1
|
Dasgupta I, Bagnis CI, Floris M, Furuland H, Zurro DG, Gesualdo L, Heirman N, Minutolo R, Pani A, Portolés J, Rosenberger C, Alvarez JES, Torres PU, Vanholder RC, Wanner C. Anaemia and quality of life in chronic kidney disease: a consensus document from the European Anaemia of CKD Alliance. Clin Kidney J 2024; 17:sfae205. [PMID: 39135937 PMCID: PMC11318044 DOI: 10.1093/ckj/sfae205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Indexed: 08/15/2024] Open
Abstract
Anaemia is common in chronic kidney disease (CKD) and has a significant impact on quality of life (QoL), work productivity and outcomes. Current management includes oral or intravenous iron and erythropoiesis-stimulating agents (ESAs), to which hypoxia-inducible factor prolyl hydroxylase inhibitors (HIF-PHIs) have been recently added, increasing the available therapeutic options. In randomised controlled trials, only intravenous iron improved cardiovascular outcome, while some ESAs were associated with increased adverse cardiovascular events. Despite therapeutic advances, several challenges and unmet needs remain in the current management of anaemia of CKD. In particular, clinical practice does not include an assessment of QoL, which prompted a group of European nephrologists and representatives of patient advocacy groups to revisit the current approach. In this consensus document, the authors propose a move towards a more holistic, personalised and long-term approach, based on existing evidence. The focus of treatment should be on improving QoL without increasing the risk of adverse cardiovascular events, and tailoring management strategies to the needs of the individual. In addition, the authors discuss the suitability of a currently available anaemia of CKD-specific health-related QoL measure for inclusion in the routine clinical management of anaemia of CKD. The authors also outline the logistics and challenges of incorporating such a measure into electronic health records and how it may be used to improve QoL for people with anaemia of CKD.
Collapse
Affiliation(s)
- Indranil Dasgupta
- University Hospitals of Birmingham NHS Foundation Trust, Birmingham, UK
- Warwick Medical School, University of Warwick, West Midlands, UK
| | | | - Matteo Floris
- Department of Nephrology, Dialysis, and Transplantation, ARNAS G. Brotzu, Cagliari, Italy
| | - Hans Furuland
- Department of Medical Sciences, Nephrology Unit, Uppsala University Hospital, Uppsala, Sweden
| | | | - Loreto Gesualdo
- Department of Precision and Regenerative Medicine and Ionian Area, Nephrology and Urology Units, University of Bari Aldo Moro, Bari, Italy
| | | | - Roberto Minutolo
- Department of Advanced Medical and Surgical Sciences, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Antonello Pani
- Department of Nephrology, Dialysis, and Transplantation, ARNAS G. Brotzu, Cagliari, Italy
- Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - José Portolés
- Nephrology Department, University Hospital Puerta de Hierro, Madrid, Spain
- Anaemia Working Group of S.E.N
| | - Christian Rosenberger
- Nephrology and Medical Intensive Care, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | | | - Pablo Ureña Torres
- Department of Nephrology and Dialysis, AURA Saint Ouen-sur-Seine, Paris, France
- Department of Renal Physiology, Necker Hospital, University of Paris Descartes, Paris, France
| | - Raymond C Vanholder
- Department of Internal Medicine and Pediatrics, Nephrology Section, University Hospital, Ghent, Belgium
- European Kidney Health Alliance, Brussels, Belgium
| | - Christoph Wanner
- Department of Clinical Research and Epidemiology, Comprehensive Heart Failure Centre, University of Würzburg, Würzburg, Germany
| |
Collapse
|
2
|
Kawai K, Ishii M, Kokado Y, Horikawa T, Hoshino J. Outcomes of Early Versus Delayed Anemia Treatment in Nondialysis-Dependent CKD. Kidney Int Rep 2024; 9:2056-2066. [PMID: 39081766 PMCID: PMC11284398 DOI: 10.1016/j.ekir.2024.04.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 03/28/2024] [Accepted: 04/08/2024] [Indexed: 08/02/2024] Open
Abstract
Introduction The association of hemoglobin level at treatment initiation with renal and cardiovascular outcomes in patients with anemia in nondialysis-dependent (NDD) chronic kidney disease (CKD) is unclear. Methods This retrospective cohort study utilized 2 Japanese databases (Medical Data Vision Co. Ltd., Tokyo, Japan [MDV]; and Real World Data Co. Ltd, Kyoto, Japan [RWD]). Patients initiated on long-acting erythropoiesis-stimulating agent (ESA) treatment were divided into early (hemoglobin levels ≥9.0 g/dl) and delayed (<9.0 g/dl) treatment groups. The primary outcome was a renal composite (renal replacement therapy, ≥50% estimated glomerular filtration rate [eGFR] reduction, eGFR <6.0 ml/min per 1.73 m2, and all-cause mortality), and secondary outcomes were a cardiovascular composite (hospitalization by ischemic heart disease, including myocardial infarction, hospitalization by stroke and heart failure, and cardiovascular death) and components of the composite outcomes. Results After propensity score matching, 1472 (MDV) and 1264 (RWD) patients were evaluated. Delayed treatment was not associated with a risk of the renal composite outcome (MDV: hazard ratio [HR]: 1.15, 95% confidence interval [CI]: 0.99-1.33; RWD: HR: 1.08, 95% CI: 0.92-1.28). However, delayed treatment was associated with higher risks of the cardiovascular composite outcome (MDV: HR: 1.47, 95% CI: 1.16-1.84; RWD: HR: 1.34, 95% CI: 1.09-1.64), heart failure (MDV: HR: 1.50, 95% CI: 1.13-2.00; RWD: HR: 1.53, 95% CI: 1.20-1.96) and all-cause mortality (MDV: HR: 1.83, 95% CI: 1.32-2.54; RWD: HR: 1.64, 95% CI: 1.21-2.22). Conclusion Although the risk of renal events was not increased following delayed treatment of anemia in patients with NDD-CKD, the risks of cardiovascular events and all-cause mortality were increased, suggesting the importance of early intervention before hemoglobin falls below 9.0 g/dl.
Collapse
Affiliation(s)
- Kouji Kawai
- Mitsubishi Tanabe Pharma Corporation, Tokyo, Japan
| | - Manabu Ishii
- Mitsubishi Tanabe Pharma Corporation, Tokyo, Japan
| | | | | | - Junichi Hoshino
- Department of Nephrology, Tokyo Women’s Medical University, Tokyo, Japan
| |
Collapse
|
3
|
Liu J, Li S, Yang F, Li T, Li R, Waheed Y, Meng C, Li S, Liu K, Tong Y, Xu H, Tian C, Zhou X. A retrospective study on the efficacy of Roxadustat in peritoneal dialysis patients with erythropoietin hyporesponsiveness. Korean J Intern Med 2024; 39:488-500. [PMID: 38649158 PMCID: PMC11076887 DOI: 10.3904/kjim.2023.520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/25/2024] [Accepted: 02/20/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND/AIMS Roxadustat, an oral medication for treating renal anemia, is a hypoxia-inducible factor prolyl hydroxylase inhibitor used for regulating iron metabolism and promoting erythropoiesis. To investigate the efficacy and safety of roxadustat in patients undergoing peritoneal dialysis (PD) with erythropoietin hyporesponsiveness. METHODS Single-center, retrospective study, 81 PD patients (with erythropoietin hyporesponsiveness) were divided into the roxadustat group (n = 61) and erythropoiesis-stimulating agents (ESAs) group (n = 20). Hemoglobin (Hb), total cholesterol, intact parathyroid hormone (iPTH), brain natriuretic peptide (BNP), related indicators of cardiac function and high-sensitivity C-reactive protein (hs-CRP) were collected. Additionally, adverse events were also recorded. The follow-up period was 16 weeks. RESULTS The two groups exhibited similar baseline demographic and clinical characteristics. At baseline, the roxadustat group had a mean Hb level of 89.8 ± 18.9 g/L, while the ESAs group had a mean Hb level of 95.2 ± 16.0 g/L. By week 16, the Hb levels had increased to 118 ± 19.8 g/L (p < 0.05) in the roxadustat group and 101 ± 19.3 g/L (p > 0.05) in the ESAs group. The efficacy of roxadustat in improving anemia was not influenced by baseline levels of hs-CRP and iPTH. Cholesterol was decreased in the roxadustat group without statin use. An increase in left ventricular ejection fraction and stabilization of BNP were observed in the roxadustat group. CONCLUSION For PD patients with erythropoietin hyporesponsiveness, roxadustat can significantly improve renal anemia. The efficacy of roxadustat in improving renal anemia was not affected by baseline levels of hs-CRP0 and iPTH.
Collapse
Affiliation(s)
- Jie Liu
- Department of Nephrology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou,
China
| | - Shuang Li
- Department of Nephrology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou,
China
| | - Fan Yang
- Department of Nephrology, Beijing Aerospace General Hospital, Beijing,
China
| | - Tianyu Li
- Department of Nephrology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou,
China
| | - Rui Li
- Department of Nephrology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou,
China
| | - Yousuf Waheed
- Department of Nephrology, Affiliated Hospital of Xuzhou Medical University, Xuzhou,
China
| | - Chen Meng
- Department of Nephrology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou,
China
| | - Shulin Li
- Department of Nephrology, Affiliated Hospital of Xuzhou Medical University, Xuzhou,
China
| | - Kun Liu
- Department of Nephrology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou,
China
| | - Yanshan Tong
- Department of Nephrology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou,
China
| | - Haisheng Xu
- Department of Nephrology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou,
China
| | - Chuankuo Tian
- Department of Nephrology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou,
China
| | - Xinglei Zhou
- Department of Nephrology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou,
China
| |
Collapse
|
4
|
Locatelli F, Ravera M, Esposito C, Grandaliano G, Gesualdo L, Minutolo R. A novel scenario in the therapeutic management of anemia of chronic kidney disease: placement and use of roxadustat. J Nephrol 2024; 37:1107-1119. [PMID: 38189866 DOI: 10.1007/s40620-023-01849-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 11/23/2023] [Indexed: 01/09/2024]
Abstract
Anemia is a frequent and early chronic kidney disease (CKD) complication. Its management is currently based on oral or intravenous iron supplements, erythropoiesis-stimulating agents, and red blood cell transfusions, when the benefits of transfusion outweigh the risks. Anemia in CKD patients is underdiagnosed and undertreated. Current standard of care is associated with challenges and therefore new treatment approaches have been sought. Hypoxia-inducible factor-prolyl-hydroxylase enzyme inhibitors are a new class of orally administered drugs used to treat anemia associated with CKD. Small-molecule hypoxia-inducible factor-prolyl-hydroxylase inhibitors have a novel mechanism of action that activates the hypoxia-inducible factor (oxygen-sensing) pathway resulting in a coordinated erythropoietic response, leading to increased endogenous erythropoietin production, improved iron absorption and transport, and reduced hepcidin. Roxadustat is the first hypoxia-inducible factor-prolyl-hydroxylase inhibitor approved by the European Medicines Agency (EMA) and reimbursed in Italy by the Italian Medicines Agency (AIFA) for the treatment of adult patients with symptomatic CKD-related anemia. This authorization was based on the outcome of a globally-conducted phase 3 clinical trial program comprising eight pivotal multicenter randomized studies. In the absence of up-to-date guidelines, we performed a critical appraisal of the placement and use of roxadustat in this therapeutic context.
Collapse
Affiliation(s)
- Francesco Locatelli
- Department of Nephrology and Dialysis, Alessandro Manzoni Hospital, past Director, ASST Lecco, Lecco, Italy.
| | - Maura Ravera
- Nephrology, Dialysis and Transplantation Unit, Policlinico San Martino, Genoa, Italy
| | - Ciro Esposito
- Nephrology and Dialysis Unit, IRCSS Maugeri, University of Pavia, Pavia, Italy
- Department of Internal Medicine and Medical Therapy, University of Pavia, Pavia, Italy
| | - Giuseppe Grandaliano
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
- Dipartimento di Scienze Mediche e Chirurgiche, U.O.C. Nefrologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Loreto Gesualdo
- Renal, Dialysis and Transplantation Unit, Department of Precision and Regenerative Medicine and Ionian Area (DIMEPRE-J), University of Bari, Bari, Italy
| | - Roberto Minutolo
- Division of Nephrology, Department of Advanced Medical and Surgical Sciences, University of Campania, Luigi Vanvitelli, Naples, Italy
| |
Collapse
|
5
|
Le Gall L, Harambat J, Combe C, Philipps V, Proust-Lima C, Dussartre M, Drüeke T, Choukroun G, Fouque D, Frimat L, Jacquelinet C, Laville M, Liabeuf S, Pecoits-Filho R, Massy ZA, Stengel B, Alencar de Pinho N, Leffondré K, Prezelin-Reydit M. Haemoglobin trajectories in chronic kidney disease and risk of major adverse cardiovascular events. Nephrol Dial Transplant 2024; 39:669-682. [PMID: 37935529 DOI: 10.1093/ndt/gfad235] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND The trajectories of haemoglobin in patients with chronic kidney disease (CKD) have been poorly described. In such patients, we aimed to identify typical haemoglobin trajectory profiles and estimate their risks of major adverse cardiovascular events (MACE). METHODS We used 5-year longitudinal data from the CKD-REIN cohort patients with moderate to severe CKD enrolled from 40 nationally representative nephrology clinics in France. A joint latent class model was used to estimate, in different classes of haemoglobin trajectory, the competing risks of (i) MACE + defined as the first event among cardiovascular death, non-fatal myocardial infarction, stroke or hospitalization for acute heart failure, (ii) initiation of kidney replacement therapy (KRT) and (iii) non-cardiovascular death. RESULTS During the follow-up, we gathered 33 874 haemoglobin measurements from 3011 subjects (median, 10 per patient). We identified five distinct haemoglobin trajectory profiles. The predominant profile (n = 1885, 62.6%) showed an overall stable trajectory and low risks of events. The four other profiles had nonlinear declining trajectories: early strong decline (n = 257, 8.5%), late strong decline (n = 75, 2.5%), early moderate decline (n = 356, 11.8%) and late moderate decline (n = 438, 14.6%). The four profiles had different risks of MACE, while the risks of KRT and non-cardiovascular death consistently increased from the haemoglobin decline. CONCLUSION In this study, we observed that two-thirds of patients had a stable haemoglobin trajectory and low risks of adverse events. The other third had a nonlinear trajectory declining at different rates, with increased risks of events. Better attention should be paid to dynamic changes of haemoglobin in CKD.
