Treatment of Anemia With Darbepoetin Prior to Dialysis Initiation and Clinical Outcomes: Analyses From the Trial to Reduce Cardiovascular Events With Aranesp Therapy (TREAT)

Publication date: Available online 19 December 2018Source: American Journal of Kidney DiseasesAuthor(s): Finnian R. Mc Causland, Brian Claggett, Emmanuel A. Burdmann, Glenn M. Chertow, Mark E. Cooper, Kai-Uwe Eckardt, Peter Ivanovich, Andrew S. Levey, Eldrin F. Lewis, Janet B. McGill, John J.V. McMurray, Patrick Parfrey, Hans-Henrik Parving, Giuseppe Remuzzi, Ajay K. Singh, Scott D. Solomon, Robert D. Toto, Marc A. PfefferRationale &ObjectiveEvidence from clinical trials to guide patient preparation for maintenance dialysis therapy is limited. Although anemia is associated with mortality and cardiovascular (CV) disease in individuals initiating maintenance dialysis therapy, it is not known if treatment of anemia before dialysis therapy initiation with erythropoiesis-stimulating agents alters outcomes.Study DesignPost hoc analysis of a randomized controlled trial.Setting &ParticipantsParticipants with type 2 diabetes and chronic kidney disease who progressed to dialysis therapy (n = 590) in the Trial to Reduce Cardiovascular Events With Aranesp Therapy (TREAT).ExposureRandomized treatment assignment (darbepoetin vs placebo).OutcomesAll-cause mortality, CV mortality, nonfatal myocardial infarction, heart failure, and stroke within the first 180 days of dialysis therapy initiation.Analytical ApproachProportional hazards regression.ResultsOverall, 590 of 4,038 (14.6%) participants initiated dialysis therapy during the trial (n = 298 and 292 in the darb...
Source: American Journal of Kidney Diseases - Category: Urology & Nephrology Source Type: research

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Conclusions Most ESRD cases occurred in individuals without intercurrent CV events who had lower eGFRs than individuals with intercurrent CV events, but similar post-ESRD mortality. Nevertheless, intercurrent CV events, particularly heart failure, are strongly associated with risk for ESRD. These findings underscore the need for kidney-specific therapies in addition to treatment of CV risk factors to lower ESRD incidence in diabetes.
Source: American Journal of Kidney Diseases - Category: Urology & Nephrology Source Type: research
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