| Abstract | AIMS: Anemia and cardiovascular (CV) events are major complications of chronic kidney disease (CKD) during dialysis. We conducted a retrospective observational study in CKD patients with anemia to evaluate the association between predialysis use of erythropoiesis-stimulating agents (ESAs) and postdialysis CV outcomes. METHODS: The study analyzed claims data on incident hemodialysis patients aged > or = 18 years (identified between January 2000 and November 2005). Patients were identified as anemic and ESA-treated prior to dialysis. ESA treatment was categorized into 4 consistency groups (from least to most consistent ESA use). RESULTS: Of 5,848 hemodialysis patients, 52% were identified as anemic prior to onset of dialysis. Predialysis ESA treatment was received by 62% of anemic patients, with only 23% receiving the most consistent treatment. The risk of a CV event was significantly lower for the ESA-treated compared with ESA-untreated patients (relative risk (RR) 0.70, 95% (95% confidence intervals (CI) 0.61 - 0.82)). Compared with ESA-untreated, those who received ESAs had significantly lower risk of acute myocardial infarction (RR 0.65 (95% CI 0.44 - 0.95)) or inpatient mortality (RR 0.52 (95% CI 0.40 - 0.68)). ESA-treated patients in each of the 4 consistency groups had significantly lower risk of CV events compared with ESA-untreated patients, with the greatest benefit seen in patients who received most consistent ESA (RR 0.61 (95% CI 0.48 - 0.76)). CONCLUSIONS: This analysis suggests consistent ESA use to treat anemia of CKD in the predialysis period is associated with improved cardiovascular outcomes in postdialysis patients. |
| Authors | J B Wish, G M Nassar, K Schulman, M del Aguila, R Provenzano
(Affiliation: Department of Nephrology, Case Western Reserve University, Cleveland, OH 44106, USA. jaywish at earthlink.net)
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| Journal | Clinical nephrology
(Clin Nephrol)
Vol. 69
Issue 4
Pg. 251-9
(Apr 2008)
ISSN: 0301-0430 Germany |
| PMID | 18397699
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
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| Chemical References |
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| Topics |
- Adult
- Anemia
(complications, drug therapy)
- Cardiovascular Diseases
(epidemiology)
- Female
- Hematinics
(therapeutic use)
- Humans
- Kidney Failure, Chronic
(complications, therapy)
- Male
- Middle Aged
- Renal Dialysis
- Retrospective Studies
- Treatment Outcome
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