Collapse
Affiliation(s)
- Lisa Le Gall
- University Bordeaux, INSERM, Bordeaux Population Health, UMR1219, Bordeaux, France
- University Bordeaux, INSERM, CIC-1401-EC, Bordeaux, France
| | - Jérôme Harambat
- University Bordeaux, INSERM, Bordeaux Population Health, UMR1219, Bordeaux, France
- University Bordeaux, INSERM, CIC-1401-EC, Bordeaux, France
- Bordeaux University Hospital, Pediatric Nephrology Unit, Centre de Référence des Maladies Rénales Rares Sorare, Pellegrin-Enfants Hospital, Bordeaux, France
| | - Christian Combe
- Bordeaux University Hospital, Department of Nephrology, transplantation, dialysis, Bordeaux, France
- University Bordeaux, INSERM U1026, Bordeaux, France
| | - Viviane Philipps
- University Bordeaux, INSERM, Bordeaux Population Health, UMR1219, Bordeaux, France
| | - Cécile Proust-Lima
- University Bordeaux, INSERM, Bordeaux Population Health, UMR1219, Bordeaux, France
| | - Maris Dussartre
- University Bordeaux, INSERM, Bordeaux Population Health, UMR1219, Bordeaux, France
| | - Tilman Drüeke
- Centre for research in Epidemiology and Population Health (CESP), Paris-Saclay University, Versailles Saint-Quentin University, Inserm U1018 Clinical Epidemiology Team, Villejuif, France
| | - Gabriel Choukroun
- Amiens Picardie University Hospital, Department of Nephrology Dialysis Transplantation, Amiens, France
- University of Picardie Jules Verne, MP3CV Research Unit, Amiens, France
| | - Denis Fouque
- Hopital Lyon Sud, Département de néphrologie, Lyon, France
- Université Claude Bernard Lyon 1, Carmen INSERM U1060, Pierre-Bénite, France
| | - Luc Frimat
- CHRU de Nancy, Department of Nephrology, Vandoeuvre-lès-Nancy, France
- Lorraine University, APEMAC, Nancy, France
| | - Christian Jacquelinet
- Centre for research in Epidemiology and Population Health (CESP), Paris-Saclay University, Versailles Saint-Quentin University, Inserm U1018 Clinical Epidemiology Team, Villejuif, France
- Agence de la biomedecine, La Plaine-Saint-Denis, France
| | - Maurice Laville
- Université Claude Bernard Lyon 1, Carmen INSERM U1060, Pierre-Bénite, France
| | - Sophie Liabeuf
- University of Picardie Jules Verne, MP3CV Research Unit, Amiens, France
- Amiens-Picardie University Medical Center, Pharmacoepidemiology Unit, Department of Clinical Pharmacology, Amiens, France
| | - Roberto Pecoits-Filho
- DOPPS Program Area, Arbor Research Collaborative for Health, Ann Arbor, MI, USA
- School of Medicine, Pontificia Universidade Catolica do Parana, Cutitiba, PR, Brazil
| | - Ziad A Massy
- Centre for research in Epidemiology and Population Health (CESP), Paris-Saclay University, Versailles Saint-Quentin University, Inserm U1018 Clinical Epidemiology Team, Villejuif, France
- Ambroise Paré University Hospital, APHP, Department of Nephrology, Boulogne-Billancourt/Paris, France
| | - Bénédicte Stengel
- Centre for research in Epidemiology and Population Health (CESP), Paris-Saclay University, Versailles Saint-Quentin University, Inserm U1018 Clinical Epidemiology Team, Villejuif, France
| | - Natalia Alencar de Pinho
- Centre for research in Epidemiology and Population Health (CESP), Paris-Saclay University, Versailles Saint-Quentin University, Inserm U1018 Clinical Epidemiology Team, Villejuif, France
| | - Karen Leffondré
- University Bordeaux, INSERM, Bordeaux Population Health, UMR1219, Bordeaux, France
- University Bordeaux, INSERM, CIC-1401-EC, Bordeaux, France
| | - Mathilde Prezelin-Reydit
- University Bordeaux, INSERM, Bordeaux Population Health, UMR1219, Bordeaux, France
- University Bordeaux, INSERM, CIC-1401-EC, Bordeaux, France
- Maison du REIN AURAD Aquitaine, Néphrologie, Gradignan, Nouvelle-Aquitaine, FR
| |
Collapse
|
6
|
Garbelli M, Bellocchio F, Baro Salvador ME, Chermisi M, Rincon Bello A, Godoy IB, Perez SO, Shkolenko K, Perez AS, Toro DS, Apel C, Petrovic J, Stuard S, Barbieri C, Mari F, Neri L. The Use of Anemia Control Model Is Associated with Improved Hemoglobin Target Achievement, Lower Rates of Inappropriate Erythropoietin Stimulating Agents, and Severe Anemia among Dialysis Patients. Blood Purif 2024; 53:405-417. [PMID: 38382484 DOI: 10.1159/000536181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 12/29/2023] [Indexed: 02/23/2024]
Abstract
INTRODUCTION The Anemia Control Model (ACM) is a certified medical device suggesting the optimal ESA and iron dosage for patients on hemodialysis. We sought to assess the effectiveness and safety of ACM in a large cohort of hemodialysis patients. METHODS This is a retrospective study of dialysis patients treated in NephroCare centers between June 1, 2013 and December 31, 2019. We compared patients treated according to ACM suggestions and patients treated in clinics where ACM was not activated. We stratified patients belonging to the reference group by historical target achievement rates in their referral centers (tier 1: <70%; tier 2: 70-80%; tier 3: >80%). Groups were matched by propensity score. RESULTS After matching, we obtained four groups with 85,512 patient-months each. ACM had 18% higher target achievement rate, 63% smaller inappropriate ESA administration rate, and 59% smaller severe anemia risk compared to Tier 1 centers (all p < 0.01). The corresponding risk ratios for ACM compared to Tier 2 centers were 1.08 (95% CI: 1.08-1.09), 0.49 (95% CI: 0.47-0.51), and 0.64 (95% CI: 0.61-0.68); for ACM compared to Tier 3 centers, 1.01 (95% CI: 1.01-1.02), 0.66 (95% CI: 0.63-0.69), and 0.94 (95% CI: 0.88-1.00), respectively. ACM was associated with statistically significant reductions in ESA dose administration. CONCLUSION ACM was associated with increased hemoglobin target achievement rate, decreased inappropriate ESA usage and a decreased incidence of severe anemia among patients treated according to ACM suggestion.
Collapse
Affiliation(s)
- Mario Garbelli
- Global Medical Office - Clinical Advanced Analytics - Data Science - EMEA, APAC, LATAM region, Fresenius Medical Care Italia spa, Vaiano Cremasco, Italy,
| | - Francesco Bellocchio
- Global Medical Office - Clinical Advanced Analytics - Data Science - EMEA, APAC, LATAM region, Fresenius Medical Care Italia spa, Vaiano Cremasco, Italy
| | | | - Milena Chermisi
- Global Medical Office - Clinical Advanced Analytics - Data Science - EMEA, APAC, LATAM region, Fresenius Medical Care Italia spa, Vaiano Cremasco, Italy
| | - Abraham Rincon Bello
- Country Medical Office - NephroCare Spain, Fresenius Medical Care, Madrid, Spain
| | - Isabel Berdud Godoy
- Country Medical Office - NephroCare Spain, Fresenius Medical Care, Madrid, Spain
| | - Sofia Ortego Perez
- Country Medical Office - NephroCare Spain, Fresenius Medical Care, Madrid, Spain
| | - Kateryna Shkolenko
- Country Medical Office - NephroCare Spain, Fresenius Medical Care, Madrid, Spain
| | - Alicia Sobrino Perez
- Country Medical Office - NephroCare Spain, Fresenius Medical Care, Madrid, Spain
| | - Diana Samaniego Toro
- Country Medical Office - NephroCare Spain, Fresenius Medical Care, Madrid, Spain
| | - Christian Apel
- Health Economics and Market Access, Fresenius Medical Care, Bad Homburg, Germany
| | - Jovana Petrovic
- Health Economics and Market Access, Fresenius Medical Care, Bad Homburg, Germany
| | - Stefano Stuard
- Global Medical Office - Clinical and Therapeutic Governance EMEA, Fresenius Medical Care, Bad Homburg, Germany
| | - Carlo Barbieri
- Global Digital Transformation and Innovation, Clinical Digital Center of Excellence, Fresenius Medical Care, Vaiano Cremasco, Italy
| | - Flavio Mari
- Global Digital Transformation and Innovation, Clinical Digital Center of Excellence, Fresenius Medical Care, Vaiano Cremasco, Italy
| | - Luca Neri
- Global Medical Office - Clinical Advanced Analytics - Data Science - EMEA, APAC, LATAM region, Fresenius Medical Care Italia spa, Vaiano Cremasco, Italy
| |
Collapse
|
7
|
Xu X, Yang Z, Li S, Pei H, Zhao J, Zhang Y, Xiong Z, Liao Y, Li Y, Lin Q, Hu W, Li Y, Zheng Z, Duan L, Fu G, Guo S, Zhang B, Yu R, Sun F, Ma X, Hao L, Liu G, Zhao Z, Xiao J, Shen Y, Zhang Y, Du X, Ji T, Wang C, Deng L, Yue Y, Chen S, Ma Z, Li Y, Zuo L, Zhao H, Zhang X, Wang X, Liu Y, Gao X, Chen X, Li H, Du S, Zhao C, Xu Z, Zhang L, Chen H, Li L, Wang L, Yan Y, Ma Y, Wei Y, Zhou J, Li Y, Zheng Y, Wang J, Zhao MH, Dong J. Cut-off values of haemoglobin and clinical outcomes in incident peritoneal dialysis: the PDTAP study. Nephrol Dial Transplant 2024; 39:251-263. [PMID: 37458807 DOI: 10.1093/ndt/gfad166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND To explore the cut-off values of haemoglobin (Hb) on adverse clinical outcomes in incident peritoneal dialysis (PD) patients based on a national-level database. METHODS The observational cohort study was from the Peritoneal Dialysis Telemedicine-assisted Platform (PDTAP) dataset. The primary outcomes were all-cause mortality, major adverse cardiovascular events (MACE) and modified MACE (MACE+). The secondary outcomes were the occurrences of hospitalization, first-episode peritonitis and permanent transfer to haemodialysis (HD). RESULTS A total of 2591 PD patients were enrolled between June 2016 and April 2019 and followed up until December 2020. Baseline and time-averaged Hb <100 g/l were associated with all-cause mortality, MACE, MACE+ and hospitalizations. After multivariable adjustments, only time-averaged Hb <100 g/l significantly predicted a higher risk for all-cause mortality {hazard ratio [HR] 1.83 [95% confidence interval (CI) 1.19-281], P = .006}, MACE [HR 1.99 (95% CI 1.16-3.40), P = .012] and MACE+ [HR 1.77 (95% CI 1.15-2.73), P = .010] in the total cohort. No associations between Hb and hospitalizations, transfer to HD and first-episode peritonitis were observed. Among patients with Hb ≥100 g/l at baseline, younger age, female, use of iron supplementation, lower values of serum albumin and renal Kt/V independently predicted the incidence of Hb <100 g/l during the follow-up. CONCLUSION This study provided real-world evidence on the cut-off value of Hb for predicting poorer outcomes through a nation-level prospective PD cohort.
Collapse
Affiliation(s)
- Xiao Xu
- Renal Division, Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University, Key Laboratory of Renal Disease, Ministry of Health, Key Laboratory of Renal Disease, Ministry of Education, Beijing, China
| | - Zhikai Yang
- Renal Division, Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University, Key Laboratory of Renal Disease, Ministry of Health, Key Laboratory of Renal Disease, Ministry of Education, Beijing, China
| | - Shaomei Li
- Renal Division, Department of Medicine, Second Hospital of Hebei Medical University, Hebei, China
| | - Huayi Pei
- Renal Division, Department of Medicine, Second Hospital of Hebei Medical University, Hebei, China
| | - Jinghong Zhao
- Department of Nephrology, Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Chongqing Clinical Research Center of Kidney and Urology Diseases, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Ying Zhang
- Department of Nephrology, Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Chongqing Clinical Research Center of Kidney and Urology Diseases, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Zibo Xiong
- Renal Division, Department of Medicine, Peking University Shenzhen Hospital, Guangdong, China
| | - Yumei Liao
- Renal Division, Department of Medicine, Peking University Shenzhen Hospital, Guangdong, China
| | - Ying Li
- Renal Division, Department of Medicine, Third Hospital of Hebei Medical University; Hebei, China
| | - Qiongzhen Lin
- Renal Division, Department of Medicine, Third Hospital of Hebei Medical University; Hebei, China
| | - Wenbo Hu
- Renal Division, Department of Medicine, People's Hospital of Qinghai Province, Qinghai, China
| | - Yulin Li
- Renal Division, Department of Medicine, People's Hospital of Qinghai Province, Qinghai, China
| | - Zhaoxia Zheng
- Renal Division, Department of Medicine, Handan Central Hospital, Hebei, China
| | - Liping Duan
- Renal Division, Department of Medicine, Handan Central Hospital, Hebei, China
| | - Gang Fu
- Renal Division, Department of Medicine, Peking Haidian Hospital, Beijing, China
| | - Shanshan Guo
- Renal Division, Department of Medicine, Peking Haidian Hospital, Beijing, China
| | - Beiru Zhang
- Department of Nephrology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Rui Yu
- Department of Nephrology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Fuyun Sun
- Renal Division, Department of Medicine, Cangzhou Central Hospital, Hebei, China
| | - Xiaoying Ma
- Renal Division, Department of Medicine, Cangzhou Central Hospital, Hebei, China
| | - Li Hao
- Renal Division, Department of Medicine, Second Affiliated Hospital of Anhui Medical University, Anhui, China
| | - Guiling Liu
- Renal Division, Department of Medicine, Second Affiliated Hospital of Anhui Medical University, Anhui, China
| | - Zhanzheng Zhao
- Renal Division, Department of Medicine, First Affiliated Hospital of Zhengzhou University, Henan, China
| | - Jing Xiao
- Renal Division, Department of Medicine, First Affiliated Hospital of Zhengzhou University, Henan, China
| | - Yulan Shen
- Renal Division, Department of Medicine, Beijing Miyun District Hospital, Beijing, China
| | - Yong Zhang
- Renal Division, Department of Medicine, Beijing Miyun District Hospital, Beijing, China
| | - Xuanyi Du
- Renal Division, Department of Medicine, Second Affiliated Hospital of Harbin Medical University, Heilongjiang, China
| | - Tianrong Ji
- Renal Division, Department of Medicine, Second Affiliated Hospital of Harbin Medical University, Heilongjiang, China
| | - Caili Wang
- Renal Division, Department of Medicine, First Affiliated Hospital of BaoTou Medical College, Neimenggu, China
| | - Lirong Deng
- Renal Division, Department of Medicine, First Affiliated Hospital of BaoTou Medical College, Neimenggu, China
| | - Yingli Yue
- Renal Division, Department of Medicine, People's Hospital of Langfang, Hebei, China
| | - Shanshan Chen
- Renal Division, Department of Medicine, People's Hospital of Langfang, Hebei, China
| | - Zhigang Ma
- Renal Division, Department of Medicine, People's Hospital of Gansu, Gansu, China
| | - Yingping Li
- Renal Division, Department of Medicine, People's Hospital of Gansu, Gansu, China
| | - Li Zuo
- Renal Division, Department of Medicine, Peking University People's Hospital, Beijing, China
| | - Huiping Zhao
- Renal Division, Department of Medicine, Peking University People's Hospital, Beijing, China
| | - Xianchao Zhang
- Renal Division, Department of Medicine, Pingdingshan First People's Hospital, Henan, China
| | - Xuejian Wang
- Renal Division, Department of Medicine, Pingdingshan First People's Hospital, Henan, China
| | - Yirong Liu
- Renal Division, Department of Medicine, First People's Hospital of Xining, Qinghai, China
| | - Xinying Gao
- Renal Division, Department of Medicine, First People's Hospital of Xining, Qinghai, China
| | - Xiaoli Chen
- Renal Division, Department of Medicine, Taiyuan Central Hospital, Shanxi, China
| | - Hongyi Li
- Renal Division, Department of Medicine, Taiyuan Central Hospital, Shanxi, China
| | - Shutong Du
- Renal Division, Department of Medicine, Cangzhou People's Hospital, Hebei, China
| | - Cui Zhao
- Renal Division, Department of Medicine, Cangzhou People's Hospital, Hebei, China
| | - Zhonggao Xu
- Renal Division, Department of Medicine, First Hospital of Jilin University, Jilin, China
| | - Li Zhang
- Renal Division, Department of Medicine, First Hospital of Jilin University, Jilin, China
| | - Hongyu Chen
- Renal Division, Department of Medicine, People's Hospital of Chuxiong Yi Autonomous Prefecture, Yunnan, China
| | - Li Li
- Renal Division, Department of Medicine, People's Hospital of Chuxiong Yi Autonomous Prefecture, Yunnan, China
| | - Lihua Wang
- Renal Division, Department of Medicine, Second Hospital of Shanxi Medical University, Shanxi, China
| | - Yan Yan
- Renal Division, Department of Medicine, Second Hospital of Shanxi Medical University, Shanxi, China
