Impact of higher hemoglobin targets on blood pressure and clinical outcomes: a secondary analysis of CHOIR.

Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association
Jula K InrigLynda Szczech

Abstract

Targeting a higher hemoglobin in patients with chronic kidney disease leads to adverse cardiovascular outcomes, yet the reasons remain unclear. Herein, we sought to determine whether changes in erythropoiesis-stimulating agent (ESA) dose and in hemoglobin were predictive of changes in blood pressure (BP) and whether these changes were associated with cardiovascular outcomes. In this secondary analysis of 1421 Correction of Hemoglobin and Outcomes in Renal Disease (CHOIR) participants, mixed model analyses were used to describe monthly changes in ESA dose and hemoglobin with changes in diastolic BP (DBP) and systolic BP (SBP). Poisson modeling was performed to determine whether changes in hemoglobin and BP were associated with the composite end point of death or cardiovascular outcomes. Monthly average DBP, but not SBP, was higher in participants in the higher hemoglobin arm. Increases in ESA doses and in hemoglobin were significantly associated with linear increases in DBP, but not consistently with increases in SBP. In models adjusted for demographics and comorbid conditions, increases in ESA dose (>0 U) and larger increases in hemoglobin (>1.0 g/dL/month) were associated with poorer outcomes [event rate ratio per 1000 U weekl...Continue Reading

References

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Citations

Feb 27, 2013·Nature Reviews. Nephrology·Walter H Hörl
Nov 25, 2014·Seminars in Nephrology·Suzanne M Boyle, Jeffrey S Berns
Oct 25, 2016·American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation·Jiacong LuoSteven M Brunelli
Dec 9, 2014·The Cochrane Database of Systematic Reviews·Suetonia C PalmerGiovanni F M Strippoli
Jul 28, 2020·Pharmacology Research & Perspectives·Francisca Johanna van den OeverYvonne C Schrama

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