Higher Haemoglobin Level Variation under Treatment with Erythropoitin is Associated with Mortality in Haemodialysis
Journal Title: Journal of Pharmaceutical Research International - Year 2016, Vol 11, Issue 1
Abstract
Background: During recent years therapy with erythropoesis stimulating agents (ESA) in chronic kidney disease necessitating dialysis (CKD5D) has been challenged following worse study outcome in patients exceeding upper haemoglobin (Hb) target levels. Considering such difficulties to establish a certain and safe Hb target, a focus more on trends of Hb change and fluctuation might be beneficial to encase alternative parameters and hypotheses into anemia management. We conducted an analysis investigating the association of hemoglobin variation, and achievement of Hb targets with mortality in 245 hemodialysis patients from an outpatient center within 15 years follow-up. Methods: Variation coefficients of Hb course, Hb levels, proportion of Hb within guideline targets, means of ESA dose and dose response were considered as independent variables. Further variables for population characterization and multivariate survival analysis were age, gender and laboratory surrogates. Outcome was computed as (i) Overall mortality by computing OR for death and (ii) Mortality difference between two Hb variation groups compared by Kaplan-Meier and multivariate survival analysis. Results: The OR of death in the higher of two Hb variation groups was 5.01 (95% CI 2.85 to 9.11). Hb variation coefficient above 4% had a strong association with all-cause mortality (LogRank=54.1, p<0.001). Hb variation, Hb levels, Hb within targets and ESA dose response, entered overall and conditional multivariate models for survival (x2=131.3; p<0.001) with Hb variation holding the strongest place in every model. Conclusion: This unselected population exhibited a strong, significant association of Hb variation and a weaker association of reaching Hb targets with crude mortality. Clinical pathways as well as future controlled trials should encounter these findings in algorithms for ESA therapy.
Authors and Affiliations
Joachim Beige, Grit Glombig, Ralph Wendt
Keywords
Related Articles
- EP ID EP342394
- DOI 10.9734/BJPR/2016/25146
- Views 96
- Downloads 0
The Expression Patterns of APC2 and APC7 in Newly Diagnosed Acute Lymphoblastic Leukemia
Acute lymphoblastic leukemia (ALL) is a heterogeneous type of disease that is currently categorized based on cell morphology, immunophenotype, genetic abnormalities and gene expression pattern. Although these classificat...
Assessment of the Hematological Parameters of Albino Rats Fed on High Dose of whole Wheat
Aim: The aim of this study was to investigate the hematological profile of albino rats fed on whole wheat based on its widespread use. Whole wheat grain (Triticum aestivum) is a cereal regularly consumed and also used fo...
Rumex usambarensis (Dammer) Leaf and Stem Extract Effect on Body Weight and Lipid Profile: A Study in Albino Rats
Aims: The aim of the study was to determine the effect of Rumex usambarensis plant extract on body weight and lipid profile of fattened albino rats. Study Design: This was an in-vivo experimental study in laboratory ani...
Phytochemical Constituents and Biological Activity of Fractions of Stem and Leaves of Acalypha inferno
Aims: Acalypha inferno is an ornamental plant which has been shown to be a phytoremediator of zinc. Other species of this genus used traditionally have been proven to possess pharmacologically active constituents. The st...
Cytotoxicity of Enterolobium timbouva Plant Extract and Its Isolated Pure Compounds
Aims: The present study aimed to evaluate the cytotoxic activities of the aqueous alcohol extract of Enterolobium timbouva leaves as well as its isolated pure compounds. Place and Duration of Study: Department of Pharma...