoking history) also were examined.

RESULTS

Participants randomly assigned to higher hemoglobin targets experienced shorter time to progression of kidney disease in both univariate (HR, 1.25; 95% CI, 1.03-1.52; P = 0.02) and multivariable models (HR, 1.22; 95% CI, 1.00-1.48; P = 0.05). These differences were attributable to higher rates of renal replacement therapy and death for participants in the high hemoglobin arm. Hemoglobin target did not interact with estimated glomerular filtration rate, proteinuria, diabetes, or heart failure (P > 0.05 for all). In the multivariable model, hemoglobin target interacted with tobacco use (P = 0.04) such that the higher target had a greater risk of CKD progression for participants who currently smoked (HR, 2.50; 95% CI, 1.23-5.09; P = 0.01), which was not present for those who did not currently smoke (HR, 1.15; 95% CI, 0.93-1.41; P = 0.2).

LIMITATIONS

A post hoc analysis; thus, cause and effect cannot be determined.

CONCLUSIONS

These results suggest that a high hemoglobin target is associated with a greater risk of progression of CKD. This risk may be augmented by concurrent smoking. Further defining the mechanism of injury may provide insight into methods to optimize outcomes in anemia management.


DOI: 10.1053/j.ajkd.2012.03.009
PubMed: 22537421
PubMed Central: PMC3408568


Affiliations:


