A secondary analysis of the CHOIR trial shows that comorbid conditions differentially affect outcomes during anemia treatment.
Identifieur interne : 000190 ( Main/Exploration ); précédent : 000189; suivant : 000191A secondary analysis of the CHOIR trial shows that comorbid conditions differentially affect outcomes during anemia treatment.
Auteurs : Lynda A. Szczech [États-Unis] ; Huiman X. Barnhart ; Shelly Sapp ; G Michael Felker ; Adrian Hernandez ; Donal Reddan ; Robert M. Califf ; Jula K. Inrig ; Uptal D. Patel ; Ajay K. SinghSource :
- Kidney international [ 1523-1755 ] ; 2010.
Descripteurs français
- KwdFr :
- Adulte d'âge moyen (MeSH), Analyse de régression (MeSH), Analyse de survie (MeSH), Anémie (mortalité), Anémie (traitement médicamenteux), Comorbidité (MeSH), Diabète (MeSH), Défaillance cardiaque (MeSH), Femelle (MeSH), Humains (MeSH), Hémoglobines (analyse), Maladie chronique (MeSH), Maladies du rein (complications), Mâle (MeSH), Protéines recombinantes (MeSH), Résultat thérapeutique (MeSH), Sujet âgé (MeSH), Sujet âgé de 80 ans ou plus (MeSH), Époétine alfa (MeSH), Érythropoïétine (effets indésirables), Études rétrospectives (MeSH).
- MESH :
- analyse : Hémoglobines.
- effets indésirables : Maladies du rein, Érythropoïétine.
- mortalité : Anémie.
- traitement médicamenteux : Anémie.
- Adulte d'âge moyen, Analyse de régression, Analyse de survie, Comorbidité, Diabète, Défaillance cardiaque, Femelle, Humains, Maladie chronique, Mâle, Protéines recombinantes, Résultat thérapeutique, Sujet âgé, Sujet âgé de 80 ans ou plus, Époétine alfa, Études rétrospectives.
English descriptors
- KwdEn :
- Aged (MeSH), Aged, 80 and over (MeSH), Anemia (drug therapy), Anemia (mortality), Chronic Disease (MeSH), Comorbidity (MeSH), Diabetes Mellitus (MeSH), Epoetin Alfa (MeSH), Erythropoietin (adverse effects), Female (MeSH), Heart Failure (MeSH), Hemoglobins (analysis), Humans (MeSH), Kidney Diseases (complications), Male (MeSH), Middle Aged (MeSH), Recombinant Proteins (MeSH), Regression Analysis (MeSH), Retrospective Studies (MeSH), Survival Analysis (MeSH), Treatment Outcome (MeSH).
- MESH :
- chemical , adverse effects : Erythropoietin.
- chemical , analysis : Hemoglobins.
- chemical : Epoetin Alfa, Recombinant Proteins.
- complications : Kidney Diseases.
- drug therapy : Anemia.
- mortality : Anemia.
- Aged, Aged, 80 and over, Chronic Disease, Comorbidity, Diabetes Mellitus, Female, Heart Failure, Humans, Male, Middle Aged, Regression Analysis, Retrospective Studies, Survival Analysis, Treatment Outcome.
Abstract
The CHOIR trial in anemic patients with chronic kidney disease compared epoetin-alfa treatment with low (11.3 g/l) and high (13.5 g/l) hemoglobin targets on the composite end point of death, hospitalization for heart failure, stroke, and myocardial infarction. However, other anemia management trials in patients with chronic kidney disease found there was increased risk when hemoglobin is targeted above 13 g/dl. In this secondary analysis of the CHOIR trial, we compared outcomes among the subgroups of patients with diabetes and heart failure to describe the comparative relationship of treatment to these two different hemoglobin goals. By Cox regression analysis, there was no increased risk associated with the higher hemoglobin target among patients with heart failure. In patients without heart failure, however, the hazard ratio (1.86) associated with the higher target was significant. Comparing survival curves in an unadjusted model, patients with diabetes did not have a greater hazard associated with the higher target. Subjects without diabetes had a significantly greater hazard in the high as compared to the low target, but the interaction between diabetes and the target was not significant. We suggest that the increased risks associated with higher hemoglobin targets are not clinically apparent among subgroups with greater mortality risk. These differential outcomes underscore the need for dedicated trials in these subpopulations.
