Target Level for Hemoglobin Correction in Patients With Diabetes and CKD: Primary Results of the Anemia Correction in Diabetes (ACORD) Study

Ritz, Eberhard; Laville, Maurice; Bilous, Rudy; O’Donoghue, Dónal; Scherhag, Armin; Bürger, Ulrich; Álvaro, Fernando de

doi:10.1053/j.ajkd.2006.11.032

Cited by 135 publications

(92 citation statements)

References 39 publications

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“…23 In DM patients with CKD stages 1-3, progressive cardiovascular events and renal function progression, as determined by the target Hb levels of 13.0-15.0 g/dL, have not been shown. 24 However, the Correction of Hemoglobin and Outcomes in Renal Insufficiency 25 and Trial to Reduce Cardiovascular Events with Aranesp Therapy 26 investigators have not shown improved renal or patient survival with ESA therapy. Therefore, we need to confirm whether early-stage DMN presents with severe anemia without definite renal damage and the early 6.7 ± 0.6 8.8 ± 0.7 8.0 ± 1.0 7.0 ± 0.9 0.5186 U-pro (g/day)…”

Section: Discussionmentioning

confidence: 99%

Association of Hypoalbuminemia with Severe Anemia in Patients with Diabetic Nephrosclerosis

et al. 2012

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Background: Anemia in patients with early diabetes mellitus nephrosclerosis (DMN) is more severe than in patients with kidney disease of other origins, and the mechanism for this remains unclear. In this study, we carried out a retrospective study in order to identify the factors associated with anemia in patients with DMN. Methods: To elucidate the factors that influence the severity of anemia in patients with DMN, we carried out a retrospective follow-up study of 124 biopsy-proven DMN cases [mean (SE) age, 55.3 (1.2) years; range, 18-78 years; male/female, 80/44]. First, a cluster analysis was performed using red blood cell counts and hemoglobin (Hb) and hematocrit levels. We then divided the clusters with regard to renal prognosis and survival and carried out simple and multifactorial analysis of clinical data, including the body mass index, age, systolic blood pressure (BP), diastolic BP, duration after the diagnosis of diabetes mellitus, serum albumin levels, blood urea nitrogen (BUN) concentrations, serum creatinine concentrations, the estimated glomerular filtration rate (eGFR) validated in the Japanese population, iron levels, total cholesterol levels, triglyceride levels, fasting blood sugar levels, HbA1c levels, urinary protein secretion, and pathohistological parameters. Results: The factors that were significantly associated with the cluster group that showed severe anemia were sex (p = 0.0162), hypoalbuminemia (p < 0.0001), high BUN concentrations (p = 0.0020), low eGFR (p = 0.0104), and Kimmelstiel-Wilson nodules (p = 0.0022). In addition, hypoalbuminemia (p = 0.0277), high BUN concentrations (p = 0.0338), and a low eGFR (p = 0.0417) were significantly associated with this group in a multifactorial analysis. Conclusion: Our data strongly suggest that hypoalbuminemia is associated with severe anemia in DMN patients.

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Section: Discussionmentioning

confidence: 99%

Association of Hypoalbuminemia with Severe Anemia in Patients with Diabetic Nephrosclerosis

et al. 2012

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“…However, on balance, among randomized controlled trials of dialysis patients, there has been no demonstration of an impact of normalization of Hgb with ESA on CVD events or survival (20)(21)(22)(23)(24)(25); moreover, many of these studies have raised questions of harm (vascular access thrombosis and stroke), which have not been definitively addressed. Smaller randomized trials among nondialysis patients have also failed to show improvements in surrogate end points for CV outcomes (left ventricular mass index on echocardiography and decline in GFR) among ESA-treated patients (26)(27)(28)(29). Recent larger randomized clinical trials have had variable and somewhat conflicting results.…”

Section: Trials Of Hgb Normalization and Cardiovascular Outcomesmentioning

confidence: 99%

Chronic kidney disease, heart failure and anemia

Virani

Khosla

Levin

2008

Canadian Journal of Cardiology

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“…These findings have led to the recommendations, recently reiterated by European (European Best Practice Guidelines) and US (Kidney Disease Outcomes Quality Initiative) clinical practice guidelines (11,12), to prescribe erythropoiesis-stimulating agents (ESA) to maintain hemoglobin Ն11 g/dl in all patients with CKD. A conclusive recommendation on the upper limit was not given, but recent studies suggest that pursuing normalization of hemoglobin levels does not ameliorate cardiorenal outcome (13)(14)(15)(16). In the real world of clinical practice, however, even a partial correction of anemia is infrequently observed in patients with CKD, regardless of the country where they live, mainly because of omission of ESA and iron therapy (1)(2)(3)(4)(17)(18)(19).…”

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confidence: 99%

Stability of Target Hemoglobin Levels during the First Year of Epoetin Treatment in Patients with Chronic Kidney Disease

Nicola¹,

Conte²,

Chiodini³

et al. 2007

Clinical Journal of the American Society of Nephrology

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Background and Objectives: Instability of hemoglobin levels during epoetin therapy is a new problem in hemodialysis. We evaluated extent and correlates of time in target, that is, the time spent with hemoglobin >11 g/dl during the first year of epoetin and its association with renal survival.Design, Setting, Participants, & Measurements: Data were collected in 917 visits for 12.0 mo in 119 patients with chronic kidney disease; thereafter, patients started renal survival analysis for 10.1 mo. At baseline, hemoglobin was 10.0 ؎ 0.8 g/dl and GFR was 22.1 ؎ 14.2 ml/min per 1.73 m 2 . Results: Hemoglobin target, reached in 1.5 mo, was steadily maintained in only 24% of patients. Time in target was not merely due to differences in time to target; after first achievement of target, in fact, a reduction of hemoglobin <11 g/dl occurred in 51% of patients. At multivariate analysis, male gender, basal GFR and hemoglobin levels, first epoetin dose, and iron supplementation were directly associated with length of time in target. A lower risk for renal death (dialysis n ‫؍‬ 53; death n ‫؍‬ 8) was detected in the higher tertile of time in target (11.3 mo) versus lower tertile (3.2 mo). This difference persisted at Cox analysis after adjustment for age, gender, GFR, BP, and proteinuria.Conclusions: In chronic kidney disease, time in target during the first year of epoetin therapy is frequently short depending not only on time to target but also on post-target hemoglobin reductions, correlates with male gender, timing, and intensity of initial therapy and is coupled with better renal survival.

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Target Level for Hemoglobin Correction in Patients With Diabetes and CKD: Primary Results of the Anemia Correction in Diabetes (ACORD) Study

Cited by 135 publications

References 39 publications

Association of Hypoalbuminemia with Severe Anemia in Patients with Diabetic Nephrosclerosis

Association of Hypoalbuminemia with Severe Anemia in Patients with Diabetic Nephrosclerosis

Chronic kidney disease, heart failure and anemia

Stability of Target Hemoglobin Levels during the First Year of Epoetin Treatment in Patients with Chronic Kidney Disease

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