Earlier Use of ESAs Benefits Non-Dialysis Kidney Disease (CKD) Patients

Renal events significantly less likely if ESAs are started at hemoglobin levels below 11 g/dL.
Renal events significantly less likely if ESAs are started at hemoglobin levels below 11 g/dL.

PHILADELPHIA—Starting erythropoiesis-stimulating agents (ESAs) when hemoglobin levels fall below 11 rather than 9 or 10 g/dL decreases the risk of renal events in patients with chronic kidney disease (CKD) not on dialysis, according to the findings of a Japanese study presented at the 2014 Kidney Week meeting.

Tadao Akizawa, MD, of Showa University School of Medicine, and colleagues, prospectively studied 1,113 non-dialysis CKD patients not previously treated with ESAs. Researchers placed patients into 3 groups based on hemoglobin (Hb) level: at least 10 but less than 11 g/dL (group 1); at least 9 but less than 10 g/dL (group 2); and less than 9 g/dL (group 3).

The primary study endpoint was the time to the first occurrence of any renal event (initiation of renal replacement therapy, doubling of serum creatinine, or an estimated glomerular filtration rate below 6 mL/min/1.73 m2. ESA treatment consisted of epoetin beta. The follow-up period was 24 months.

Patients in group 3 had a significant 2.5 times increased risk of renal events compared with those in group 1. The risk of renal events did not differ significantly between patients in groups 1 and 2.

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