DOI: 10.1038/ki.2009.415
PubMed: 19890274
PubMed Central: PMC2902281
Affiliations:
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Patel</name></author><author><name sortKey="Singh, Ajay K" sort="Singh, Ajay K" uniqKey="Singh A" first="Ajay K" last="Singh">Ajay K. 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However, other anemia management trials in patients with chronic kidney disease found there was increased risk when hemoglobin is targeted above 13 g/dl. In this secondary analysis of the CHOIR trial, we compared outcomes among the subgroups of patients with diabetes and heart failure to describe the comparative relationship of treatment to these two different hemoglobin goals. By Cox regression analysis, there was no increased risk associated with the higher hemoglobin target among patients with heart failure. In patients without heart failure, however, the hazard ratio (1.86) associated with the higher target was significant. Comparing survival curves in an unadjusted model, patients with diabetes did not have a greater hazard associated with the higher target. Subjects without diabetes had a significantly greater hazard in the high as compared to the low target, but the interaction between diabetes and the target was not significant. We suggest that the increased risks associated with higher hemoglobin targets are not clinically apparent among subgroups with greater mortality risk. These differential outcomes underscore the need for dedicated trials in these subpopulations.</div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">19890274</PMID><DateCompleted><Year>2010</Year><Month>04</Month><Day>30</Day></DateCompleted><DateRevised><Year>2018</Year><Month>11</Month><Day>13</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1523-1755</ISSN><JournalIssue CitedMedium="Internet"><Volume>77</Volume><Issue>3</Issue><PubDate><Year>2010</Year><Month>Feb</Month></PubDate></JournalIssue><Title>Kidney international</Title></Journal><ArticleTitle>A secondary analysis of the CHOIR trial shows that comorbid conditions differentially affect outcomes during anemia treatment.</ArticleTitle><Pagination><MedlinePgn>239-46</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1038/ki.2009.415</ELocationID><Abstract><AbstractText>The CHOIR trial in anemic patients with chronic kidney disease compared epoetin-alfa treatment with low (11.3 g/l) and high (13.5 g/l) hemoglobin targets on the composite end point of death, hospitalization for heart failure, stroke, and myocardial infarction. However, other anemia management trials in patients with chronic kidney disease found there was increased risk when hemoglobin is targeted above 13 g/dl. In this secondary analysis of the CHOIR trial, we compared outcomes among the subgroups of patients with diabetes and heart failure to describe the comparative relationship of treatment to these two different hemoglobin goals. By Cox regression analysis, there was no increased risk associated with the higher hemoglobin target among patients with heart failure. In patients without heart failure, however, the hazard ratio (1.86) associated with the higher target was significant. Comparing survival curves in an unadjusted model, patients with diabetes did not have a greater hazard associated with the higher target. Subjects without diabetes had a significantly greater hazard in the high as compared to the low target, but the interaction between diabetes and the target was not significant. We suggest that the increased risks associated with higher hemoglobin targets are not clinically apparent among subgroups with greater mortality risk. These differential outcomes underscore the need for dedicated trials in these subpopulations.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Szczech</LastName><ForeName>Lynda A</ForeName><Initials>LA</Initials><AffiliationInfo><Affiliation>Renal Division, Department of Medicine, Duke University Medical Center, Durham, North Carolina 27710, USA. szcze001@mc.duke.edu</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Barnhart</LastName><ForeName>Huiman X</ForeName><Initials>HX</Initials></Author><Author ValidYN="Y"><LastName>Sapp</LastName><ForeName>Shelly</ForeName><Initials>S</Initials></Author><Author ValidYN="Y"><LastName>Felker</LastName><ForeName>G Michael</ForeName><Initials>GM</Initials></Author><Author ValidYN="Y"><LastName>Hernandez</LastName><ForeName>Adrian</ForeName><Initials>A</Initials></Author><Author ValidYN="Y"><LastName>Reddan</LastName><ForeName>Donal</ForeName><Initials>D</Initials></Author><Author ValidYN="Y"><LastName>Califf</LastName><ForeName>Robert M</ForeName><Initials>RM</Initials></Author><Author ValidYN="Y"><LastName>Inrig</LastName><ForeName>Jula K</ForeName><Initials>JK</Initials></Author><Author ValidYN="Y"><LastName>Patel</LastName><ForeName>Uptal D</ForeName><Initials>UD</Initials></Author><Author ValidYN="Y"><LastName>Singh</LastName><ForeName>Ajay K</ForeName><Initials>AK</Initials></Author></AuthorList><Language>eng</Language><GrantList CompleteYN="Y"><Grant><GrantID>K23 DK075929-04</GrantID><Acronym>DK</Acronym><Agency>NIDDK NIH HHS</Agency><Country>United States</Country></Grant><Grant><GrantID>R01 DK080094</GrantID><Acronym>DK</Acronym><Agency>NIDDK NIH HHS</Agency><Country>United States</Country></Grant><Grant><GrantID>KL2 RR024127</GrantID><Acronym>RR</Acronym><Agency>NCRR NIH HHS</Agency><Country>United States</Country></Grant><Grant><GrantID>K23 