| | - Yingchun Ma
- Renal Division, Department of Medicine, China Rehabilitation Research Center, Beijing Boai Hospital, Beijing, China
| | - Yuanyuan Wei
- Renal Division, Department of Medicine, China Rehabilitation Research Center, Beijing Boai Hospital, Beijing, China
| | - Jingwei Zhou
- Renal Division, Department of Medicine, Beijing Dongzhimen Hospital, Beijing, China
| | - Yan Li
- Renal Division, Department of Medicine, Beijing Dongzhimen Hospital, Beijing, China
| | - Yingdong Zheng
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Jinwei Wang
- Renal Division, Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University, Key Laboratory of Renal Disease, Ministry of Health, Key Laboratory of Renal Disease, Ministry of Education, Beijing, China
| | - Ming-Hui Zhao
- Renal Division, Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University, Key Laboratory of Renal Disease, Ministry of Health, Key Laboratory of Renal Disease, Ministry of Education, Beijing, China
| | - Jie Dong
- Renal Division, Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University, Key Laboratory of Renal Disease, Ministry of Health, Key Laboratory of Renal Disease, Ministry of Education, Beijing, China
| |
Collapse
|
8
|
Larkin J, Hymes J, Britton ML, Oluwatosin Y, Nolen J, Zhu L, Silva A. A phase 3b, multicenter, open-label, single-arm study of roxadustat within a US dialysis organization: The DENALI study. Hemodial Int 2024; 28:59-71. [PMID: 37875459 DOI: 10.1111/hdi.13122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 06/13/2023] [Accepted: 09/06/2023] [Indexed: 10/26/2023]
Abstract
INTRODUCTION Roxadustat is an oral hypoxia-inducible factor prolyl hydroxylase inhibitor approved in several regions for the treatment of anemia of chronic kidney disease (CKD). DENALI, a phase 3b study, evaluated the efficacy, safety, and feasibility of roxadustat in patients with anemia of CKD receiving in-center or home dialysis. METHODS Eligible patients received open-label roxadustat, dosed three times weekly for 24 weeks, with an optional extension of ≤1 year. Initial dosing depended on erythropoiesis-stimulating agent (ESA) dose at screening for patients receiving ESAs (≥6 weeks) and weight-based for those not (total <6 weeks). Primary efficacy endpoints were proportion of patients with mean hemoglobin (Hb) ≥10.0 g/dL averaged over Weeks 16-24, and mean Hb change from baseline to the average during Weeks 16-24. Treatment-emergent adverse events (TEAEs) and treatment-emergent serious adverse events (TESAEs) were assessed. FINDINGS Of 281 patients screened, 203 were treated and 201 included in the full analysis set. Overall, 166 patients completed the 24-week treatment period and 126 continued into the extension period. Mean baseline Hb was 10.4 g/dL and 82.6% received in-center hemodialysis. Overall, 84.6% of patients achieved a mean Hb ≥ 10.0 g/dL averaged Weeks 16-24. Mean (standard deviation) Hb change from baseline averaged Weeks 16-24 was 0.5 (1.0) g/dL. Prespecified subgroup analyses were consistent with primary analyses. Dosing adherence was 94%. Overall, 3.0% of patients received a red blood cell transfusion at up to Week 24. TEAEs and TESAEs were reported by 71.4% and 25.6% of patients, respectively. The most frequently reported TESAEs were COVID-19 (n = 5; 2.5%), and acute myocardial infarction, pneumonia, and sepsis (each n = 4; 2.0%). DISCUSSION Roxadustat effectively achieved and/or maintained mean Hb levels ≥10.0 g/dL in patients receiving dialysis. The feasibility of incorporating oral roxadustat into dialysis organizations was successfully demonstrated with high dosing adherence. No new safety signals were identified.
Collapse
Affiliation(s)
- John Larkin
- Fresenius Medical Care, Global Medical Office, Waltham, Massachusetts, USA
| | - Jeffrey Hymes
- Fresenius Medical Care, Global Medical Office, Waltham, Massachusetts, USA
| | - Marcus L Britton
- Nephrology & Hypertension Associates Ltd, Tupelo, Mississippi, USA
| | | | | | - Lixia Zhu
- FibroGen, Inc, San Francisco, California, USA
| | - Arnold Silva
- Deparmentt of Nephrology, Boise Kidney & Hypertension Institute, Meridian, Idaho, USA
| |
Collapse
|
9
|
Gong W, Huang J, Zhu T, Lin S, Hao C, Zhang M. Functional iron deficiency anemia was associated with higher mortality in chronic kidney disease patients: the NHANES III follow-up study. Ren Fail 2023; 45:2290926. [PMID: 38059456 PMCID: PMC11001329 DOI: 10.1080/0886022x.2023.2290926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 11/29/2023] [Indexed: 12/08/2023] Open
Abstract
Anemia, a common complication of chronic kidney disease (CKD), is associated with poor prognosis. However, it is not completely clear whether this association is caused by anemia per se or other comorbidities. Whether different types of iron deficiency anemia can predict the outcomes of CKD remains unclear. The dataset from NHANES III was analyzed and Cox multivariate regression models and propensity score matching (PSM) method were used to evaluate the effect of anemia on mortality. Of 4103 patients with CKD, 14.6% had anemia. Among those with anemia, 38.8% had absolute iron deficiency (AID), and 19.8% had functional iron deficiency (FID). During the median follow-up time of 13.8 years, 2964 deaths and 804 cardiovascular deaths were observed. Anemia was robustly associated with a high risk of all-cause mortality in CKD patients after adjusting covariates by two multivariate regression models (Model 1: HR = 1.485, 95%CI:1.340-1.647, p < 0.001; Model 2: HR = 1.391, 95%CI:1.250-1.546, p < 0.001). In the PSM cohort, anemia was still an independent risk factor for all-cause mortality (Model 1: HR = 1.443, 95%CI: 1.256-1.656, p < 0.001; Model 2: HR = 1.357, 95%CI:1.177-1.564, p < 0.001). In the CKD population, anemia patients with FID had the highest risk of mortality than the other anemia groups (p < 0.05), while AID had a mortality rate similar to those without anemia (p > 0.05). In conclusion, anemia was associated with a worse prognosis in patients with CKD, which may be attributed to the higher mortality risk of FID rather than AID. AID wasn't associated with a higher mortality rate compared with CKD patients without anemia.
Collapse
Affiliation(s)
- Weiyuan Gong
- Division of Nephrology, Huashan Hospital, Fudan University, Shanghai, China
- Nephrology Research Institute, Huashan Hospital, Fudan University, Shanghai, China
| | - Jiaofeng Huang
- Department of Hepatology, Hepatology Research Institute, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Fujian Clinical Research Center for Liver and Intestinal Diseases, Fuzhou, China
| | - Tongying Zhu
- Division of Nephrology, Huashan Hospital, Fudan University, Shanghai, China
- Nephrology Research Institute, Huashan Hospital, Fudan University, Shanghai, China
| | - Su Lin
- Department of Hepatology, Hepatology Research Institute, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Fujian Clinical Research Center for Liver and Intestinal Diseases, Fuzhou, China
| | - Chuanming Hao
- Division of Nephrology, Huashan Hospital, Fudan University, Shanghai, China
- Nephrology Research Institute, Huashan Hospital, Fudan University, Shanghai, China
| | - Min Zhang
- Division of Nephrology, Huashan Hospital, Fudan University, Shanghai, China
- Nephrology Research Institute, Huashan Hospital, Fudan University, Shanghai, China
| |
Collapse
|
10
|
Wang X, Wei C, Zhao D, Sun X, Zhu F, Mei Y, Ma Q, Cai G, Chen X, Li P. Iron Supplements Concomitant within Hypoxia-Inducible Factor Prolyl Hydroxylase Domain Inhibitors in the Treatment of Chronic Kidney Disease Anemia. KIDNEY DISEASES (BASEL, SWITZERLAND) 2023; 9:485-497. [PMID: 38098876 PMCID: PMC10719729 DOI: 10.1159/000533304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 07/20/2023] [Indexed: 12/17/2023]
Abstract
Background Anemia is a common and important complication in patients with chronic kidney disease (CKD). Accordingly, the current treatment is based on erythropoiesis-stimulating agents (ESAs) and iron. Hypoxia-inducible factor (HIF) prolyl hydroxylase domain inhibitors (HIF-PHIs) have been developed to treat renal anemia through a novel mechanism. HIF-PHIs increase erythropoietin at physiologic blood concentrations and also improve the supply of hematopoietic iron. Iron is the main component of hemoglobin, and ensuring efficient iron metabolism is essential in the treatment of anemia. Summary HIF-PHIs may have advantages in improving iron utilization and mobilization compared to ESAs. Most HIF-PHI trials revealed a significant decline of hepcidin, increase in transferrin level and total iron binding capacity in patients. From a clinical point of view, improvements in iron metabolism should translate into reductions in iron supplementation. There are differences in the iron treatment regimentation currently used, so it is important to evaluate and timely iron supplementation across studies. Key Messages This review summarizes the mechanism of HIF-PHIs on improved iron metabolism and the route of iron usage in the trials for dialysis-dependent CKD and non-dialysis CKD. And this review also makes an interpretation of the clinical practice guidelines in China and recommendation by Asia Pacific Society of Nephrology.
Collapse
Affiliation(s)
- Xue Wang
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Medical School, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing, China
| | - Cuiting Wei
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Medical School, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing, China
| | - Delong Zhao
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Medical School, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing, China
| | - Xuefeng Sun
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Medical School, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing, China
| | - Fengge Zhu
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Medical School, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing, China
| | - Yan Mei
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Medical School, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing, China
| | - Qian Ma
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Medical School, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing, China
| | - Guangyan Cai
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Medical School, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing, China
| | - Xiangmei Chen
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Medical School, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing, China
| | - Ping Li
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Medical School, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing, China
| |
Collapse
|
11
|
Bu S, Zheng H, Chen S, Wu Y, He C, Yang D, Wu C, Zhou Y. An optimized machine learning model for predicting hospitalization for COVID-19 infection in the maintenance dialysis population. Comput Biol Med 2023; 165:107410. [PMID: 37672928 DOI: 10.1016/j.compbiomed.2023.107410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/17/2023] [Accepted: 08/27/2023] [Indexed: 09/08/2023]
Abstract
COVID-19 has a high rate of infection in dialysis patients and poses a serious risk to human health. Currently, there are no dialysis centers in China that have analyzed the prevalence of COVID-19 infection in dialysis patients and the mortality rate. Although machine learning-based disease prediction methods have proven to be effective, redundant attributes in the data and the interpretability of the predictive models are still worth investigating. Therefore, this paper proposed a wrapper feature selection classification model to achieve the prediction of the risk of COVID-19 infection in dialysis patients. The method was used to optimize the feature set of the sample through an enhanced JAYA optimization algorithm based on the dispersed foraging strategy and the greedy levy mutation strategy. Then, the proposed method combines fuzzy K-nearest neighbor for classification prediction. IEEE CEC2014 benchmark function experiments as well as prediction experiments on the uremia dataset are used to validate the proposed model. The experimental results showed that the proposed method has a high prediction accuracy of 95.61% for the prevalence risk of COVID-19 infection in dialysis patients. Furthermore, it was shown that proalbumin, CRP, direct bilirubin, hemoglobin, albumin, and phosphorus are of great value for clinical diagnosis. Therefore, the proposed method can be considered as a promising method.
Collapse
Affiliation(s)
- Shuangshan Bu
- Department of Nephrology, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, 322100, China.
| | - HuanHuan Zheng
- Department of Nephrology, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, 322100, China.
| | - Shanshan Chen
- Department of Nephrology, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, 322100, China.
| | - Yuemeng Wu
- Department of Nephrology, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, 322100, China.
| | - Chenlei He
- Department of Nephrology, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, 322100, China.
| | - Deshu Yang
- Key Laboratory of Intelligent Informatics for Safety & Emergency of Zhejiang Province, Wenzhou University, Wenzhou, 325035, China.
| | - Chengwen Wu
- Key Laboratory of Intelligent Informatics for Safety & Emergency of Zhejiang Province, Wenzhou University, Wenzhou, 325035, China.
| | - Ying Zhou
- Department of Nephrology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325035, China.
| |
Collapse
|
12
|
Andrade JF, Dalboni MA, Clemente OC, Silva BM, Domingues BF, Rodrigues AM, Canziani ME, Zarjou A, Cendoroglo M, Goes MA. A retrospective view of the relationship of soluble Fas with anemia and outcomes in chronic kidney disease. PLoS One 2023; 18:e0286854. [PMID: 37390095 PMCID: PMC10313056 DOI: 10.1371/journal.pone.0286854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 05/24/2023] [Indexed: 07/02/2023] Open
Abstract
BACKGROUND Anemia is common in chronic kidney disease (CKD) and is associated with outcomes. In addition, serum soluble Fas (sFas) levels are related to anemia and erythropoietin (EPO) resistance. OBJECTIVES Firstly, to compare clinical data and serum levels of sFas, EPO, and pro-inflammatory markers between patients with non-dialytic CKD (NDD-CKD) and healthy subjects. Subsequently, to compare and evaluate the relationship of serum EPO, sFas levels with anemia, and outcomes in patients with NDD-CKD over a long follow-up period. METHODS We performed a retrospective study in 58 NDD-CKD patients compared with 20 healthy subjects on complete blood count, kidney function, serum EPO, sFas, and inflammatory markers (CRP, IL- 6, and IFN-γ) at baseline. We then compared the same baseline data between patients with NDD-CKD who evolved to anemia and those who did not have anemia over the follow-up. We also evaluated the frequency of outcomes in patients with CKD with higher sFas levels. Finally, we performed a multivariate analysis of factors associated with CKD anemia. RESULTS There were lower eGFR and Hb but higher serum inflammatory markers, sFas levels, sFas/eGFR, and EPO/Hb ratios in patients with NDD-CKD. Comparatively, on the other hand, NDD-CKD patients with anemia had lower eGFR but were older, had more diabetes, and had higher sFas/ eGFR, EPO/Hb ratios, and serum levels of IL-6 and sFas than NDD-CKD without anemia for an extended period. In addition, there was an association in a multivariate analysis of diabetes, age, and sFas levels with kidney anemia. Furthermore, there were higher frequencies of outcomes in increased serum sFas levels. CONCLUSION As an elective risk factor, serum sFas levels, in addition to age and diabetes, were independently associated with kidney anemia for an extended period. Thus, more studies are necessary to analyze the proper relationship of sFas with kidney anemia and its outcomes and therapy in CKD.
