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
|
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
|
3
|
Roy M, Saroha S, Sarma U, Sarathy H, Kumar R. Quantitative systems pharmacology model of erythropoiesis to simulate therapies targeting anemia due to chronic kidney disease. Front Pharmacol 2023; 14:1274490. [PMID: 38125882 PMCID: PMC10731587 DOI: 10.3389/fphar.2023.1274490] [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: 08/12/2023] [Accepted: 10/19/2023] [Indexed: 12/23/2023] Open
Abstract
Anemia induced by chronic kidney disease (CKD) has multiple underlying mechanistic causes and generally worsens as CKD progresses. Erythropoietin (EPO) is a key endogenous protein which increases the number of erythrocyte progenitors that mature into red blood cells that carry hemoglobin (Hb). Recombinant human erythropoietin (rHuEPO) in its native and re-engineered forms is used as a therapeutic to alleviate CKD-induced anemia by stimulating erythropoiesis. However, due to safety risks associated with erythropoiesis-stimulating agents (ESAs), a new class of drugs, prolyl hydroxylase inhibitors (PHIs), has been developed. Instead of administering exogenous EPO, PHIs facilitate the accumulation of HIF-α, which results in the increased production of endogenous EPO. Clinical trials for ESAs and PHIs generally involve balancing decisions related to safety and efficacy by carefully evaluating the criteria for patient selection and adaptive trial design. To enable such decisions, we developed a quantitative systems pharmacology (QSP) model of erythropoiesis which captures key aspects of physiology and its disruption in CKD. Furthermore, CKD virtual populations of varying severities were developed, calibrated, and validated against public data. Such a model can be used to simulate alternative trial protocols while designing phase 3 clinical trials, as well as an asset for reverse translation in understanding emerging clinical data.
Collapse
Affiliation(s)
| | | | | | - Harini Sarathy
- Division of Nephrology, University of California San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States
| | | |
Collapse
|