| Nadir hemoglobin levels after discontinuation of epoetin in hemodialysis patients. | |
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MedLine Citation:
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PMID: 20651155 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND AND OBJECTIVES: In hemodialysis patients, both hemoglobin variability and targeting normalization of hemoglobin may have adverse consequences. There are few data on epoetin management in patients achieving high hemoglobin levels. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Maintenance hemodialysis patients within Dialysis Clinic Inc. (DCI) who were treated with a 20 to 30% epoetin dose reduction versus epoetin discontinuation following achievement of a hemoglobin level of > or = 13 g/dl were evaluated. The primary outcome was nadir hemoglobin within 2 months of epoetin reduction or discontinuation. RESULTS: There were 2789 patients in whom epoetin was discontinued and 754 patients in whom epoetin was reduced after hemoglobin > or = 13 g/dl. Patients treated with reduction received significantly more epoetin over the subsequent 2 months. More patients dropped below 11 (21.5 versus 10.1%) and 10 g/dl (7.2 versus 3.6%) within 2 months of discontinuing epoetin, whereas reduction was associated with more frequent nadir hemoglobin levels >12 g/dl (31.1 versus 62.8%). In multivariable models including age, ferritin, albumin, and baseline epoetin dose, discontinuation was associated with nadir hemoglobin below 10 g/dl [OR = 1.91 (CI: 1.22, 2.99)], whereas reduction was associated with a hemoglobin nadir above 12 g/dl [OR = 4.41 (CI: 3.63, 5.37)]. CONCLUSIONS: In hemodialysis patients with baseline hemoglobin >13 g/dl, epoetin discontinuation is associated with lower epoetin use and a higher probability of reaching a hemoglobin target range of 10 to 12 g/dl within 2 months; discontinuation is also associated with a higher likelihood nadir hemoglobin <10 g/dl. |
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Authors:
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Jose A Calvo; Dana C Miskulin; Klemens B Meyer; Daniel E Weiner |
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Publication Detail:
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Type: Journal Article; Research Support, N.I.H., Extramural Date: 2010-07-22 |
Journal Detail:
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Title: Clinical journal of the American Society of Nephrology : CJASN Volume: 5 ISSN: 1555-905X ISO Abbreviation: Clin J Am Soc Nephrol Publication Date: 2010 Sep |
Date Detail:
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Created Date: 2010-09-08 Completed Date: 2011-01-11 Revised Date: 2011-09-13 |
Medline Journal Info:
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Nlm Unique ID: 101271570 Medline TA: Clin J Am Soc Nephrol Country: United States |
Other Details:
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Languages: eng Pagination: 1621-7 Citation Subset: IM |
Affiliation:
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Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts, USA. dweiner@tuftsmedicalcenter.org |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Biological Markers / blood Chi-Square Distribution Drug Administration Schedule Erythropoietin, Recombinant / administration & dosage* Female Hematinics / administration & dosage* Hemoglobins / metabolism* Humans Logistic Models Male Middle Aged Odds Ratio Renal Dialysis* Risk Assessment Risk Factors Time Factors Treatment Outcome United States |
| Grant Support | |
ID/Acronym/Agency:
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K23DK071636/DK/NIDDK NIH HHS; T32DK007777/DK/NIDDK NIH HHS |
| Chemical | |
Reg. No./Substance:
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0/Biological Markers; 0/Erythropoietin, Recombinant; 0/Hematinics; 0/Hemoglobins |
| Comments/Corrections | |
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