Skip to main content
Erschienen in: Clinical and Experimental Nephrology 10/2019

24.07.2019 | Original article

Treatment for renal anemia and outcomes in non-dialysis patients with chronic kidney disease: the current status of regional medicine according to the Kyoto Fushimi Renal Anemia (KFRA) study

verfasst von: Kensei Yahata, Koichi Seta, Yuko Kikuchi, Mitsuteru Koizumi, Maki Murata, Hiromichi Wada, Shogo Murakami, Mariko Ohishi, Hikari Tsuji, the Kyoto Fushimi Renal Anemia study investigators

Erschienen in: Clinical and Experimental Nephrology | Ausgabe 10/2019

Einloggen, um Zugang zu erhalten

Abstract

Background

The baseline data obtained in the CKD-JAC demonstrated that insufficient treatment was being provided for renal anemia by institutions specializing in renal disease. The objective of this study was to investigate the status of treatment for renal anemia, including renal/cardiovascular outcomes and mortality, at regional medical facilities since the development of long-acting erythropoiesis-stimulating agents (LA-ESA).

Methods

Non-dialysis outpatients with chronic kidney disease and renal anemia were eligible. Anemia was treated based on the clinical condition of each patient and targeted hemoglobin (Hb) levels.

Results

A total of 283 patients from 21 institutions were enrolled and followed up for a maximum of 3 years. A doubling of the serum creatinine level was observed in 89 patients, and renal replacement therapy was initiated in 57 patients. Multivariate Cox regression analysis revealed that a lower mean Hb level (mHb) and receiving fewer frequency of ESA during the follow-up period were independent determinants of the composite renal outcome and overall mortality. During the follow-up period, the percentages of patients with mHb of 10–10.9 g/dL and ≥ 11 g/dL were increased. Similar trends were seen regardless of whether the patients were treated by nephrologists or non-nephrologists. The frequency of ESA treatment was increased among the patients treated by non-nephrologists; however, it was much lower than nephrologists.