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Le document en format XML

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<term>Aged, 80 and over (MeSH)</term>
<term>Analysis of Variance (MeSH)</term>
<term>Anemia (drug therapy)</term>
<term>Anemia (etiology)</term>
<term>Anemia (mortality)</term>
<term>Confidence Intervals (MeSH)</term>
<term>Disease Progression (MeSH)</term>
<term>Drug Delivery Systems (MeSH)</term>
<term>Epoetin Alfa (MeSH)</term>
<term>Erythropoietin (therapeutic use)</term>
<term>Female (MeSH)</term>
<term>Follow-Up Studies (MeSH)</term>
<term>Glomerular Filtration Rate (drug effects)</term>
<term>Hematinics (therapeutic use)</term>
<term>Hemoglobinometry (MeSH)</term>
<term>Hemoglobins (analysis)</term>
<term>Hemoglobins (drug effects)</term>
<term>Humans (MeSH)</term>
<term>Kaplan-Meier Estimate (MeSH)</term>
<term>Male (MeSH)</term>
<term>Middle Aged (MeSH)</term>
<term>Multivariate Analysis (MeSH)</term>
<term>Proportional Hazards Models (MeSH)</term>
<term>Prospective Studies (MeSH)</term>
<term>Recombinant Proteins (therapeutic use)</term>
<term>Regression Analysis (MeSH)</term>
<term>Renal Insufficiency, Chronic (complications)</term>
<term>Renal Insufficiency, Chronic (diagnosis)</term>
<term>Renal Insufficiency, Chronic (mortality)</term>
<term>Risk Assessment (MeSH)</term>
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<term>Adulte d'âge moyen (MeSH)</term>
<term>Analyse de régression (MeSH)</term>
<term>Analyse de variance (MeSH)</term>
<term>Analyse multifactorielle (MeSH)</term>
<term>Antianémiques (usage thérapeutique)</term>
<term>Anémie (mortalité)</term>
<term>Anémie (traitement médicamenteux)</term>
<term>Anémie (étiologie)</term>
<term>Appréciation des risques (MeSH)</term>
<term>Débit de filtration glomérulaire (effets des médicaments et des substances chimiques)</term>
<term>Estimation de Kaplan-Meier (MeSH)</term>
<term>Femelle (MeSH)</term>
<term>Humains (MeSH)</term>
<term>Hémoglobines (analyse)</term>
<term>Hémoglobines (effets des médicaments et des substances chimiques)</term>
<term>Hémoglobinométrie (MeSH)</term>
<term>Indice de gravité de la maladie (MeSH)</term>
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<term>Insuffisance rénale chronique (diagnostic)</term>
<term>Insuffisance rénale chronique (mortalité)</term>
<term>Intervalles de confiance (MeSH)</term>
<term>Modèles des risques proportionnels (MeSH)</term>
<term>Mâle (MeSH)</term>
<term>Protéines recombinantes (usage thérapeutique)</term>
<term>Résultat thérapeutique (MeSH)</term>
<term>Sujet âgé (MeSH)</term>
<term>Sujet âgé de 80 ans ou plus (MeSH)</term>
<term>Systèmes de délivrance de médicaments (MeSH)</term>
<term>Taux de survie (MeSH)</term>
<term>Époétine alfa (MeSH)</term>
<term>Érythropoïétine (usage thérapeutique)</term>
<term>Études de suivi (MeSH)</term>
<term>Études prospectives (MeSH)</term>
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<term>Hemoglobins</term>
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<term>Hémoglobines</term>
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<term>Renal Insufficiency, Chronic</term>
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<term>Glomerular Filtration Rate</term>
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<term>Anemia</term>
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<term>Insuffisance rénale chronique</term>
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<term>Renal Insufficiency, Chronic</term>
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<term>Insuffisance rénale chronique</term>
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<term>Anémie</term>
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<term>Protéines recombinantes</term>
<term>Érythropoïétine</term>
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<term>Analysis of Variance</term>
<term>Confidence Intervals</term>
<term>Disease Progression</term>
<term>Drug Delivery Systems</term>
<term>Female</term>
<term>Follow-Up Studies</term>
<term>Hemoglobinometry</term>
<term>Humans</term>
<term>Kaplan-Meier Estimate</term>
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<term>Middle Aged</term>
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<term>Analyse de régression</term>
<term>Analyse de variance</term>
<term>Analyse multifactorielle</term>
<term>Appréciation des risques</term>
<term>Estimation de Kaplan-Meier</term>
<term>Femelle</term>
<term>Humains</term>
<term>Hémoglobinométrie</term>
<term>Indice de gravité de la maladie</term>
<term>Intervalles de confiance</term>
<term>Modèles des risques proportionnels</term>
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<term>Résultat thérapeutique</term>
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<term>Sujet âgé de 80 ans ou plus</term>
<term>Systèmes de délivrance de médicaments</term>
<term>Taux de survie</term>
<term>Époétine alfa</term>
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<front>
<div type="abstract" xml:lang="en">
<p>
<b>BACKGROUND</b>
</p>
<p>Conflicting relationships have been described between anemia correction using erythropoiesis-stimulating agents and progression of chronic kidney disease (CKD). This study was undertaken to examine the impact of target hemoglobin level on progression of kidney disease in the CHOIR (Correction of Hemoglobin and Outcomes in Renal Insufficiency) trial.</p>