Collapse
Affiliation(s)
| | - Maria A. Dalboni
- Department of Research and Graduate, Universidade Nove de Julho/UNINOVE, São Paulo, Brazil
| | | | | | | | | | | | - Abolfazl Zarjou
- Division of Nephrology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Miguel Cendoroglo
- Department of Superintendence and Board, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Miguel Angelo Goes
- Division of Nephrology, Federal University of São Paulo, São Paulo, Brazil
- Medical School, Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, Brazil
| |
Collapse
|
13
|
Koyama AK, Lundeen E, McKeever Bullard K, Pavkov ME. Prevalence of Anemia and Associated All-Cause Mortality Among Adults With Diabetes: The Role of Chronic Kidney Disease. Diabetes Res Clin Pract 2023; 200:110695. [PMID: 37156427 DOI: 10.1016/j.diabres.2023.110695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 04/26/2023] [Accepted: 05/03/2023] [Indexed: 05/10/2023]
Abstract
AIMS Among adults with diabetes in the United States, we evaluated anemia prevalence by CKD status as well as the role of CKD and anemia, as potential risk factors for all-cause mortality. METHODS In a retrospective cohort study, we included 6,718 adult participants with prevalent diabetes from the 2003-March 2020 National Health and Nutrition Examination Survey (NHANES), a nationally representative sample of the non-institutionalized civilian population in the United States. Cox regression models evaluated the role of anemia and CKD, alone or combined, as predictors of all-cause mortality. RESULTS Anemia prevalence among adults with diabetes and CKD was 20%. Having anemia or CKD alone, compared with having neither condition, was significantly associated with all-cause mortality (anemia: HR=2.10 [1.49-2.96], CKD: HR=2.24 [1.90-2.64]). Having both conditions conferred a greater potential risk (HR=3.41 [2.75-4.23]). CONCLUSIONS Approximately one-quarter of the adult US population with diabetes and CKD also has anemia. The presence of anemia, with or without CKD, is associated with a two- to threefold increased risk of death by compared with adults who have neither condition, suggesting that anemia may be a strong predictor of death among adults with diabetes.
Collapse
Affiliation(s)
- Alain K Koyama
- Centers for Disease Control and Prevention, Division of Diabetes Translation, 4770 Buford Hwy, NE, MS-S107-3, Atlanta, GA 30341-3724.
| | - Elizabeth Lundeen
- Centers for Disease Control and Prevention, Division of Diabetes Translation, 4770 Buford Hwy, NE, MS-S107-3, Atlanta, GA 30341-3724.
| | - Kai McKeever Bullard
- Centers for Disease Control and Prevention, Division of Diabetes Translation, 4770 Buford Hwy, NE, MS-S107-3, Atlanta, GA 30341-3724.
| | - Meda E Pavkov
- Centers for Disease Control and Prevention, Division of Diabetes Translation, 4770 Buford Hwy, NE, MS-S107-3, Atlanta, GA 30341-3724
| |
Collapse
|
14
|
Tabibi MA, Cheema B, Salimian N, Corrêa HDL, Ahmadi S. The effect of intradialytic exercise on dialysis patient survival: a randomized controlled trial. BMC Nephrol 2023; 24:100. [PMID: 37069527 PMCID: PMC10108498 DOI: 10.1186/s12882-023-03158-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 04/07/2023] [Indexed: 04/19/2023] Open
Abstract
BACKGROUND Patients with kidney failure have a high mortality rate. This study aimed to evaluate the effect of intradialytic exercise on survival in patients receiving hemodialysis (HD). METHODS In this randomized controlled trial conducted in a HD center in Iran, adult patients receiving chronic HD were randomized to intradialytic exercise (60 min) in the second hour of thrice weekly dialysis for 6 months (intervention) or no intradialytic exercise (control). The primary outcome was survival rate at 12 months. Secondary outcomes were serum albumin, hemoglobin, hematocrit, red blood cell count, serum calcium, serum phosphorous, parathyroid hormone, physical function (6-min walk test) and nutritional status (Geriatric Nutritional Risk Index) during the first 6 months. The trial follow-up period was 12 months. RESULTS The study included 74 participants (44 males) with an age average of 64 ± 12 years old and a dialysis history of 27 ± 12 months, randomized to intervention (n = 37) or control (n = 37). Compared with controls, 1-year survival was higher in the intervention group (94% vs 73%, P = 0.01). The hazard ratio in univariate analysis in intervention group was 0.17 (95% CI 0.04-0.8; P = 0.02) compared to that in control group. During the 6-month intervention period, significant between-group changes were observed in all secondary outcomes between the intervention and control groups. CONCLUSION Intradialytic exercise performed for at least 60 min during thrice weekly dialysis sessions improves survival in adult patients receiving HD. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04898608. Retrospectively registered on 24/05/2021. Registered trial name: The Effect of Intradialytic Exercise on Dialysis Patients Survival.
Collapse
Affiliation(s)
- Mohammad Ali Tabibi
- Department of Exercise Physiology, Pardis Specialized Wellness Institute, Isfahan, Iran.
| | - Bobby Cheema
- School of Health Sciences, Western Sydney University, Campbelltow, NSW, 2560, Australia
- National Institute of Complementary Medicine Health Research Institute, Western Sydney University, Westmead, NSW, 2145, Australia
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW, 2560, Australia
| | - Nasrin Salimian
- Department of Research and Development, Pardis Specialized Wellness Institute, Isfahan, Iran
| | - Hugo de Luca Corrêa
- Graduate Program of Physical Education, Catholic University of Brasilia, Distrito Federal, Brazil
| | - Saghar Ahmadi
- Department of Health and Palliative Care, Pardis Specialized Wellness Institute, Isfahan, Iran
| |
Collapse
|
15
|
Qamar MA, Kogut LM, Tebha SS, Arif A, Ninmol J, Abdul Razzaque MR, Qamar K, Yosufi A. Collapsing focal segmental glomerulosclerosis secondary to COVID-19: A systematic review and meta-analysis. Ann Med Surg (Lond) 2023; 85:92-101. [PMID: 36845824 PMCID: PMC9949810 DOI: 10.1097/ms9.0000000000000107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 12/22/2022] [Indexed: 02/28/2023] Open
Abstract
The renal system manifestations of coronavirus disease-2019 have been documented extensively; however, scientific literature remains scarce regarding collapsing glomerulopathy hence the need for this investigation. Methods A comprehensive review was conducted covering a timeline from 1 January 2020 to 5 February 2022 without any restrictions. The data extraction was conducted independently, and articles were assessed for the risk of bias. Data analysis was conducted using Comprehensive Meta-Analysis version 3.3.070 and RevMan version 5.4 for pooled proportions and risk ratio (RR) between dialysis-dependent and independent treatment groups with a P-value less than 0.05 considered significant. Results A total of 38 studies were included in this review, including 74 (65.9%) males. The mean age was 54.2 years old. The most common symptoms reported were related to the respiratory system (59.6%, 95% CI: 50.4-68.2%) and hematuria (34.2%, 95% CI: 26.1-43.4). Antibiotics (25.9%, 95% CI: 12.9-45.3%) was the commonest management used. Proteinuria was the most reported laboratory finding at 89.5% (95% CI: 82.4-93.9%), while the commonest microscopic finding was acute tubular injury (77.2%, 95% CI: 68.6-84.0%). An increased risk of the presence of symptoms (P=0.005) and microscopic findings (P=0.0003) related to collapsing glomerulopathy in dialysis-dependent group was noted with increased management (P=0.01) used in this group for coronavirus disease-2019 infection. Conclusion The findings of this study portray the prognostic value of the variables (symptoms and microscopic findings, etc.) reported in the analysis. Hence this study serves as a foundation for future investigations that minimize the study's limitations to provide a more robust conclusion.
Collapse
Affiliation(s)
| | - Lucas M. Kogut
- Department of Nephrology, Hope Medical Institute, Newport News, Virginia, USA
| | - Sameer S. Tebha
- Department of Neurosurgery and Neurology, Jinnah Medical and Dental College
| | | | - Jesse Ninmol
- Department of Public Health, University of California, Berkeley, California
| | - Muhammad R. Abdul Razzaque
- Department of Medicine, Section of Nephrology, Jinnah Medical and Dental College, Karachi, Sindh, Pakistan
| | | | - Abubakr Yosufi
- Medical School, Kabul University of Medical Sciences, Kabul, Afghanistan
| |
Collapse
|
16
|
Umoren E, Asiwe JN, Okon IA, Levi Amangieka A, Nyenke CU, Nnamudi AC, Modo EU, Bassey AIL, Nwikue G, Etim OE. Terminalia catappa attenuates phenylhydrazine-induced anaemia and hepato-renal toxicity in male Wistar rat by boosting blood cells, modulation of lipoproteins and up-regulation of in vivo antioxidant armouries. Biomarkers 2023; 28:302-312. [PMID: 36625008 DOI: 10.1080/1354750x.2023.2166588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
AIM This study investigated the haematinic, antihyperlipidaemic, hepato-renal protective effects of Terminalia catappa aqueous leaf extract on male Wistar rats exposed to phenylhydrazine toxicity. METHODS Animals were exposed to phenylhydrazine (PHZ) 50 mg/kg intraperitoneal for two consecutive days thereafter, treated with T. catappa extract (100 mg/kg and 200 mg/kg) orally for 21 days. After the experimentation, animals were sedated with ketamine (70 mg/kg) and euthanized by cervical dislodgement. Blood and organs were collected for haematology and biochemical studies following standard laboratory methods. RESULTS Our study showed that T. catappa significantly increased erythrocytes, haemoglobin, haematocrit and high density lipoprotein as well as down-regulating leukocytes, thrombocytes, ALP AST, ALT creatinine, urea, total cholesterol as well as low density lipoprotein. The liver, kidney and spleen antioxidant defence were also up-regulated against the adverse effect caused by phenylhydrazine exposure. CONCLUSION Terminalia catappa attenuated Phenylhydrazine-induced anaemia and hepato-renal toxicity in male Wistar rat by boosting blood cells, modulation of lipoproteins and up-regulation of in vivo antioxidant armouries.
Collapse
Affiliation(s)
- Elizabeth Umoren
- Department of Physiology, PAMO University of Medical Sciences, Port-Harcourt, Nigeria
| | - Jerome Ndudi Asiwe
- Department of Physiology, PAMO University of Medical Sciences, Port-Harcourt, Nigeria.,Department of Physiology, Delta State University, Abraka, Nigeria
| | - Idara Asuquo Okon
- Department of Physiology, PAMO University of Medical Sciences, Port-Harcourt, Nigeria
| | - Albert Levi Amangieka
- Department of Physiology, PAMO University of Medical Sciences, Port-Harcourt, Nigeria
| | - Clement U Nyenke
- Department of Medical Laboratory Sciences, PAMO University of Medical Sciences, Port-Harcourt, Nigeria
| | | | - Emmanuel U Modo
- Department of Biochemistry, PAMO University of Medical Sciences, Port-Harcourt, Nigeria
| | - Augustine I L Bassey
- Department of Pharmacology, PAMO University of Medical Sciences, Port-Harcourt, Nigeria
| | - Gospel Nwikue
- Department of Pharmacology, PAMO University of Medical Sciences, Port-Harcourt, Nigeria
| | - Okon E Etim
- Department of Biochemistry, PAMO University of Medical Sciences, Port-Harcourt, Nigeria
| |
Collapse
|
17
|
Mata Lorenzo M, Ali M, Mealing S, Moss J. Development of a health economic model to evaluate the cost-effectiveness of roxadustat in treating anemia associated with non-dialysis-dependent chronic kidney disease. J Med Econ 2023; 26:1250-1260. [PMID: 37752891 DOI: 10.1080/13696998.2023.2263263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 09/22/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND Treatment for anemia of chronic kidney disease (CKD) largely consists of erythropoiesis-stimulating agents (ESAs) with iron supplementation. Although ESAs are well-established and efficacious, their use has been associated with considerable economic and humanistic burdens. Roxadustat, an oral medication, is a hypoxia-inducible factor prolyl hydroxylase inhibitor that targets multiple causes of CKD and has a similar efficacy and safety profile to ESAs. The cost-effectiveness of this treatment, however, has yet to be investigated. OBJECTIVE The study objective was to develop a health economic model to evaluate the cost-effectiveness of roxadustat compared with ESAs for treating anemia of non-dialysis-dependent (NDD) CKD. METHODS A cohort-based model was developed for a hypothetical cohort of 1,000 patients with anemia of NDD CKD, incorporating eight health states, representing the hemoglobin level of each patient. The model was informed by individual patient-level data from the roxadustat global phase 3 clinical trial program. Total and incremental costs as well as quality-adjusted life-years (QALYs) associated with roxadustat versus ESAs were estimated from the perspective of the UK National Health Service. Sensitivity analyses were performed to assess the robustness of the model. Analyses exploring alternative scenarios were also conducted. RESULTS On a per-person basis, over 1,000 simulations, roxadustat was found to be on average less costly (-£32) and more effective (+0.01 QALYs) than ESAs, with a dominant incremental cost-effectiveness ratio. The probability of cost-effectiveness at a £20,000 per QALY willingness-to-pay threshold from the UK perspective was 67%. CONCLUSION The model developed may be a useful instrument that, alongside expert clinical opinion, can inform clinical and policy decision-making regarding treatment of anemia of NDD CKD. The model highlights the cost-effectiveness of roxadustat, as well as its potential to have a meaningful impact in reducing the burden of anemia of NDD CKD.
