A prospective observational study of early intervention with erythropoietin therapy and renal survival in non-dialysis chronic kidney disease patients with anemia: JET-STREAM Study.

Abstract

BACKGROUND:

There is limited data showing that early treatment for anemia could prolong renal survival in non-dialysis chronic kidney disease (CKD) patients. We therefore investigated the relationship between hemoglobin (Hb) levels at initiation of epoetin beta therapy and renal outcome in non-dialysis CKD patients with anemia.

METHODS:

In this prospective, multi-center, observational study, non-dialysis CKD patients with anemia who were naïve to erythropoiesis-stimulating agents (ESAs) were divided into three groups based on their Hb levels at initiation of epoetin beta therapy (Group I: 10 ≤ Hb < 11 g/dL, Group II: 9 ≤ Hb < 10 g/dL, and Group III: Hb < 9 g/dL). The primary endpoint was time to first occurrence of any renal event. For the primary analysis, an inverse probability weighted Cox regression model was used to adjust time-dependent selection bias in the artificially censored data.

RESULTS:

A total of 1113 patients were eligible for primary endpoint analysis. Risk of renal events was significantly higher in Group III compared with Group I (HR, 2.52; 95 % CI, 1.98-3.21; P < 0.0001); although not significant, the risk was also higher in Group II compared with Group I (HR, 1.48; 95 % CI, 0.91-2.40; P = 0.11).

CONCLUSION:

Initiation of ESA therapy when Hb levels decreased below 11 g/dL but not below 10 g/dL could be more effective at reducing the risk of renal events in non-dialysis CKD patients with anemia compared with initiation of ESA therapy at below 9 g/dL or even 10 g/dL.

• Authors: Tadao Akizawa, Yoshiharu Tsubakihara, Hideki Hirakata, Yuzo Watanabe, Hiroki Hase, Shinichi Nishi, Tetsuya Babazono, Michiko Kumagai, Shingo Katakura, Yukari Uemura, Yasuo Ohashi, JET-STREAM Study Group
• Journal: Clinical and experimental nephrology (Clin Exp Nephrol) Vol. 20 Issue 6 Pg. 885-895 (Dec 2016) ISSN: 1437-7799 [Electronic] Japan
• PMID: 26779906 (Publication Type: Journal Article, Multicenter Study, Observational Study)

Chemical References

• Hematinics
• Hemoglobins
• Erythropoietin

Topics

• Aged
• Aged, 80 and over
• Anemia (drug therapy)
• Erythropoietin (therapeutic use)
• Female
• Hematinics (therapeutic use)
• Hemoglobins (analysis)
• Humans
• Male
• Middle Aged
• Proportional Hazards Models
• Prospective Studies
• Renal Insufficiency, Chronic (complications)