DK075929</GrantID><Acronym>DK</Acronym><Agency>NIDDK NIH HHS</Agency><Country>United States</Country></Grant><Grant><GrantID>R01 DK080094-01A1</GrantID><Acronym>DK</Acronym><Agency>NIDDK NIH HHS</Agency><Country>United States</Country></Grant><Grant><GrantID>R01 DK080094-02</GrantID><Acronym>DK</Acronym><Agency>NIDDK NIH HHS</Agency><Country>United States</Country></Grant></GrantList><PublicationTypeList><PublicationType UI="D016430">Clinical Trial</PublicationType><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D016449">Randomized Controlled Trial</PublicationType><PublicationType UI="D052061">Research Support, N.I.H., Extramural</PublicationType><PublicationType UI="D013485">Research Support, Non-U.S. Gov't</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2009</Year><Month>11</Month><Day>04</Day></ArticleDate></Article><MedlineJournalInfo><Country>United States</Country><MedlineTA>Kidney Int</MedlineTA><NlmUniqueID>0323470</NlmUniqueID><ISSNLinking>0085-2538</ISSNLinking></MedlineJournalInfo><ChemicalList><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D006454">Hemoglobins</NameOfSubstance></Chemical><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D011994">Recombinant Proteins</NameOfSubstance></Chemical><Chemical><RegistryNumber>11096-26-7</RegistryNumber><NameOfSubstance UI="D004921">Erythropoietin</NameOfSubstance></Chemical><Chemical><RegistryNumber>64FS3BFH5W</RegistryNumber><NameOfSubstance UI="D000068817">Epoetin Alfa</NameOfSubstance></Chemical></ChemicalList><CitationSubset>IM</CitationSubset><CommentsCorrectionsList><CommentsCorrections RefType="CommentIn"><RefSource>Kidney Int. 2010 Feb;77(3):175-7</RefSource><PMID Version="1">20075952</PMID></CommentsCorrections></CommentsCorrectionsList><MeshHeadingList><MeshHeading><DescriptorName UI="D000368" MajorTopicYN="N">Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000369" MajorTopicYN="N">Aged, 80 and over</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000740" MajorTopicYN="N">Anemia</DescriptorName><QualifierName UI="Q000188" MajorTopicYN="Y">drug therapy</QualifierName><QualifierName UI="Q000401" MajorTopicYN="N">mortality</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D002908" MajorTopicYN="N">Chronic Disease</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D015897" MajorTopicYN="N">Comorbidity</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D003920" MajorTopicYN="N">Diabetes Mellitus</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000068817" MajorTopicYN="N">Epoetin Alfa</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D004921" MajorTopicYN="N">Erythropoietin</DescriptorName><QualifierName UI="Q000009" MajorTopicYN="Y">adverse effects</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006333" MajorTopicYN="N">Heart Failure</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006454" MajorTopicYN="N">Hemoglobins</DescriptorName><QualifierName UI="Q000032" MajorTopicYN="Y">analysis</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D007674" MajorTopicYN="N">Kidney Diseases</DescriptorName><QualifierName UI="Q000150" MajorTopicYN="Y">complications</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008875" MajorTopicYN="N">Middle Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D011994" MajorTopicYN="N">Recombinant Proteins</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D012044" MajorTopicYN="N">Regression Analysis</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D012189" MajorTopicYN="N">Retrospective Studies</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D016019" MajorTopicYN="N">Survival Analysis</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D016896" MajorTopicYN="N">Treatment Outcome</DescriptorName></MeshHeading></MeshHeadingList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="entrez"><Year>2009</Year><Month>11</Month><Day>6</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2009</Year><Month>11</Month><Day>6</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2010</Year><Month>5</Month><Day>1</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId 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Barnhart</name><name sortKey="Califf, Robert M" sort="Califf, Robert M" uniqKey="Califf R" first="Robert M" last="Califf">Robert M. Califf</name><name sortKey="Felker, G Michael" sort="Felker, G Michael" uniqKey="Felker G" first="G Michael" last="Felker">G Michael Felker</name><name sortKey="Hernandez, Adrian" sort="Hernandez, Adrian" uniqKey="Hernandez A" first="Adrian" last="Hernandez">Adrian Hernandez</name><name sortKey="Inrig, Jula K" sort="Inrig, Jula K" uniqKey="Inrig J" first="Jula K" last="Inrig">Jula K. Inrig</name><name sortKey="Patel, Uptal D" sort="Patel, Uptal D" uniqKey="Patel U" first="Uptal D" last="Patel">Uptal D. Patel</name><name sortKey="Reddan, Donal" sort="Reddan, Donal" uniqKey="Reddan D" first="Donal" last="Reddan">Donal Reddan</name><name sortKey="Sapp, Shelly" sort="Sapp, Shelly" uniqKey="Sapp S" first="Shelly" last="Sapp">Shelly Sapp</name><name sortKey="Singh, Ajay K" sort="Singh, Ajay K" uniqKey="Singh A" first="Ajay K" last="Singh">Ajay K. Singh</name></noCountry><country name="États-Unis"><noRegion><name sortKey="Szczech, Lynda A" sort="Szczech, Lynda A" uniqKey="Szczech L" first="Lynda A" last="Szczech">Lynda A. Szczech</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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