High Target Hemoglobin With Erythropoiesis-Stimulating Agents Has Advantages in the Renal Function of Non-Dialysis Chronic Kidney Disease Patients
Article first published online: 19 JUN 2012
© 2012 The Authors. Therapeutic Apheresis and Dialysis © 2012 International Society for Apheresis
Therapeutic Apheresis and Dialysis
Volume 16, Issue 6, pages 529–540, December 2012
How to Cite
Tsubakihara, Y., Gejyo, F., Nishi, S., Iino, Y., Watanabe, Y., Suzuki, M., Saito, A., Akiba, T., Hirakata, H. and Akizawa, T. (2012), High Target Hemoglobin With Erythropoiesis-Stimulating Agents Has Advantages in the Renal Function of Non-Dialysis Chronic Kidney Disease Patients. Therapeutic Apheresis and Dialysis, 16: 529–540. doi: 10.1111/j.1744-9987.2012.01082.x
- Issue published online: 29 NOV 2012
- Article first published online: 19 JUN 2012
- Received December 2011; revised March 2012.
Vol. 18, Issue 4, 370, Article first published online: 13 AUG 2014
- Chronic kidney disease;
- Erythropoiesis-stimulating agent;
- Renal function
We investigated the long-term effects of maintaining high hemoglobin (Hb) on renal function in patients with chronic kidney disease not on dialysis. Subjects (Hb < 10 g/dL and serum creatinine (Cr) 2–6 mg/dL) were randomized to either a high Hb group (N = 161, 11.0 ≤ Hb < 13.0 g/dL) receiving darbepoetin alfa or to a low Hb group (N = 160, 9.0 ≤ Hb < 11.0 g/dL) with epoetin alfa, stratified according to baseline Hb and serum Cr levels, comorbidity of diabetes, and study centers. Primary endpoints were composites of the following events: doubling of serum Cr, initiation of dialysis, renal transplantation, or death. Three-year cumulative renal survival rates (95% CI) were 39.9% (30.7–49.1%) and 32.4% (24.0–40.8%) in the high and low Hb groups, respectively (log-rank test; P = 0.111). A Cox proportional-hazards model adjusted by age, sex and the randomization factors showed a significantly lower event rate in the high Hb group (P = 0.035). The estimated hazard ratio (95% CI) for the high versus the low Hb group was 0.71 (0.52–0.98), the risk reduction was 29% in the high Hb group. Incidences of serious adverse cardiovascular events did not differ significantly between the high and low Hb groups (3.1% and 4.4%, respectively). No safety issues were noted in either group. Maintaining higher Hb levels with darbepoetin alfa better preserved renal function in patients with chronic kidney disease not on dialysis.