Conclusion

This study demonstrated that, in the era of LA-ESA treatment, higher Hb levels are associated with reduced composite renal outcomes at regional medical facilities. The importance of renal anemia management should be highlighted, even among non-nephrologists.
Anhänge
Nur mit Berechtigung zugänglich
Literatur
1.
Zurück zum Zitat Kazmi WH, Kausz AT, Khan S, et al. Anemia: an early complication of chronic renal insufficiency. Am J Kidney Dis. 2001;38:803–12.CrossRefPubMed Kazmi WH, Kausz AT, Khan S, et al. Anemia: an early complication of chronic renal insufficiency. Am J Kidney Dis. 2001;38:803–12.CrossRefPubMed
2.
Zurück zum Zitat Gouva C, Nikolopoulos P, Ioannidis JP, et al. Treating anemia early in renal failure patients slows the decline of renal function: a randomized controlled trial. Kidney Int. 2004;66:753–60.CrossRefPubMed Gouva C, Nikolopoulos P, Ioannidis JP, et al. Treating anemia early in renal failure patients slows the decline of renal function: a randomized controlled trial. Kidney Int. 2004;66:753–60.CrossRefPubMed
3.
Zurück zum Zitat Kuriyama S, Tomonari H, Yoshida H, et al. Reversal of anemia by erythropoietin therapy retards the progression of chronic renal failure, especially in nondiabetic patients. Nephron. 1997;77:176–85.CrossRefPubMed Kuriyama S, Tomonari H, Yoshida H, et al. Reversal of anemia by erythropoietin therapy retards the progression of chronic renal failure, especially in nondiabetic patients. Nephron. 1997;77:176–85.CrossRefPubMed
4.
Zurück zum Zitat Silverberg DS, Wexler D, Blum M, et al. Aggressive therapy of congestive heart failure and associated chronic renal failure with medications and correction of anemia stops or slows the progression of both diseases. Perit Dial Int. 2001;21(Suppl 3):S236–S240.PubMed Silverberg DS, Wexler D, Blum M, et al. Aggressive therapy of congestive heart failure and associated chronic renal failure with medications and correction of anemia stops or slows the progression of both diseases. Perit Dial Int. 2001;21(Suppl 3):S236–S240.PubMed
5.
Zurück zum Zitat Hayashi T, Suzuki A, Shoji T, et al. Cardiovascular effect of normalizing the hematocrit level during erythropoietin therapy in predialysis patients with chronic renal failure. Am J Kidney Dis. 2000;35:250–6.CrossRefPubMed Hayashi T, Suzuki A, Shoji T, et al. Cardiovascular effect of normalizing the hematocrit level during erythropoietin therapy in predialysis patients with chronic renal failure. Am J Kidney Dis. 2000;35:250–6.CrossRefPubMed
6.
Zurück zum Zitat Locatelli F, Aljama P, Barany P, et al. Revised European best practice guidelines for the management of anaemia in patients with chronic renal failure. Nephrol Dial Transplant. 2004;19(Suppl 2):ii1–ii47.PubMed Locatelli F, Aljama P, Barany P, et al. Revised European best practice guidelines for the management of anaemia in patients with chronic renal failure. Nephrol Dial Transplant. 2004;19(Suppl 2):ii1–ii47.PubMed
7.
Zurück zum Zitat KDOQI Clinical Practice Guidelines and Clinical Practice. Recommendations for anemia in chronic kidney disease. Am J Kidney Dis. 2006;47:S11–S145.CrossRef KDOQI Clinical Practice Guidelines and Clinical Practice. Recommendations for anemia in chronic kidney disease. Am J Kidney Dis. 2006;47:S11–S145.CrossRef
8.
Zurück zum Zitat KDOQI Clinical Practice Guideline Clinical Practice. Recommendations for anemia in chronic kidney disease: 2007 update of hemoglobin target. Am J Kidney Dis. 2007;50:471–530.CrossRef KDOQI Clinical Practice Guideline Clinical Practice. Recommendations for anemia in chronic kidney disease: 2007 update of hemoglobin target. Am J Kidney Dis. 2007;50:471–530.CrossRef
9.
Zurück zum Zitat McMurray JJV, Parfrey PS, Adamson JW, et al. KDIGO clinical practice guideline for anemia in chronic kidney disease. Kidney Int. 2012;2:279–335.CrossRef McMurray JJV, Parfrey PS, Adamson JW, et al. KDIGO clinical practice guideline for anemia in chronic kidney disease. Kidney Int. 2012;2:279–335.CrossRef
10.
Zurück zum Zitat Gejyo F, Saito A, Akizawa T, et al. 2004 Japanese Society for Dialysis Therapy guidelines for renal anemia in chronic hemodialysis patients. Ther Apher Dial. 2004;8:443–59.CrossRefPubMed Gejyo F, Saito A, Akizawa T, et al. 2004 Japanese Society for Dialysis Therapy guidelines for renal anemia in chronic hemodialysis patients. Ther Apher Dial. 2004;8:443–59.CrossRefPubMed
11.
Zurück zum Zitat Tsubakihara Y, Nishi S, Akiba T, et al. 2008 Japanese Society for Dialysis Therapy: guidelines for renal anemia in chronic kidney disease. Ther Apher Dial. 2010;14:240–75.CrossRefPubMed Tsubakihara Y, Nishi S, Akiba T, et al. 2008 Japanese Society for Dialysis Therapy: guidelines for renal anemia in chronic kidney disease. Ther Apher Dial. 2010;14:240–75.CrossRefPubMed
12.
Zurück zum Zitat Yamamoto H, Nishi S, Tomo T, et al. 2015 Japanes Society for Dialysis Therepy: guidelines for renal anemia in chronic kidney disease. Ren Replace Ther. 2017;3:1–46.CrossRef Yamamoto H, Nishi S, Tomo T, et al. 2015 Japanes Society for Dialysis Therepy: guidelines for renal anemia in chronic kidney disease. Ren Replace Ther. 2017;3:1–46.CrossRef
13.