Collapse
Affiliation(s)
| | | | - Stuart Mealing
- York Health Economics Consortium, University of York, York, UK
| | - Joe Moss
- York Health Economics Consortium, University of York, York, UK
| |
Collapse
|
18
|
Perrone V, Veronesi C, Dovizio M, Ancona DD, Bartolini F, Ferrante F, Lupi A, Palcic S, Re D, Terlizzi AP, Ramirez de Arellano Serna A, Cogliati P, Degli Esposti L. The Influence of Iron-Deficiency Anaemia (IDA) Therapy on Clinical Outcomes and Healthcare Resource Consumptions in Chronic Kidney Disease Patients Affected by IDA: A Real-Word Evidence Study among the Italian Population. J Clin Med 2022; 11:jcm11195820. [PMID: 36233688 PMCID: PMC9573467 DOI: 10.3390/jcm11195820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 09/23/2022] [Accepted: 09/26/2022] [Indexed: 11/16/2022] Open
Abstract
Anaemia is a uraemia-related complication frequently found in non-dialysis-dependent chronic kidney disease (ND-CKD) patients, with iron-deficiency anaemia (IDA) as the main underlying mechanism. Given the suboptimal anaemia management in ND-CKD patients with a co-diagnosis of IDA, this study evaluated the role of IDA therapy on clinical outcomes and healthcare resource consumptions in an Italian clinical setting. A retrospective observational real-world analysis was performed on administrative databases of healthcare entities, covering around 6.9 million health-assisted individuals. From January 2010 to March 2019, ND-CKD patients were included and diagnosed with IDA in the presence of two low-haemoglobin (Hb) measurements. Patients were divided into IDA-treated and untreated, based on the prescription of iron [Anatomical-Therapeutic Chemical (ATC) code B03A] or anti-anaemia preparations (ATC code B03X), and evaluated during a 6-month follow-up from the index date [first low haemoglobin (Hb) detection]. IDA treatment resulted in significantly decreased incidence of all cause-related, cardiovascular-related, and IDA-related hospitalizations (treated vs. untreated: 44.5% vs. 81.8%, 12.3% vs. 25.3%, and 16.2% vs. 26.2%, respectively, p < 0.001). A healthcare direct cost estimation showed that overall mean expenditure per patient reduced by 47% with IDA treatment (5245€ vs. 9918€, p < 0.001), mainly attributable to hospitalizations (3767€ vs. 8486€, p < 0.001). This real-life analysis on Italian ND-CKD-IDA patients indicates that IDA therapy administration provides significant benefits in terms of patients’ clinical outcomes and healthcare cost savings.
Collapse
Affiliation(s)
- Valentina Perrone
- CliCon Società Benefit S.r.l. Health, Economics & Outcomes Research, 40137 Bologna, Italy
| | - Chiara Veronesi
- CliCon Società Benefit S.r.l. Health, Economics & Outcomes Research, 40137 Bologna, Italy
| | - Melania Dovizio
- CliCon Società Benefit S.r.l. Health, Economics & Outcomes Research, 40137 Bologna, Italy
| | - Domenica Daniela Ancona
- Dipartimento Farmaceutico, Azienda Sanitaria Locale delle province di Barletta- Andria- Trani (BAT), 76125 Andria, Italy
| | - Fausto Bartolini
- Dipartimento Farmaceutico, Unità Sanitaria Locale Umbria 2, 05100 Terni, Italy
| | - Fulvio Ferrante
- Dipartimento della Diagnostica ed Assistenza Farmaceutica, ASL Frosinone, 03100 Frosinone, Italy
| | - Alessandro Lupi
- Azienda Sanitaria Locale del Verbano Cusio Ossola (VCO), 28887 Omegna, Italy
| | - Stefano Palcic
- Azienda Sanitaria Universitaria Integrata Giuliano-Isontina (ASUGI), 34148 Trieste, Italy
| | - Davide Re
- Dipartimento Assistenza Territoriale, Azienda Sanitaria Locale di Teramo, 64100 Teramo, Italy
| | - Annamaria Pia Terlizzi
- Dipartimento Farmaceutico, Azienda Sanitaria Locale delle province di Barletta- Andria- Trani (BAT), 76125 Andria, Italy
| | | | | | - Luca Degli Esposti
- CliCon Società Benefit S.r.l. Health, Economics & Outcomes Research, 40137 Bologna, Italy
- Correspondence:
| |
Collapse
|
19
|
Kumar S, Arnold M, James G, Padman R. Developing a common data model approach for DISCOVER CKD: A retrospective, global cohort of real-world patients with chronic kidney disease. PLoS One 2022; 17:e0274131. [PMID: 36173958 PMCID: PMC9521926 DOI: 10.1371/journal.pone.0274131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 08/22/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To describe a flexible common data model (CDM) approach that can be efficiently tailored to study-specific needs to facilitate pooled patient-level analysis and aggregated/meta-analysis of routinely collected retrospective patient data from disparate data sources; and to detail the application of this CDM approach to the DISCOVER CKD retrospective cohort, a longitudinal database of routinely collected (secondary) patient data of individuals with chronic kidney disease (CKD). METHODS The flexible CDM approach incorporated three independent, exchangeable components that preceded data mapping and data model implementation: (1) standardized code lists (unifying medical events from different coding systems); (2) laboratory unit harmonization tables; and (3) base cohort definitions. Events between different coding vocabularies were not mapped code-to-code; for each data source, code lists of labels were curated at the entity/event level. A study team of epidemiologists, clinicians, informaticists, and data scientists were included within the validation of each component. RESULTS Applying the CDM to the DISCOVER CKD retrospective cohort, secondary data from 1,857,593 patients with CKD were harmonized from five data sources, across three countries, into a discrete database for rapid real-world evidence generation. CONCLUSIONS This flexible CDM approach facilitates evidence generation from real-world data within the DISCOVER CKD retrospective cohort, providing novel insights into the epidemiology of CKD that may expedite improvements in diagnosis, prognosis, early intervention, and disease management. The adaptable architecture of this CDM approach ensures scalable, fast, and efficient application within other therapy areas to facilitate the combined analysis of different types of secondary data from multiple, heterogeneous sources.
Collapse
Affiliation(s)
- Supriya Kumar
- Real World Evidence Data and Analytics, BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, MD, United States of America
| | - Matthew Arnold
- Real World Evidence Data and Analytics, BioPharmaceuticals Medical, AstraZeneca, Cambridge, United Kingdom
| | - Glen James
- Formerly Cardiovascular, Renal, Metabolism & Epidemiology, BioPharmaceuticals Medical, AstraZeneca, Cambridge, United Kingdom
| | - Rema Padman
- Heinz College of Information Systems and Public Policy, Carnegie Mellon University, Pittsburgh, PA, United States of America
| |
Collapse
|
20
|
Lamerato L, James G, van Haalen H, Hedman K, Sloand JA, Tang A, Wittbrodt ET, Yee J. Epidemiology and outcomes in patients with anemia of CKD not on dialysis from a large US healthcare system database: a retrospective observational study. BMC Nephrol 2022; 23:166. [PMID: 35490226 PMCID: PMC9055693 DOI: 10.1186/s12882-022-02778-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 03/22/2022] [Indexed: 11/12/2022] Open
Abstract
Background Optimal management of anemia of chronic kidney disease (CKD) remains controversial. This retrospective study aimed to describe the epidemiology and selected clinical outcomes of anemia in patients with CKD in the US. Methods Data were extracted from Henry Ford Health System databases. Adults with stages 3a–5 CKD not on dialysis (estimated glomerular filtration rate < 60 mL/min/1.73m2) between January 1, 2013 and December 31, 2017 were identified. Patients on renal replacement therapy or with active cancer or bleeding were excluded. Patients were followed for ≥12 months until December 31, 2018. Outcomes included incidence rates per 100 person-years (PY) of anemia (hemoglobin < 10 g/dL), renal and major adverse cardiovascular events, and of bleeding and hospitalization outcomes. Adjusted Cox proportional hazards models identified factors associated with outcomes after 1 and 5 years. Results Among the study cohort (N = 50,701), prevalence of anemia at baseline was 23.0%. Treatments used by these patients included erythropoiesis-stimulating agents (4.1%), iron replacement (24.2%), and red blood cell transfusions (11.0%). Anemia incidence rates per 100 PY in patients without baseline anemia were 7.4 and 9.7 after 1 and 5 years, respectively. Baseline anemia was associated with increased risk of renal and major cardiovascular events, hospitalizations (all-cause and for bleeding), and transfusion requirements. Increasing CKD stage was associated with increased risk of incident anemia, renal and major adverse cardiovascular events, and hospitalizations. Conclusions Anemia was a prevalent condition associated with adverse renal, cardiovascular, and bleeding/hospitalization outcomes in US patients with CKD. Anemia treatment was infrequent. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-022-02778-8.
Collapse
Affiliation(s)
- Lois Lamerato
- Department of Public Health Sciences, Henry Ford Health System, 1 Ford Place - 3E, Detroit, MI, 48202, USA.
| | - Glen James
- Cardiovascular, Renal, Metabolism Epidemiology, BioPharmaceuticals Medical, AstraZeneca, Cambridge, UK.,Integrated Evidence Generation & Business Innovation, Bayer PLC, Reading, UK
| | - Heleen van Haalen
- Global Health Economics and Payer Evidence, BioPharmaceuticals Medical, AstraZeneca, Gothenburg, Sweden
| | - Katarina Hedman
- Late Cardiovascular, Renal, Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - James A Sloand
- Present affiliation: Division of Kidney Diseases & Hypertension, the George Washington University, Washington, DC, USA.,Global Medical Affairs, Cardiovascular, Renal and Metabolism, BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, MD, USA
| | - Amy Tang
- Department of Public Health Sciences, Henry Ford Health System, 1 Ford Place - 3E, Detroit, MI, 48202, USA
| | - Eric T Wittbrodt
- Cardiovascular, Renal, Metabolism Epidemiology, BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, MD, USA
| | - Jerry Yee
- Division of Nephrology and Hypertension, Henry Ford Hospital, Detroit, MI, USA
| |
Collapse
|
21
|
Wu T, Qi Y, Ma S, Zhang L, Pu X, Chen K, Zhao Y, Sang S, Xiao J. Efficacy of Roxadustat on anemia and residual renal function in patients new to peritoneal dialysis. Ren Fail 2022; 44:529-540. [PMID: 35318873 PMCID: PMC8956311 DOI: 10.1080/0886022x.2022.2050754] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background Both early correction of anemia and preserving residual renal function (RRF) are reported to improve patient survival. The aim of this study was to explore the efficacy and safety of Roxadustat for treatment of renal anemia in patients new to peritoneal dialysis (PD) and to assess its impact on RRF. Methods A retrospective analysis was performed on 60 initial peritoneal dialysis (PD) patients with renal anemia. Twenty-eight cases were treated with Roxadustat (Roxadustat group) and 32 with recombinant human erythropoietin (control group). Clinical characteristics, hemoglobin (Hb), C-reactive protein, blood lipids, iron metabolism, dialysis adequacy and RRF of the two groups were evaluated and adverse events were recorded. All patients were followed up for at least 40 weeks. Results After 40 weeks of treatment, mean Hb levels were significantly higher from baseline values in both groups, the mean Hb change in Roxadustat group was higher than control group (3.46 ± 1.59 g/dL vs. 2.28 ± 2.27 g/dL, p < 0.05). At 40 weeks, 92.9% patients met the target level of Hb in Roxadustat group and 84.4% in control group. Total iron binding was higher and ferritin was lower in Roxadustat group from baseline values and Roxadustat-induced Hb increases were independent of baseline C-reactive protein levels and history of rhuEPO administration. RRF decreased over time in both groups, the mean RRF change was lower in Roxadustat group than control group (1.15 ± 1.66 mL/min/1.73 m2 vs. 2.31 ± 1.46 mL/min/1.73 m2, p < 0.01). Compared with control group, patients in Roxadustat group had higher levels of total iron binding, 24 h urine volume, total weekly Ccr, and lower systolic pressure, ferritin, C-reactive protein, total cholesterol, LDL. No serious adverse reactions occurred in either group. Conclusion In patients new to PD, Roxadustat effectively and safely improved renal anemia and delay the decline of RRF.
Collapse
Affiliation(s)
- Tong Wu
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuanyuan Qi
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shuang Ma
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lijie Zhang
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xinyu Pu
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Kui Chen
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ying Zhao
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shenghua Sang
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jing Xiao
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| |
Collapse
|
22
|
Wittbrodt ET, James G, Kumar S, van Haalen H, Chen H, Sloand JA, Kalantar-Zadeh K. Contemporary outcomes of anemia in US patients with chronic kidney disease. Clin Kidney J 2022; 15:244-252. [PMID: 35145639 PMCID: PMC8824810 DOI: 10.1093/ckj/sfab195] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Indexed: 12/20/2022] Open
Abstract
Background Long-term clinical outcome data from patients with non-dialysis-dependent (NDD) chronic kidney disease (CKD) are lacking. We characterized patients with NDD-CKD and anemia using real-world data from the USA. Methods This retrospective longitudinal observational study evaluated integrated Limited Claims and Electronic Health Record Data (IBM Health, Armonk, NY), including patients ≥18 years with two or more estimated glomerular filtration rate (eGFR) measures <60 mL/min/1.73 m2 ≥90 days apart. Anemia was defined as the first observed hemoglobin <10 g/dL within 6-month pre- and post-CKD index date. Data were analyzed from January 2012 to June 2018. Patients with documented iron-deficiency anemia at baseline were excluded. Results Comprising 22 720 patients (57.4% female, 63.9% CKD stage 3, median hemoglobin 12.5 g/dL), median (interquartile range) follow-up for patients with and without anemia were 2.9 (1.5-4.4) and 3.8 (2.2-4.8) years, respectively. The most prevalent comorbidities were dyslipidemia (57.6%), type 2 diabetes mellitus (38.8%) and uncontrolled hypertension (20.0%). Overall, 23.3% of patients had anemia, of whom 1.9% and <0.1% received erythropoiesis-stimulating agents (ESAs) or intravenous iron, respectively. Anemia prevalence increased with CKD stage from 18.2% (stage 3a) to 72.8% (stage 5). Patients with anemia had a higher incidence rate of hospitalizations for heart failure (1.6 versus 0.8 per 100 patient-years), CKD stage advancement (43.5 versus 27.5 per 100 patient-years), and a 40% eGFR decrease (18.1 versus 7.3 per 100 patient-years) versus those without anemia. Conclusions Anemia, frequently observed in NDD-CKD and associated with adverse clinical outcomes, is rarely treated with ESAs and intravenous iron. These data suggest that opportunities exist for improved anemia management in patients with NDD-CKD.
Collapse
Affiliation(s)
| | - Glen James
- AstraZeneca, Biopharmaceuticals Medical, Cambridge, UK
| | - Supriya Kumar
- AstraZeneca, Biopharmaceuticals Medical, Gaithersburg, MD, USA
| | | | - Hungta Chen
- AstraZeneca, Biopharmaceuticals Medical, Gaithersburg, MD, USA
| | - James A Sloand
- AstraZeneca, Biopharmaceuticals Medical, Gaithersburg, MD, USA
| | | |
Collapse
|
23
|
Soraci L, Corica F, Corsonello A, Remelli F, Abete P, Bellelli G, Bo M, Cherubini A, Di Bari M, Maggio M, Martone AM, Rizzo MR, Manca GM, Rossi AP, Zambon A, Volpato S, Landi F. Prognostic interplay of kidney function with sarcopenia, anemia, disability and cognitive impairment. The GLISTEN study. Eur J Intern Med 2021; 93:57-63. [PMID: 34253448 DOI: 10.1016/j.ejim.2021.06.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 06/01/2021] [Accepted: 06/29/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Interactions between chronic kidney disease (CKD) and several comorbidities may potentially affect prognosis of older hospitalized patients. This study aims at evaluating the prognostic interactions between estimated glomerular filtration rate (eGFR), anemia, sarcopenia, functional and cognitive dysfunction, and 3-year mortality among older patients discharged from acute care hospitals. METHODS Our series consisted of 504 older adults enrolled in a multicenter observational study carried out in twelve Acute Geriatric and Internal Medicine wards throughout Italy. CKD was defined as an eGFR< 60 ml/min/1.73 m2. Anemia, Short Portable Status Mental Questionnaire (SPMSQ), Basic Activities of Daily Living (BADL), sarcopenia, and Charlson index were considered in the analysis. 3-year survival was investigated by Cox regression and prognostic interactions among study variables were assessed by survival tree analysis. Accuracy of different survival models was investigated by C-index. RESULTS eGFR < 30 mL/min/1.73 m2, anemia, sarcopenia, SPMSQ ≥ 5, and impairment in 1 or more BADL were significantly associated with mortality. Survival tree analysis showed that patients with eGFR < 35.32 ml/min/1.73 m2 and SPMSQ ≥ 5 had the highest risk of mortality [hazard ratio (HR): 5.49, 95%CI: 3.04-9.94] followed by those with eGFR < 35.32 ml/min/1.73 m2, hemoglobin < 11.95 g/dL and SPMSQ < 5 (HR:3.65; 95%CI: 2.21-6.02) and those with eGFR 35.32-47.99 ml/min/1.73 m2 and sarcopenia (HR:3.65; 95%CI: 1.99-6.69). Survival tree leaf node membership had good accuracy in predicting the study outcome (C-index: 0.73, 95%CI:0.70-0.76). CONCLUSIONS Interactions among study risk factors designed distinct risk profiles in older patients discharged from acute care hospitals, that may help identify patients needing targeted interventions and appropriate follow-up after discharge.
