Teehan Geoffrey, Benz Robert L
Department of Medicine, Division of Nephrology, Lankenau Medical Center, Suite 130 MOBW, 100 Lancaster Avenue, Wynnewood, PA 19096, USA.
Anemia. 2011;2011:623673. doi: 10.1155/2011/623673. Epub 2011 Apr 10.
Background. Erythropoietin deficiency and anemia occur in Chronic Kidney Disease (CKD) and may be treated with Erythropoietin Stimulating Agents (ESAs). The optimal hemoglobin, in non-End Stage Renal Disease CKD, is controversial. Methods. We review three recent randomized trials in anemia in CKD: CHOIR, CREATE, and TREAT. Results. CHOIR (N = 1432) was terminated early with more frequent death and cardiovascular outcomes in the higher Hb group (HR 1.34: 95% C.I. 1.03-1.74, P = .03). CREATE (N = 603) showed no difference in primary cardiovascular endpoints. Stroke was more common in the higher Hb group (HR 1.92; 95% C.I. 1.38-2.68; P < .001) in TREAT (N = 4038). Conclusions. There is no benefit to an Hb outside the 10-12 g/dL range in this population. To avoid transfusions and improve Quality of Life, ESAs should be used cautiously, especially in patients with Diabetes, CKD, risk factors for stroke, and ESA resistance.
背景。促红细胞生成素缺乏和贫血在慢性肾脏病（CKD）中出现，可使用促红细胞生成素刺激剂（ESA）进行治疗。在非终末期肾病CKD中，最佳血红蛋白水平存在争议。方法。我们回顾了最近三项关于CKD贫血的随机试验：CHOIR、CREATE和TREAT。结果。CHOIR（N = 1432）提前终止，较高血红蛋白组的死亡和心血管事件更频繁（HR 1.34：95%置信区间1.03 - 1.74，P = 0.03）。CREATE（N = 603）在主要心血管终点方面未显示出差异。在TREAT（N = 4038）中，较高血红蛋白组中风更常见（HR 1.92；95%置信区间1.38 - 2.68；P < 0.001）。结论。在该人群中，血红蛋白水平超出10 - 12 g/dL范围没有益处。为避免输血并改善生活质量，应谨慎使用ESA，尤其是在患有糖尿病、CKD、有中风风险因素以及存在ESA抵抗的患者中。