Zurück zum Zitat Akizawa T, Makino H, Matsuo S, et al. Management of anemia in chronic kidney disease patients: baseline findings from Chronic Kidney Disease Japan Cohort Study. Clin Exp Nephrol. 2011;15:248–57.CrossRefPubMed Akizawa T, Makino H, Matsuo S, et al. Management of anemia in chronic kidney disease patients: baseline findings from Chronic Kidney Disease Japan Cohort Study. Clin Exp Nephrol. 2011;15:248–57.CrossRefPubMed
14.
Zurück zum Zitat Panichi V, Rosati A, Bigazzi R, et al. Anaemia and resistance to erythropoiesis-stimulating agents as prognostic factors in haemodialysis patients: results from the RISCAVID study. Nephrol Dial Transplant. 2011;26:2641–8.CrossRefPubMed Panichi V, Rosati A, Bigazzi R, et al. Anaemia and resistance to erythropoiesis-stimulating agents as prognostic factors in haemodialysis patients: results from the RISCAVID study. Nephrol Dial Transplant. 2011;26:2641–8.CrossRefPubMed
15.
Zurück zum Zitat Johnson DW, Pascoe EM, Badve SV, et al. A randomized, placebo-controlled trial of pentoxifylline on erythropoiesis-stimulating agent hyporesponsiveness in anemic patients with CKD: the handling erythropoietin resistance with oxpentifylline (HERO) trial. Am J Kidney Dis. 2015;65:49–57.CrossRefPubMed Johnson DW, Pascoe EM, Badve SV, et al. A randomized, placebo-controlled trial of pentoxifylline on erythropoiesis-stimulating agent hyporesponsiveness in anemic patients with CKD: the handling erythropoietin resistance with oxpentifylline (HERO) trial. Am J Kidney Dis. 2015;65:49–57.CrossRefPubMed
16.
Zurück zum Zitat Koibuchi K, Miyagi M, Arai T, et al. Comparing the efficacy of continuous erythropoietin receptor activator and darbepoetin Alfa treatments in Japanese patients with chronic kidney disease during the predialysis period: a propensity-matched analysis. Nephrology (Carlton). 2015;20(Suppl 4):22–8.CrossRef Koibuchi K, Miyagi M, Arai T, et al. Comparing the efficacy of continuous erythropoietin receptor activator and darbepoetin Alfa treatments in Japanese patients with chronic kidney disease during the predialysis period: a propensity-matched analysis. Nephrology (Carlton). 2015;20(Suppl 4):22–8.CrossRef
17.
Zurück zum Zitat Kawahara K, Minakuchi J, Yokota N, et al. Treatment of renal anaemia with erythropoiesis-stimulating agents in predialysis chronic kidney disease patients: haemoglobin profile during the 6 months before initiation of dialysis. Nephrology (Carlton). 2015;20(Suppl 4):29–32.CrossRef Kawahara K, Minakuchi J, Yokota N, et al. Treatment of renal anaemia with erythropoiesis-stimulating agents in predialysis chronic kidney disease patients: haemoglobin profile during the 6 months before initiation of dialysis. Nephrology (Carlton). 2015;20(Suppl 4):29–32.CrossRef
18.
Zurück zum Zitat Mohanram A, Zhang Z, Shahinfar S, et al. Anemia and end-stage renal disease in patients with type 2 diabetes and nephropathy. Kidney Int. 2004;66:1131–8.CrossRefPubMed Mohanram A, Zhang Z, Shahinfar S, et al. Anemia and end-stage renal disease in patients with type 2 diabetes and nephropathy. Kidney Int. 2004;66:1131–8.CrossRefPubMed
19.
Zurück zum Zitat Maggioni AP, Opasich C, Anand I, et al. Anemia in patients with heart failure: prevalence and prognostic role in a controlled trial and in clinical practice. J Card Fail. 2005;11:91–8.CrossRefPubMed Maggioni AP, Opasich C, Anand I, et al. Anemia in patients with heart failure: prevalence and prognostic role in a controlled trial and in clinical practice. J Card Fail. 2005;11:91–8.CrossRefPubMed
20.
Zurück zum Zitat Sabatine MS, Morrow DA, Giugliano RP, et al. Association of hemoglobin levels with clinical outcomes in acute coronary syndromes. Circulation. 2005;111:2042–9.CrossRefPubMed Sabatine MS, Morrow DA, Giugliano RP, et al. Association of hemoglobin levels with clinical outcomes in acute coronary syndromes. Circulation. 2005;111:2042–9.CrossRefPubMed
21.
Zurück zum Zitat Tanaka T. Expanding roles of the hypoxia-response network in chronic kidney disease. Clin Exp Nephrol. 2016;20:835–44.CrossRefPubMed Tanaka T. Expanding roles of the hypoxia-response network in chronic kidney disease. Clin Exp Nephrol. 2016;20:835–44.CrossRefPubMed
22.
Zurück zum Zitat Maxwell PH, Eckardt KU. HIF prolyl hydroxylase inhibitors for the treatment of renal anaemia and beyond. Nat Rev Nephrol. 2016;12:157–68.CrossRefPubMed Maxwell PH, Eckardt KU. HIF prolyl hydroxylase inhibitors for the treatment of renal anaemia and beyond. Nat Rev Nephrol. 2016;12:157–68.CrossRefPubMed
Metadaten
Titel
Treatment for renal anemia and outcomes in non-dialysis patients with chronic kidney disease: the current status of regional medicine according to the Kyoto Fushimi Renal Anemia (KFRA) study
verfasst von
Kensei Yahata
Koichi Seta
Yuko Kikuchi
Mitsuteru Koizumi
Maki Murata
Hiromichi Wada
Shogo Murakami
Mariko Ohishi
Hikari Tsuji
the Kyoto Fushimi Renal Anemia study investigators
Publikationsdatum
24.07.2019
Verlag
Springer Singapore
Erschienen in
Clinical and Experimental Nephrology / Ausgabe 10/2019
Print ISSN: 1342-1751
Elektronische ISSN: 1437-7799
DOI
https://doi.org/10.1007/s10157-019-01767-w

Weitere Artikel der Ausgabe 10/2019

Clinical and Experimental Nephrology 10/2019 Zur Ausgabe

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.