Collapse
Affiliation(s)
- Luca Soraci
- Unit of Geriatric Medicine, IRCCS INRCA, Cosenza, Italy
| | - Francesco Corica
- Department of Clinical and Experimental Medicine, University of Messina, University of Messina, Messina, Italy.
| | - Andrea Corsonello
- Unit of Geriatric Medicine, IRCCS INRCA, Cosenza, Italy; Unit of Geriatric Pharmacoepidemiology and Biostatistics, IRCCS INRCA, Ancona and Cosenza, Italy
| | - Francesca Remelli
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy; Center for Clinical Epidemiology, School of Medicine, University of Ferrara, Ferrara, Italy
| | - Pasquale Abete
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Giuseppe Bellelli
- School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy; Acute Geriatric Unit, S. Gerardo Hospital, Monza, Italy
| | - Mario Bo
- Section of Geriatrics, Department of Medical Sciences, University of Turin, Città della Salute e della Scienza, Molinette, Turin, Italy
| | - Antonio Cherubini
- Geriatria, Accettazione Geriatrica e Centro di ricerca per l'invecchiamento, IRCCS INRCA, Ancona, Italy
| | - Mauro Di Bari
- Research Unit of Medicine of Aging, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Geriatric Intensive Care Unit, Department of Geriatrics and Medicine, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Marcello Maggio
- Department of Medicine and Surgery, Geriatric Rehabilitation Department, University of Parma, Parma, Italy
| | - Anna Maria Martone
- Department of Geriatrics, Neurosciences and Orthopaedics, Catholic University of the Sacred Heart, Rome, Italy
| | - Maria Rosaria Rizzo
- Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, Second University of Naples, Naples, Italy
| | | | - Andrea P Rossi
- Department of Medicine, Geriatric Division, University of Verona, Verona, Italy
| | - Antonella Zambon
- Department of Statistics and Quantitative Methods, Unit of Biostatistics, Epidemiology and Public Health, University of Milan-Bicocca, Milan, Italy; IRCCS Istituto Auxologico Italiano, Biostatistics Unit, Milan, Italy
| | - Stefano Volpato
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy; Center for Clinical Epidemiology, School of Medicine, University of Ferrara, Ferrara, Italy
| | - Francesco Landi
- Department of Geriatrics, Neurosciences and Orthopaedics, Catholic University of the Sacred Heart, Rome, Italy
| |
Collapse
|
24
|
Is there an association between the plasma levels of uremic toxins from gut microbiota and anemia in patients on hemodialysis? Int Urol Nephrol 2021; 54:1271-1277. [PMID: 34561817 DOI: 10.1007/s11255-021-03001-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 09/19/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Anemia is one of the most frequent complications in patients with chronic kidney disease (CKD). Despite being multifactorial, the relative or absolute deficiency of erythropoietin production is the leading cause. Recent studies have shown that uremic toxins produced by the gut microbiota also may play a role in the genesis of anemia in these patients. OBJECTIVE To evaluate the possible association between uremic toxins plasma levels and anemia in patients with CKD on hemodialysis (HD). METHODS This cross-sectional study evaluated one hundred fifty-four patients (53.2% men, 51.2 ± 11.2 years, hemoglobin (Hb) levels of 11.2 ± 1.6 g/dL). Biochemical variables such as urea, creatinine, hemoglobin, hematocrit, were measured according to standard methods and uremic toxins such as indoxyl sulfate (IS), indole-3-acetic acid (IAA), p-cresyl sulfate (p-CS) plasma levels were measured by reverse-phase high-performance liquid chromatography (RP-HPLC). RESULTS The levels of uremic toxins such as IS, IAA, p-CS were increased in all patients. However, no correlation was found between uremic toxins plasma levels and anemia parameters. Only patients with Hb < 11 g/dL presented a negative correlation between hematocrit and IAA plasma levels. CONCLUSION There is no strong evidence that uremic toxins produced by the gut microbiota may be associated with anemia in patients with CKD on HD.
Collapse
|
25
|
Zhu XW, Zhang CX, Xu TH, Jiang GN, Yao L. Efficacy of roxadustat in treatment of peritoneal dialysis patients with renal anaemia. World J Clin Cases 2021; 9:7682-7692. [PMID: 34621819 PMCID: PMC8462256 DOI: 10.12998/wjcc.v9.i26.7682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/02/2021] [Accepted: 07/27/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND There are no studies on the use of roxadustat in patients on regular peritoneal dialysis in China.
AIM To observe the efficacy and safety of roxadustat in treating renal anaemia in peritoneal dialysis patients.
METHODS Patients with renal anaemia who were regularly followed at the Peritoneal Dialysis Center of the First Affiliated Hospital of China Medical University from November 1, 2019 to June 30, 2020 were selected. A before-and-after self-control design was performed to retrospectively analyse the treatment effects on anaemia in patients treated with recombinant human erythropoietin (EPO) and roxadustat.
RESULTS A total of 31 patients with renal anaemia on long-term peritoneal dialysis treated with roxadustat were included. Haemoglobin (Hb) levels were maintained or increased in all patients (100%), and no patients had a decrease in Hb compared with the previous phase. Patients had a mean Hb of 86.2 ± 14.8 g/L with Hb compliance (Hb ≥ 110 g/L) of 16.1% during the EPO phase and a mean Hb of 112.4 ± 18.5 g/L with Hb compliance of 67.7% during the roxadustat phase. No major adverse cardiovascular events occurred in any patient.
CONCLUSION The application of roxadustat in peritoneal dialysis patients with renal anaemia can effectively improve the Hb compliance rate.
Collapse
Affiliation(s)
- Xin-Wang Zhu
- Department of Nephrology, The First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Cong-Xiao Zhang
- Blood Purification Center, The Fourth People’s Hospital of Shenyang, Shenyang 110031, Liaoning Province, China
| | - Tian-Hua Xu
- Department of Nephrology, The First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Guan-Nan Jiang
- Department of Nephrology, The First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Li Yao
- Department of Nephrology, The First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| |
Collapse
|
26
|
Zheng L, Tian J, Liu D, Zhao Y, Fang X, Zhang Y, Liu Y. Efficacy and safety of roxadustat for anaemia in dialysis-dependent and non-dialysis-dependent chronic kidney disease patients: A systematic review and meta-analysis. Br J Clin Pharmacol 2021; 88:919-932. [PMID: 34428860 DOI: 10.1111/bcp.15055] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 08/08/2021] [Accepted: 08/12/2021] [Indexed: 12/29/2022] Open
Abstract
AIMS Renal anaemia is a common complication of chronic kidney disease (CKD). Roxadustat is the first-in-class oral hypoxia-inducible factor prolyl hydroxylase inhibitor for the treatment of anaemia. In this systematic review, we aimed to investigate the efficacy and safety of roxadustat in the treatment of anaemia in CKD patients. METHODS PubMed, Cochrane Library, Embase, and ClinicalTrials.gov databases were searched from their inception to February 2021 for randomised controlled trials (RCTs) that compared the efficacy and safety of roxadustat to those of an erythropoiesis-stimulating agent (ESA) or a placebo in treating anaemia in CKD patients. RESULTS Nine RCTs involving 2743 patients were found. The meta-analysis showed that roxadustat increased haemoglobin (Hb) level by 0.91 g/dL (95% confidence interval [CI]: 0.47-1.34, P < .05), transferrin level by 0.50 mg/dL (95% CI: 0.34-0.65, P < .05), and total iron-binding capacity by 50.64 μg/dL (95% CI: 36.21-65.07, P < .05) in CKD patients. Decreases in hepcidin (mean difference [MD] = -23.16, 95% CI: -37.12 to -9.19, P < .05) and ferritin (MD = -38.35, 95% CI: -67.41 to -9.29, P < .05) levels were also observed. There was no significant difference in the incidence of adverse events (AEs) (OR: 1.12, 95% CI: 0.95-1.32, P = .17) between the roxadustat and control groups; however, the incidence of serious AEs in the roxadustat group was significantly higher than that in the ESA group (OR: 1.33, 95% CI: 1.06-1.68, P < .05). CONCLUSION Roxadustat can significantly improve renal anaemia in CKD patients by increasing Hb level and iron metabolism. However, attention must be paid to the risk of SAEs during treatment.
Collapse
Affiliation(s)
- Li Zheng
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.,Department of Pharmacy, China Aerospace Science & Industry Corporation 731 Hospital, Beijing, China
| | - Jinhui Tian
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Deping Liu
- Department of Cardiovascular Medicine, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Yan Zhao
- Department of Pharmacy, China Aerospace Science & Industry Corporation 731 Hospital, Beijing, China
| | - Xiaoyong Fang
- Department of Pharmacy, China Aerospace Science & Industry Corporation 731 Hospital, Beijing, China
| | - Yatong Zhang
- Department of Pharmacy, Beijing Hospital, Beijing, China
| | - Yuming Liu
- Department of Endocrinology and Metabolism and Nephropathy, China Aerospace Science & Industry Corporation 731 Hospital, Beijing, China
| |
Collapse
|
27
|
Sultan AA, James G, Wang X, Kuranz S, Hedman K, Houser M, Haque SA, Little D. Incidence of Uncommon Clinical Events in USA Patients with Dialysis-Dependent and Nondialysis-Dependent Chronic Kidney Disease: Analysis of Electronic Health Records from TriNetX. Nephron Clin Pract 2021; 145:462-473. [PMID: 34082426 DOI: 10.1159/000516280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 03/30/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Further understanding of adverse clinical events in patients with chronic kidney disease (CKD) is needed. This study aimed to describe characteristics of patients with nondialysis-dependent (NDD) and dialysis-dependent (DD) CKD and to assess incidence rates of uncommon adverse clinical events of interest in these patients. METHODS This retrospective study used electronic medical record data from USA CKD patients (≥18 years) with estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 between January 1, 2010, and December 31, 2018, obtained from the USA-based TriNetX database. NDD-CKD and DD-CKD were diagnosed and staged from ≥2 consecutive eGFR readings, recorded ≥90 days apart. Dialysis was identified using procedure codes for renal replacement therapy. Outcomes assessed were select uncommon adverse clinical events, defined by International Classification of Disease, 9th and 10th Revision codes. RESULTS Incidence rates of adverse clinical events per 100 person-years (95% confidence interval) were generally higher in patients with DD-CKD versus NDD-CKD. Differences were particularly pronounced for hyperkalemia (26.9 [26.2-27.6] vs. 4.5 [4.5-4.6]), acidosis (15.1 [14.7-15.6] vs. 3.4 [3.4-3.4]), and sepsis (14.6 [14.2-15.1] vs. 3.3 [3.3-3.4]). Among DD-CKD patients, incidence rates of adverse events were particularly high during the first 3 months following dialysis initiation. Incidence of adverse clinical events generally increased with decreasing eGFR among patients with NDD-CKD and with hemoglobin <10 g/dL in both NDD- and DD-CKD patients. CONCLUSIONS Our results help establish baseline rates of uncommon adverse clinical events and provide additional evidence of increased morbidity for patients with DD-CKD versus NDD-CKD.
Collapse
Affiliation(s)
| | | | - Xia Wang
- AstraZeneca, Gaithersburg, Maryland, USA
| | | | | | | | | | | |
Collapse
|
28
|
Luo D, Zhong Z, Qiu Y, Wang Y, Li H, Lin J, Chen W, Yang X, Mao H. Abnormal iron status is associated with an increased risk of mortality in patients on peritoneal dialysis. Nutr Metab Cardiovasc Dis 2021; 31:1148-1155. [PMID: 33618923 DOI: 10.1016/j.numecd.2020.12.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 12/12/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND AIMS Iron deficiency is prevalent, but there is limited data about the relationship between iron status and poor outcomes in chronic kidney disease patients undergoing peritoneal dialysis (PD). We aimed to investigate the association between iron status and mortality in PD patients. METHODS AND RESULTS This retrospective study was conducted on incident PD patients from January 2006 to December 2016 and followed up until December 2018. Patients were categorized into four groups according to baseline serum transferrin saturation (percent) and ferritin levels (ng/ml): reference (20-30%, 100-500 ng/ml), absolute iron deficiency (<20%, <100 ng/ml), function iron deficiency (FID) (<20%, >100 ng/ml), and high iron (>30%, >500 ng/ml). Among the 1173 patients, 77.5% had iron deficiency. During a median follow-up period of 43.7 months, compared with the reference group, the FID group was associated with increased risk for all-cause [adjusted hazard ratio (aHR) 1.87, 95% confidence interval (95% CI) 1.05-3.31, P = 0.032], but not cardiovascular (CV) mortality. Additionally, the high iron group had a more than four-fold increased risk of both all-cause and CV mortality [aHR 4.32 (95% CI 1.90-9.81), P < 0.001; aHR 4.41 (95% CI 1.47-13.27), P = 0.008; respectively]. CONCLUSION FID and high iron predict worse prognosis of patients on PD.
