In:
PLOS ONE, Public Library of Science (PLoS), Vol. 17, No. 11 ( 2022-11-29), p. e0277921-
Abstract:
Among non-dialysis-dependent chronic kidney disease (ND-CKD) patients, a low hematopoietic response to erythropoiesis-stimulating agents (ESAs) is a predictor for poor renal and cardiovascular outcome. To assess the method for evaluating hyporesponsiveness to ESA in patients with ND-CKD, a multicenter, prospective, observational study of 1,980 adult patients with ND-CKD with renal anemia was conducted. Darbepoetin alfa (DA) and iron supplement administrations were provided according to the recommendation of the attached document and the guidelines of JSDT (Japanese Society of Dialysis and Transplantation). The primary outcomes were progression of renal dysfunction and major adverse cardiovascular events. ESA responsiveness was assessed using pre-defined candidate formulae. During the mean follow-up period of 96 weeks, renal and cardiovascular disease (CVD) events occurred in 683 (39.6%) and 174 (10.1%) of 1,724 patients, respectively. Among pre-set candidate formulae, the one expressed by dividing the dose of DA by Hb level at the 12-week DA treatment was statistically significant in predicting renal (hazard ratio [HR] , 1.449; 95% confidence interval [CI], 1.231–1.705; P 〈 0.0001) and CVD events (HR, 1.719; 95% CI, 1.239–2.386; P = 0.0010). The optimum cut-off values for both events were close to 5.2. In conclusion, hyporesponsiveness to ESA in ND-CKD cases, which is associated with a risk for renal and CVD events, may be evaluated practicably as the dose of DA divided by the Hb level at the 12-week DA treatment, and the cut-off value of this index is 5.2. A search for the causes of poor response and measures for them should be recommended in such patients. Trial registration : ClinicalTrials. gov Identifier: NCT02136563; UMIN Clinical Trial Registry Identifier: UMIN000013464.
Type of Medium:
Online Resource
ISSN:
1932-6203
DOI:
10.1371/journal.pone.0277921
DOI:
10.1371/journal.pone.0277921.g001
DOI:
10.1371/journal.pone.0277921.g002
DOI:
10.1371/journal.pone.0277921.t001
DOI:
10.1371/journal.pone.0277921.t002
DOI:
10.1371/journal.pone.0277921.t003
DOI:
10.1371/journal.pone.0277921.t004
DOI:
10.1371/journal.pone.0277921.s001
DOI:
10.1371/journal.pone.0277921.s002
DOI:
10.1371/journal.pone.0277921.s003
DOI:
10.1371/journal.pone.0277921.s004
DOI:
10.1371/journal.pone.0277921.s005
DOI:
10.1371/journal.pone.0277921.s006
DOI:
10.1371/journal.pone.0277921.r001
DOI:
10.1371/journal.pone.0277921.r002
DOI:
10.1371/journal.pone.0277921.r003
DOI:
10.1371/journal.pone.0277921.r004
DOI:
10.1371/journal.pone.0277921.r005
DOI:
10.1371/journal.pone.0277921.r006
Language:
English
Publisher:
Public Library of Science (PLoS)
Publication Date:
2022
detail.hit.zdb_id:
2267670-3
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