</div>
<div type="abstract" xml:lang="en">
<p>
<b>STUDY DESIGN</b>
</p>
<p>Secondary analysis of a randomized controlled trial.</p>
</div>
<div type="abstract" xml:lang="en">
<p>
<b>SETTING & PARTICIPANTS</b>
</p>
<p>1,432 participants with CKD and anemia.</p>
</div>
<div type="abstract" xml:lang="en">
<p>
<b>INTERVENTION</b>
</p>
<p>Participants were randomly assigned to target hemoglobin levels of 13.5 versus 11.3 g/dL with the use of epoetin alfa.</p>
</div>
<div type="abstract" xml:lang="en">
<p>
<b>OUTCOMES & MEASUREMENTS</b>
</p>
<p>Cox regression was used to estimate HRs for progression of CKD (a composite of doubling of creatinine level, initiation of renal replacement therapy, or death). Interactions between hemoglobin target and select baseline variables (estimated glomerular filtration rate, proteinuria, diabetes, heart failure, and smoking history) also were examined.</p>
</div>
<div type="abstract" xml:lang="en">
<p>
<b>RESULTS</b>
</p>
<p>Participants randomly assigned to higher hemoglobin targets experienced shorter time to progression of kidney disease in both univariate (HR, 1.25; 95% CI, 1.03-1.52; P = 0.02) and multivariable models (HR, 1.22; 95% CI, 1.00-1.48; P = 0.05). These differences were attributable to higher rates of renal replacement therapy and death for participants in the high hemoglobin arm. Hemoglobin target did not interact with estimated glomerular filtration rate, proteinuria, diabetes, or heart failure (P > 0.05 for all). In the multivariable model, hemoglobin target interacted with tobacco use (P = 0.04) such that the higher target had a greater risk of CKD progression for participants who currently smoked (HR, 2.50; 95% CI, 1.23-5.09; P = 0.01), which was not present for those who did not currently smoke (HR, 1.15; 95% CI, 0.93-1.41; P = 0.2).</p>
</div>
<div type="abstract" xml:lang="en">
<p>
<b>LIMITATIONS</b>
</p>
<p>A post hoc analysis; thus, cause and effect cannot be determined.</p>
</div>
<div type="abstract" xml:lang="en">
<p>
<b>CONCLUSIONS</b>
</p>
<p>These results suggest that a high hemoglobin target is associated with a greater risk of progression of CKD. This risk may be augmented by concurrent smoking. Further defining the mechanism of injury may provide insight into methods to optimize outcomes in anemia management.</p>
</div>
</front>
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<Year>2012</Year>
<Month>Sep</Month>
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<AbstractText Label="BACKGROUND" NlmCategory="BACKGROUND">Conflicting relationships have been described between anemia correction using erythropoiesis-stimulating agents and progression of chronic kidney disease (CKD). This study was undertaken to examine the impact of target hemoglobin level on progression of kidney disease in the CHOIR (Correction of Hemoglobin and Outcomes in Renal Insufficiency) trial.</AbstractText>
<AbstractText Label="STUDY DESIGN" NlmCategory="METHODS">Secondary analysis of a randomized controlled trial.</AbstractText>
<AbstractText Label="SETTING & PARTICIPANTS" NlmCategory="METHODS">1,432 participants with CKD and anemia.</AbstractText>
<AbstractText Label="INTERVENTION" NlmCategory="METHODS">Participants were randomly assigned to target hemoglobin levels of 13.5 versus 11.3 g/dL with the use of epoetin alfa.</AbstractText>
<AbstractText Label="OUTCOMES & MEASUREMENTS" NlmCategory="METHODS">Cox regression was used to estimate HRs for progression of CKD (a composite of doubling of creatinine level, initiation of renal replacement therapy, or death). Interactions between hemoglobin target and select baseline variables (estimated glomerular filtration rate, proteinuria, diabetes, heart failure, and smoking history) also were examined.</AbstractText>
<AbstractText Label="RESULTS" NlmCategory="RESULTS">Participants randomly assigned to higher hemoglobin targets experienced shorter time to progression of kidney disease in both univariate (HR, 1.25; 95% CI, 1.03-1.52; P = 0.02) and multivariable models (HR, 1.22; 95% CI, 1.00-1.48; P = 0.05). These differences were attributable to higher rates of renal replacement therapy and death for participants in the high hemoglobin arm. Hemoglobin target did not interact with estimated glomerular filtration rate, proteinuria, diabetes, or heart failure (P > 0.05 for all). In the multivariable model, hemoglobin target interacted with tobacco use (P = 0.04) such that the higher target had a greater risk of CKD progression for participants who currently smoked (HR, 2.50; 95% CI, 1.23-5.09; P = 0.01), which was not present for those who did not currently smoke (HR, 1.15; 95% CI, 0.93-1.41; P = 0.2).</AbstractText>
<AbstractText Label="LIMITATIONS" NlmCategory="CONCLUSIONS">A post hoc analysis; thus, cause and effect cannot be determined.</AbstractText>
<AbstractText Label="CONCLUSIONS" NlmCategory="CONCLUSIONS">These results suggest that a high hemoglobin target is associated with a greater risk of progression of CKD. This risk may be augmented by concurrent smoking. Further defining the mechanism of injury may provide insight into methods to optimize outcomes in anemia management.</AbstractText>
<CopyrightInformation>Copyright © 2012 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.</CopyrightInformation>
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