Collapse
Affiliation(s)
- Dan Luo
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China; Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, Guangdong, China
| | - Zhong Zhong
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China; Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, Guangdong, China
| | - Yagui Qiu
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China; Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, Guangdong, China
| | - Yating Wang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China; Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, Guangdong, China
| | - Hongyu Li
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China; Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, Guangdong, China
| | - Jianxiong Lin
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China; Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, Guangdong, China
| | - Wei Chen
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China; Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, Guangdong, China
| | - Xiao Yang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China; Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, Guangdong, China
| | - Haiping Mao
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China; Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, Guangdong, China.
| |
Collapse
|
29
|
Cirillo L, Somma C, Allinovi M, Bagalà A, Ferro G, Di Marcantonio E, Bellelli S, Dallari LA, Ballo P, Dattolo PC. Ferric carboxymaltose vs. ferrous sulfate for the treatment of anemia in advanced chronic kidney disease: an observational retrospective study and cost analysis. Sci Rep 2021; 11:7463. [PMID: 33811227 PMCID: PMC8018957 DOI: 10.1038/s41598-021-86769-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 03/15/2021] [Indexed: 01/02/2023] Open
Abstract
In non-dialysis-dependent chronic kidney disease (NDD-CKD), erythropoiesis-stimulating agents (ESAs) and iron supplementation are essential for anemia management. Ferric carboxymaltose (FCM) is a relatively novel intravenous iron formulation used in different clinical settings, although scarce data exist in NDD-CKD patients. Primary objective of this study was to retrospectively evaluate the efficacy of FCM compared with oral ferrous sulfate for the treatment of iron-deficiency anemia in a cohort of NDD-CKD patients, considering also the treatment costs. This was a monocentric, retrospective observational study reviewing 349 NDD-CKD patients attending an outpatient clinic between June 2013 and December 2016. Patients were treated by either FCM intravenous infusion or oral ferrous sulfate. We collected serum values of hemoglobin, ferritin and transferrin saturation (TSAT) and ESAs doses at 12 and 18 months. The costs related to both treatments were also analysed. 239 patients were treated with FCM intravenous infusion and 110 patients with oral ferrous sulfate. The two groups were not statistically different for age, BMI and eGFR values. At 18 months, hemoglobin, serum ferritin and TSAT values increased significantly from baseline in the FCM group, compared with the ferrous sulfate group. ESAs dose and rate of infusion decreased only in the FCM group. At 18 months, the treatment costs, analysed per week, was higher in the ferrous sulfate group, compared with the FCM group, and this was mostly due to a reduction in ESAs prescription in the FCM group. Routine intravenous FCM treatment in an outpatient clinic of NDD-CKD patients results in better correction of iron-deficiency anemia when compared to ferrous sulfate. In addition to this, treating NDD-CKD patients with FCM leads to a significant reduction of the treatment costs by reducing ESAs use.
Collapse
Affiliation(s)
- Luigi Cirillo
- Nephrology and Dialysis Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | - Chiara Somma
- Nephrology and Dialysis Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | - Marco Allinovi
- Nephrology, Dialysis and Transplant Unit, Careggi University Hospital, Florence, Italy
| | - Alfredo Bagalà
- Nephrology and Dialysis Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | - Giuseppe Ferro
- Nephrology and Dialysis Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | - Elio Di Marcantonio
- Nephrology and Dialysis Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | - Stefania Bellelli
- Health Technology Assessment and Management (HTAM) Research Area, IRES Piemonte, Torino, Italy
| | - Lorenzo Antonio Dallari
- Nephrology and Dialysis Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | - Piercarlo Ballo
- Cardiology Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | - Pietro Claudio Dattolo
- Nephrology and Dialysis Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy.
| |
Collapse
|
30
|
Ali I, Chinnadurai R, Ibrahim ST, Kalra PA. Adverse outcomes associated with rapid linear and non-linear patterns of chronic kidney disease progression. BMC Nephrol 2021; 22:82. [PMID: 33676423 PMCID: PMC7937251 DOI: 10.1186/s12882-021-02282-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 02/25/2021] [Indexed: 12/13/2022] Open
Abstract
Background Patients with rapidly declining renal function face the dual threat of end-stage renal disease (ESRD) and mortality prior to ESRD. What is less well characterised is whether the pattern of the renal trajectory, linear or non-linear, unmasks subgroups of rapidly progressing patients that face adverse outcomes in a differential manner. Methods An individual eGFR slope was applied to all outpatient estimated glomerular filtration rate (eGFR) values for each patient in the Salford Kidney Study from 2002 to 2018 who had at least 2 years follow-up, ≥4 eGFR values and baseline eGFR 15 to < 60 ml/min/1.73m2. Rapid progression was defined as an annual eGFR slope of ≤ − 3 ml/min/1.73m2/yr and patients were categorised as linear or non-linear progressors based on the nature of their eGFR-time graphs. A Fine-Gray competing risk hazard model was used to determine factors associated with progression to ESRD and with mortality prior to ESRD. Cumulative incidence function curves highlighted differences in outcomes between linear and non-linear patients. Results There were 211 rapidly deteriorating patients with linear eGFR trajectories and 61 rapid non-linear patients in the study cohort. Factors associated with ESRD included younger age, male gender, lower baseline eGFR and higher serum phosphate, whilst older age, history of myocardial infarction and anaemia predicted mortality prior to ESRD. Over a median follow-up of 3.7 years, linear progressors reached ESRD sooner whilst those with non-linear progression faced significantly higher rates of mortality prior to ESRD. Conclusions Patients with rapid eGFR decline have high rates of adverse outcomes that are differentially expressed in those progressing linearly and non-linearly as a result of differing phenotypic profiles. Consequently, addressing individual risk factor profiles is important to deliver optimal personalised patient care. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-021-02282-5.
Collapse
Affiliation(s)
- Ibrahim Ali
- Department of Renal Medicine, Salford Royal NHS Foundation Trust, Stott Lane, Salford, M6 8HD, UK. .,Division of Cardiovascular Sciences, University of Manchester, Manchester, M13 9PL, UK.
| | - Rajkumar Chinnadurai
- Department of Renal Medicine, Salford Royal NHS Foundation Trust, Stott Lane, Salford, M6 8HD, UK
| | - Sara T Ibrahim
- Department of Internal Medicine and Nephrology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Philip A Kalra
- Department of Renal Medicine, Salford Royal NHS Foundation Trust, Stott Lane, Salford, M6 8HD, UK.,Division of Cardiovascular Sciences, University of Manchester, Manchester, M13 9PL, UK
| |
Collapse
|
31
|
Fishbane S, El-Shahawy MA, Pecoits-Filho R, Van BP, Houser MT, Frison L, Little DJ, Guzman NJ, Pergola PE. Roxadustat for Treating Anemia in Patients with CKD Not on Dialysis: Results from a Randomized Phase 3 Study. J Am Soc Nephrol 2021; 32:737-755. [PMID: 33568383 PMCID: PMC7920165 DOI: 10.1681/asn.2020081150] [Citation(s) in RCA: 102] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 12/01/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Current anemia therapies for patients with non-dialysis-dependent CKD may require injection and medical visits. Roxadustat, an oral hypoxia-inducible factor prolyl hydroxylase inhibitor, stimulates erythropoiesis and improves iron homeostasis. METHODS In this double-blind phase 3 study, we randomized patients with non-dialysis-dependent CKD stages 3-5 and hemoglobin <10.0 g/dl (1:1) to thrice-weekly 70-mg oral roxadustat or placebo. Doses were titrated throughout the study based on hemoglobin levels. The primary efficacy end point was mean change from baseline in hemoglobin averaged over weeks 28-52 versus placebo, irrespective of rescue therapy use. We assessed patients for adverse events. RESULTS The study included 2781 patients, 1393 who received roxadustat and 1388 who received placebo. Mean baseline hemoglobin was 9.1 g/dl for both groups. The mean change in hemoglobin from baseline was 1.75 g/dl (95% confidence interval [95% CI], 1.68 to 1.81) with roxadustat versus 0.40 g/dl (95% CI, 0.33 to 0.47) with placebo, (P<0.001). Among 411 patients with baseline elevated high-sensitivity C-reactive protein, mean change in hemoglobin from baseline was 1.75 g/dl (95% CI, 1.58 to 1.92) with roxadustat versus 0.62 g/dl (95% CI, 0.44 to 0.80) with placebo, (P<0.001). Roxadustat reduced the risk of red blood cell transfusion by 63% (hazard ratio, 0.37; 95% CI, 0.30 to 0.44). The most common adverse events with roxadustat and placebo, respectively, were ESKD (21.0% versus 20.5%), urinary tract infection (12.8% versus 8.0%), pneumonia (11.9% versus 9.4%), and hypertension (11.5% versus 9.1%). CONCLUSIONS Roxadustat effectively increased hemoglobin in patients with non-dialysis-dependent CKD and reduced the need for red blood cell transfusion, with an adverse event profile comparable to that of placebo. CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER Safety and Efficacy Study of Roxadustat to Treat Anemia in Patients With CKD, Not on Dialysis, NCT02174627.
Collapse
Affiliation(s)
- Steven Fishbane
- Department of Medicine, Zucker School of Medicine at Hofstra/Northwell Health, Great Neck, New York
| | - Mohamed A. El-Shahawy
- Department of Medicine, Keck-University of Southern California School of Medicine, Los Angeles, California
| | - Roberto Pecoits-Filho
- School of Medicine, Pontifical Catholic University of Parana, Curitiba, Brazil,Arbor Research Collaborative for Health, Ann Arbor, Michigan
| | - Bui Pham Van
- Department of Medicine, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Mark T. Houser
- Global Medicines Development, Biopharmaceuticals Research & Development, AstraZeneca Gaithersburg, Gaithersburg, Maryland
| | - Lars Frison
- Biostatistics, Biopharmaceuticals Research & Development, AstraZeneca Gothenburg, Mölndal, Sweden
| | - Dustin J. Little
- Global Medicines Development, Biopharmaceuticals Research & Development, AstraZeneca Gaithersburg, Gaithersburg, Maryland
| | - Nicolas J. Guzman
- Global Medicines Development, Biopharmaceuticals Research & Development, AstraZeneca Gaithersburg, Gaithersburg, Maryland
| | | |
Collapse
|
32
|
Hao CM, Wittbrodt ET, Palaka E, Guzman N, Dunn A, Grandy S. Understanding Patient Perspectives and Awareness of the Impact and Treatment of Anemia with Chronic Kidney Disease: A Patient Survey in China. Int J Nephrol Renovasc Dis 2021; 14:53-64. [PMID: 33654421 PMCID: PMC7910152 DOI: 10.2147/ijnrd.s291393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 01/20/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Anemia is a common complication of chronic kidney disease (CKD) that may reduce patients' health-related quality of life (HRQoL). This study explored the experience and knowledge of patients with CKD, with and without anemia, in China. METHODS A quantitative online survey was administered to 500 consenting Chinese patient volunteers aged ≥18 years with self-reported CKD, with or without anemia, between August 29, and September 17, 2018. Patients with cancer were excluded. The 27-question survey explored knowledge of anemia, HRQoL, anemia management, and interactions with healthcare providers. RESULTS Of 456 evaluable patients, 148 (32.5%) reported having anemia and 262 (57.5%) did not. Knowledge of anemia and its symptoms varied, and approximately half of all patients did not know their hemoglobin level. Patients with anemia expressed an adverse impact of anemia on HRQoL, most commonly lack of energy (65.5%), sadness/depression (54.1%), and feeling ill (50.0%). The most frequently reported treatments among these patients were dietary advice (68.9%), iron supplements (63.5%), and oral medications (53.4%). Although 89.2% of patients with anemia trusted their healthcare providers above other information sources, only 29.0% reported seeking information from them; this was despite 92.6% reporting wanting further information and support about managing conditions like anemia. CONCLUSION Our findings suggest that patients with CKD, both with and without anemia, would benefit from increased awareness of anemia and more in-depth discussions with healthcare providers in order to facilitate better management of CKD and optimization of treatment plans.
Collapse
Affiliation(s)
- Chuan-Ming Hao
- Fudan University, Huashan Hospital, Shanghai, People’s Republic of China
| | - Eric T Wittbrodt
- Biopharmaceuticals Medical Unit, AstraZeneca, Gaithersburg, MD, USA
| | - Eirini Palaka
- Biopharmaceuticals Global Market Access, AstraZeneca, Cambridge, UK
| | - Nicolas Guzman
- Global Medicines Development, AstraZeneca, Gaithersburg, MD, USA
| | - Alicia Dunn
- AstraZeneca Global Corporate Affairs Gaithersburg, Gaithersburg, MD, USA
| | - Susan Grandy
- Biopharmaceuticals Global Market Access, AstraZeneca, Gaithersburg, MD, USA
| |
Collapse
|
33
|
ESA, Iron Therapy and New Drugs: Are There New Perspectives in the Treatment of Anaemia? J Clin Med 2021; 10:jcm10040839. [PMID: 33670704 PMCID: PMC7922992 DOI: 10.3390/jcm10040839] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 02/11/2021] [Accepted: 02/12/2021] [Indexed: 02/07/2023] Open
Abstract
Anemia is a well-known consequence of chronic kidney disease (CKD); it is mainly due to a relative insufficiency of erythropoietin synthesis by the failing kidneys. Over the years, the combination of erythropoiesis stimulating agents (ESA) and iron has become the standard of care of anemia. All ESAs effectively increase hemoglobin (Hb) levels in a substantial percentage of patients. However, in the last decade, their use has been surrounded by safety issues in increased cardiovascular risk, especially when used at high doses in inflamed and hyporesponsive patients. This has led to the definition of a more cautious Hb target. Iron deficiency is very frequent in CKD patients, with a higher frequency in non-dialysis patients. Traditionally, iron supplementation is mostly used as supportive therapy for anemia control. However, the concept is growing that intravenous iron therapy per se could be beneficial in the presence of heart failure. A new class of drugs, prolyl hydroxylase domain (PHD) inhibitors (PHD inhibitors) is becoming available for the treatment of anemia in CKD patients. Theoretically, these agents have a number of advantages, the main ones being that of stimulating the synthesis of endogenous erythropoietin and increasing iron availability. The impact of their future use in clinical practice is still to be defined. Another possible strategy could be targeting serum hepcidin and its related pathways. This possibility is fascinating from the scientific point of view, but at present its development phase is still far from clinical application.
Collapse
|
34
|
Maruyama Y, Kanda E, Kikuchi K, Abe M, Masakane I, Yokoo T, Nitta K. Association between anemia and mortality in hemodialysis patients is modified by the presence of diabetes. J Nephrol 2021; 34:781-790. [PMID: 33555578 DOI: 10.1007/s40620-020-00879-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 03/20/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND The prevalence and severity of anemia differ between diabetic and non-diabetic patients. We investigated whether the effect of hemoglobin (Hb) on patient outcome was affected by the presence or absence of diabetes among Japanese patients receiving chronic hemodialysis (HD). METHODS We enrolled 149,308 patients from a nationwide dialysis registry in Japan at the end of 2012 (mean age, 67.6 ± 12.3 years; male, 61.7%; diabetes, 43.5%; median dialysis duration, 65 months) who underwent three HD sessions weekly. One-year all-cause and cardiovascular (CV) mortality were assessed using Cox regression analysis and competing-risks regression analysis. We used multiple imputation to deal with missing covariate data. RESULTS Baseline Hb and serum ferritin levels were independently associated with all-cause and CV mortality. In non-diabetic patients, a significantly higher risk for all-cause mortality compared to the reference group (10 to 11 g/dL) was observed in patients with Hb < 8 g/dL (hazard ratio (HR): 1.266; 95% confidence interval (CI) 1.097-1.460) and 8 to 9 g/dL(HR: 1.153; 95% CI 1.030-1.290). On the other hand, diabetic HD patients in the same Hb category group did not have increased risk of all-cause mortality. CONCLUSIONS We found that non-diabetic HD patients had an increased risk of all-cause mortality if they had lower Hb levels, whereas the effect of Hb levels on mortality was attenuated in diabetic HD patients. These data suggest that the association between Hb levels and mortality rate could be different between diabetic and non-diabetic HD patients.
