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- Drueke, Tilman B., et al.
(author)
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Normalization of hemoglobin level in patients with chronic kidney disease and anemia
- 2006
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In: New England Journal of Medicine. - 0028-4793. ; 355:20, s. 2071-2084
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Journal article (peer-reviewed)abstract
- Background: Whether correction of anemia in patients with stage 3 or 4 chronic kidney disease improves cardiovascular outcomes is not established. Methods: We randomly assigned 603 patients with an estimated glomerular filtration rate (GFR) of 15.0 to 35.0 ml per minute per 1.73 m(sup 2) of body-surface area and mild-to-moderate anemia (hemoglobin level, 11.0 to 12.5 g per deciliter) to a target hemoglobin value in the normal range (13.0 to 15.0 g per deciliter, group 1) or the subnormal range (10.5 to 11.5 g per deciliter, group 2). Subcutaneous erythropoietin (epoetin beta) was initiated at randomization (group 1) or only after the hemoglobin level fell below 10.5 g per deciliter (group 2). The primary end point was a composite of eight cardiovascular events; secondary end points included left ventricular mass index, quality-of-life scores, and the progression of chronic kidney disease. Results: During the 3-year study, complete correction of anemia did not affect the likelihood of a first cardiovascular event (58 events in group 1 vs. 47 events in group 2; hazard ratio, 0.78; 95% confidence interval, 0.53 to 1.14; P=0.20). Left ventricular mass index remained stable in both groups. The mean estimated GFR was 24.9 ml per minute in group 1 and 24.2 ml per minute in group 2 at baseline and decreased by 3.6 and 3.1 ml per minute per year, respectively (P=0.40). Dialysis was required in more patients in group 1 than in group 2 (127 vs. 111, P=0.03). General health and physical function improved significantly (P=0.003 and P<0.001, respectively, in group 1, as compared with group 2). There was no significant difference in the combined incidence of adverse events between the two groups, but hypertensive episodes and headaches were more prevalent in group 1. Conclusions: In patients with chronic kidney disease, early complete correction of anemia does not reduce the risk of cardiovascular events.
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- Eckardt, Kai-Uwe, et al.
(author)
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Left Ventricular Geometry Predicts Cardiovascular Outcomes Associated with Anemia Correction in CKD
- 2009
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In: Journal of the American Society of Nephrology. - 1046-6673. ; 20:12, s. 2651-2660
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Journal article (peer-reviewed)abstract
- Partial correction of anemia in patients with chronic kidney disease (CKD) reduces left ventricular hypertrophy (LVH), which is a risk factor for cardiovascular (CV) morbidity, but complete correction of anemia does not improve CV outcomes. Whether LV geometry associates with CV events in patients who are treated to different hemoglobin (Hb) targets is unknown. One of the larger trials to study the effects of complete correction of anemia in stages 3 to 4 CKD was the Cardiovascular Risk Reduction by Early Anemia Treatment with Epoetin Beta (CREATE) trial. Here, we analyzed echocardiographic data from CREATE to determine the prevalence, dynamics, and prognostic implications of abnormal LV geometry in patients who were treated to different Hb targets. The prevalence of LVH at baseline was 47%, with eccentric LVH more frequent than concentric. During the study, LVH prevalence and mean left ventricular mass index did not change significantly, but LV geometry fluctuated considerably within 2 yr in both groups. CV event-free survival was significantly worse in the presence of concentric LVH and eccentric LVH compared with the absence of LVH (P = 0.0009 and P <= 0.0001, respectively). Treatment to the higher Hb target associated with reduced event-free survival in the subgroup with eccentric LVH at baseline (P = 0.034). In conclusion, LVH is common and associates with poor outcomes among patients with stages 3 to 4 CKD, although both progression and regression of abnormal LV geometry occur. Complete anemia correction may aggravate the adverse prognosis of eccentric LVH.
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- Hagren, Birger, 1951-, et al.
(author)
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Maintenance haemodialysis: patients’ experiences of their life situation
- 2005
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In: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 14:3, s. 294-300
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Journal article (peer-reviewed)abstract
- The aim of this study was to examine how patients suffering from CKD on maintenance haemodialysis experience their life situation. The focus was on how treatment encroaches on time and space and how patients experience care. The rationale was that this knowledge is necessary to provide professional support that takes into consideration a person's whole life situation.The experiences of patients with chronic kidney disease (CKD) undergoing maintenance haemodialysis have been studied in many quantitative studies, which translate patients’ subjective experiences into objectively quantifiable data. However, there are few qualitative studies examining the experiences of these patients’ life situation and expressing their experiences within the context of a nursing and caregiver's perspective.Data were collected by interviews with 41 patients between the ages of 29 and 86 years who participated in the study. A content analysis was used to identify common themes that describe the patients’ experiences of their life situation.Three main themes were identified,‘not finding space for living’,‘feelings evoked in the care situation’ and,‘attempting to manage restricted life’. The first theme‘not finding space for living’ consisted of two sub-themes:‘struggling with time-consuming care’ and‘feeling that life is restricted’. The second theme‘feelings evoked in the care situation’ consisted of two sub-themes:‘sense of emotional distance’ and‘feeling vulnerable’.The patients in this study indirectly expressed an existential struggle, indicating that encroachment of time and space were important existential dimensions of CKD. The findings indicated that caregivers were not always aware of this inducing a sense of emotional distance and a sense of vulnerability in the patients.Caregivers in dialysis units have to consider haemodialysis patients’ experience of a sense of emotional distance in their relationship to caregivers. Nurses and doctors need to create routines within nursing practice to overcome this.
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