Collapse
Affiliation(s)
- Yukio Maruyama
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi Minato-ku, Tokyo, 1058461, Japan. .,Committee of Renal Data Registry, Japanese Society for Dialysis Therapy, Tokyo, Japan.
| | - Eiichiro Kanda
- Committee of Renal Data Registry, Japanese Society for Dialysis Therapy, Tokyo, Japan.,Medical Science, Kawasaki Medical School, Okayama, Japan
| | - Kan Kikuchi
- Committee of Renal Data Registry, Japanese Society for Dialysis Therapy, Tokyo, Japan.,Shimoochiai Clinic, Tokyo, Japan
| | - Masanori Abe
- Committee of Renal Data Registry, Japanese Society for Dialysis Therapy, Tokyo, Japan.,Division of Nephrology, Hypertension and Endocrinology, Department of Internal Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Ikuto Masakane
- Committee of Renal Data Registry, Japanese Society for Dialysis Therapy, Tokyo, Japan.,Department Nephrology, Honcho Yabuki Clinic, Yamagata, Japan
| | - Takashi Yokoo
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi Minato-ku, Tokyo, 1058461, Japan
| | - Kosaku Nitta
- Committee of Renal Data Registry, Japanese Society for Dialysis Therapy, Tokyo, Japan.,Fourth Department of Internal Medicine, Tokyo Women's Medical University, Tokyo, Japan
| |
Collapse
|
35
|
Hanna RM, Streja E, Kalantar-Zadeh K. Burden of Anemia in Chronic Kidney Disease: Beyond Erythropoietin. Adv Ther 2021; 38:52-75. [PMID: 33123967 PMCID: PMC7854472 DOI: 10.1007/s12325-020-01524-6] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 10/03/2020] [Indexed: 02/08/2023]
Abstract
Anemia is a frequent comorbidity of chronic kidney disease (CKD) and is associated with a considerable burden because of decreased patient health-related quality of life and increased healthcare resource utilization. Based on observational data, anemia is associated with an increased risk of CKD progression, cardiovascular events, and all-cause mortality. The current standard of care includes oral or intravenous iron supplementation, erythropoiesis-stimulating agents, and red blood cell transfusion. However, each of these therapies has its own set of population-specific patient concerns, including increased risk of cardiovascular disease, thrombosis, and mortality. Patients receiving dialysis or those who have concurrent diabetes or high blood pressure may be at greater risk of developing these complications. In particular, treatment with high doses of erythropoiesis-stimulating agents has been associated with increased rates of hospitalization, cardiovascular events, and mortality. Resistance to erythropoiesis-stimulating agents remains a therapeutic challenge in a subset of patients. Hypoxia-inducible factor transcription factors, which regulate several genes involved in erythropoiesis and iron metabolism, can be stabilized by a new class of drugs that act as inhibitors of hypoxia-inducible factor prolyl-hydroxylase enzymes to promote erythropoiesis and elevate hemoglobin levels. Here, we review the burden of anemia of chronic kidney disease, the shortcomings of current standard of care, and the potential practical advantages of hypoxia-inducible factor prolyl-hydroxylase inhibitors in the treatment of patients with anemia of CKD.
Collapse
Affiliation(s)
- Ramy M Hanna
- Division of Nephrology, Hypertension and Kidney Transplantation, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California, Irvine School of Medicine, Orange, CA, USA
| | - Elani Streja
- Division of Nephrology and Hypertension, University of California, Irvine School of Medicine, Orange, CA, USA
| | - Kamyar Kalantar-Zadeh
- Division of Nephrology and Hypertension, University of California, Irvine School of Medicine, Orange, CA, USA.
| |
Collapse
|
36
|
Zheng Q, Yang H, Fu X, Huang Y, Wei R, Wang Y, Liu YN, Liu WJ. The efficacy and safety of roxadustat for anemia in patients with chronic kidney disease: a meta-analysis. Nephrol Dial Transplant 2020; 36:1603-1615. [PMID: 33051677 DOI: 10.1093/ndt/gfaa110] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is an increasing public health issue. Anemia, which is a complication of CKD, is associated with reduced quality of life and increased morbidity and mortality. Currently quite a few clinical studies have been conducted to compare roxadustat with epoetin alfa [all for dialysis-dependent (DD) patients] or placebo [all for nondialysis-dependent (NDD) patients]. Our meta-analysis aimed to investigate the efficacy and safety of roxadustat for anemia in patients with CKD. METHODS We thoroughly searched eight electronic resource databases for randomized controlled trials (RCTs) comparing the efficacy and safety between roxadustat versus epoetin alfa or placebo for the treatment of anemia in patients with CKD. RESULTS Four Phase 2 and two Phase 3 studies with 1010 participants were included. Hemoglobin (Hb) and transferrin levels were increased significantly in the roxadustat group versus those in the placebo {standard mean difference [SMD] 1.57 [95% confidence interval (CI) 1.17-1.98]; SMD 1.81 [95% CI 1.53-2.08]; respectively, both low-quality evidence} or epoetin alfa group [SMD 0.47 (95% CI 0.02-0.93), very low-quality evidence; SMD 1.05 (95% CI 0.81-1.29), low-quality evidence; respectively]. Hepcidin levels were reduced significantly in the roxadustat group versus those in the placebo [SMD -1.72 (95% CI -3.03 to -0.41), very low-quality evidence] or epoetin alfa group [SMD -0.23 (95% CI -0.43 to -0.02), low-quality evidence]. Ferritin and serum transferrin saturation (TSAT) levels were reduced significantly in the roxadustat group versus those in the placebo group [SMD -0.82 (95% CI -1.31 to -0.33); SMD -0.54 (95% CI -0.76 to -0.32), respectively; both low-quality evidence] and ferritin and TSAT levels in the roxadustat group were comparable to those in the epoetin alfa group [SMD 0.02 (95% CI -0.18-0.21); SMD 0.15 (95% CI -0.04-0.35), respectively, both low-quality evidence]. As for safety, the incidence of adverse events (AEs) in the roxadustat group was insignificantly different from that of the placebo group [risk ratio (RR) 0.99 (95% CI 0.83-1.18); P = 0.89, very low-quality evidence]. But the incidence of AEs in the roxadustat group was significantly higher than that in the epoetin alfa group [RR 1.25 (95% CI 1.01-1.54); P = 0.04, low-quality evidence]. There was no significant association between roxadustat and the incidence of serious AEs (SAEs) for both NDD and DD patients [RR 1.08 (95% CI 0.51-2.28) and RR 1.43 (95% CI 0.85-2.40), respectively, both very low-quality evidence]. CONCLUSION In this meta-analysis of RCTs, we found evidence that after the oral administration of roxadustat, NDD patients' Hb levels were increased effectively and DD patients' Hb levels were maintained effectively. The risk of SAEs was not observed with the short-term use of roxadustat. These findings support roxadustat for the treatment of anemia in patients with CKD.
Collapse
Affiliation(s)
- Qiyan Zheng
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China.,Renal Research Institution of Beijing University of Chinese Medicine, Beijing, China.,Department of Endocrinology, Nephropathy of Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Huisheng Yang
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xinwen Fu
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China.,Renal Research Institution of Beijing University of Chinese Medicine, Beijing, China.,Department of Endocrinology, Nephropathy of Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Yishan Huang
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China.,Renal Research Institution of Beijing University of Chinese Medicine, Beijing, China.,Department of Endocrinology, Nephropathy of Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Ruojun Wei
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China.,Renal Research Institution of Beijing University of Chinese Medicine, Beijing, China
| | - Yahui Wang
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China.,Renal Research Institution of Beijing University of Chinese Medicine, Beijing, China.,Department of Endocrinology, Nephropathy of Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Yu Ning Liu
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China.,Renal Research Institution of Beijing University of Chinese Medicine, Beijing, China.,Department of Endocrinology, Nephropathy of Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Wei Jing Liu
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China.,Department of Endocrinology, Nephropathy of Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China.,Zhanjiang Key Laboratory of Prevention and Management of Chronic Kidney Disease, Guangdong Medical University, Zhanjiang, China
| |
Collapse
|
37
|
Pattharanitima P, Chauhan K, Shamy OE, Chaudhary K, Sharma SR, Coca SG, Nadkarni GN, Uribarri J, Chan L. The association of standard Kt/V and surface area-normalized standard Kt/V with clinical outcomes in hemodialysis patients. Hemodial Int 2020; 24:495-505. [PMID: 32809268 PMCID: PMC8006157 DOI: 10.1111/hdi.12865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 06/19/2020] [Accepted: 07/18/2020] [Indexed: 01/22/2023]
Abstract
INTRODUCTION A previous study demonstrated that the surface area-normalized standard Kt/V (SAstdKt/V) was better associated with mortality than standard Kt/V (stdKt/V). This study investigates the association of SAstdKt/V and stdKt/V with mortality, anemia, and hypoalbuminemia in a larger patient cohort with a longer follow-up period. METHODS We included adult patients on thrice-weekly hemodialysis in the USRDS database and excluded amputated patients. StdKt/V and SAstdKt/V were calculated from the available single-pool Kt/V. Patients were categorized into five groups according to their stdKt/V and SAstdKt/V: <2.00, 2.00-2.19, 2.20-2.39, 2.40-2.59, and ≥2.60. Hazard ratios (HR) and odds ratios (OR) were calculated using Cox and logistic regression analysis respectively. FINDINGS There were 507,656 patients included in the analysis. The patients had a median age of 65.5 years with a median follow-up period of 2 years. Thirty-four percent died during follow-up. HRs for mortality progressively decreased as SAstdKt/V increased in both unadjusted and adjusted models. Unlike SAstdKt/V, HRs were the lowest in the categories with stdKt/V of 2.40-2.59 and they increased in the higher stdKt/V category. The adjusted HR for SAstdKt/V vs. stdKt/V were 0.68 vs. 0.62 in the category of 2.40-2.59, and 0.63 vs. 0.73 in the category of ≥2.60. The adjusted ORs for anemia progressively decreased as SAstdKt/V increased, whereas ORs decreased to the lowest in stdKt/V category 2.40-2.59 and increased in the ≥2.60 category. The adjusted ORs for hypoalbuminemia progressively decreased as SAstdKt/V and stdKt/V increased which were both 0.45 in 2.40-2.59 category and decreased to 0.29 and 0.42 in the ≥2.60 category. DISCUSSION SAstdKt/V is better associated with mortality, anemia, and hypoalbuminemia than stdKt/V. SAstdKt/V is a better parameter in defining hemodialysis dosing which can be calculated by an available online tool. Further studies to determine the optimal SAstdKt/V dose required to achieve improved clinical outcomes with better cost-effectiveness are needed.
Collapse
Affiliation(s)
- Pattharawin Pattharanitima
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, NY
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Kinsuk Chauhan
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, NY
| | - Osama El Shamy
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, NY
| | - Kumardeep Chaudhary
- Institute for Personalized Medicine, Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, NY
| | - Shuchita R. Sharma
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, NY
| | - Steven G. Coca
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, NY
| | - Girish N. Nadkarni
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, NY
- Institute for Personalized Medicine, Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, NY
| | - Jaime Uribarri
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, NY
| | - Lili Chan
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, NY
| |
Collapse
|
38
|
Sturgill DA, Bal N, Nagavally S, Wolfgram DF. The Relationship between Dialysis Metrics and Patient-Reported Cognition, Fatigue, and Physical Function. KIDNEY DISEASES 2020; 6:364-370. [PMID: 33490116 DOI: 10.1159/000508919] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 05/25/2020] [Indexed: 12/11/2022]
Abstract
Introduction The impact of achieving hemodialysis laboratory and hemodynamic quality metrics on patient-reported outcomes (PROs) is unknown. Objective To determine if meeting dialysis laboratory quality of care measures is associated with improved PROs. Methods In this cross-sectional study, we measured the relationship between dialysis patients' Patient Reported Outcome Measurement Information System (PROMIS) scores and commonly used dialysis quality of care measures. Results PROMIS surveys were administered to 92 dialysis patients. The mean ± SD scores demonstrated higher fatigue (55.0 ± 9.8) and lower physical function (37.9 ± 7.9) but similar cognition (50.3 ± 10.9) compared to general population normative scores of 50 ± 10. Dialysis patients meeting Kt/V goals had no better scores than those who did not. Meeting the hemoglobin (Hgb) value of ≥10 g/dL was associated with a lower fatigue score, but no difference in cognitive or physical function scores. Meeting the serum albumin goal of ≥4.0 mg/dL was associated with a higher physical function score but made no difference for cognitive function or fatigue score. As a continuous variable, a higher Hgb was associated with lower reported fatigue (HR -1.74 95%, CI [-3.09, -0.39]), but no other measures were associated with PRO scores when adjusted for demographics and comorbidities. Conclusions We found little association between measures currently used to assess the quality of dialysis care and PROs. Encouraging improved utilization of PROs and incorporating PROs into quality measurements might give a more robust assessment of quality of care. Future studies should assess the benefits of this approach.
Collapse
Affiliation(s)
- Daniel A Sturgill
- Division of Nephrology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Naveet Bal
- Division of Nephrology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Sneha Nagavally
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Dawn F Wolfgram
- Division of Nephrology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| |
Collapse
|
39
|
Hu Z, Tao H, Shi A, Pan J. The efficacy and economic evaluation of roxadustat treatment for anemia in patients with kidney disease not receiving dialysis. Expert Rev Pharmacoecon Outcomes Res 2020; 20:411-418. [PMID: 32249625 DOI: 10.1080/14737167.2020.1747436] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND This study aimed to assess the efficacy, tolerance, and cost-effectiveness of roxadustat treatment for anemia in patients with chronic kidney disease not receiving dialysis (CKD ND). METHODS A meta-analysis was conducted to evaluate the clinical efficacy and tolerance of roxadustat for the correction of anemia associated with CKD ND, and a Markov model was developed to evaluate the cost-effectiveness of roxadustat compared with a placebo. RESULTS The meta-analysis results showed that compared with a placebo, roxadustat treatment was associated with a remarkably higher rate of clinical response and the differences in the rate of adverse events between these two regimens were not significant. Moreover, roxadustat treatment (70 mg, three times per week) provided an additional 0.49 QALYs at a cost of $12,526 in the time horizon of 5 years, resulting in an ICER of $25,563 per QALY, with approximately 60% probability to be cost-effective at a $29,295 per QALY willingness-to-pay (WTP) threshold from the perspective of Chinese medical system. CONCLUSION For the treatment of anemia in Chinese patients with CKD ND, roxadustat is much more effective than a placebo; moreover, it is cost-effective at conventional WTP thresholds.
Collapse
Affiliation(s)
- Zhanhong Hu
- Department of Pharmacy, The Second Affiliated Hospital of Soochow University , Suzhou, Jiangsu, China
| | - Hong Tao
- Department of Pharmacy, The Second Affiliated Hospital of Soochow University , Suzhou, Jiangsu, China
| | - Aiming Shi
- Department of Pharmacy, The Second Affiliated Hospital of Soochow University , Suzhou, Jiangsu, China
| | - Jie Pan
- Department of Pharmacy, The Second Affiliated Hospital of Soochow University , Suzhou, Jiangsu, China
| |
Collapse
|
40
|
Del Vecchio L. Anaemia epidemiology in the era of "big data". Are we aware that the revolution is already going on? J Nephrol 2020; 33:5-7. [PMID: 31912437 DOI: 10.1007/s40620-020-00699-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 12/17/2019] [Indexed: 12/19/2022]
|