Secondary analysis of the CHOIR trial epoetin-alpha dose and achieved hemoglobin outcomes.
Secondary analysis of the CHOIR trial epoetin-alpha dose and achieved hemoglobin outcomes.
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DOI：
10.1038/ki.2008.295
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发表时间：
2008-09
影响因子：
19.6
通讯作者：
Singh, Ajay K.
中科院分区：
文献类型：
--
作者：
Szczech, Lynda A.;Barnhart, Huiman X.;Inrig, Jula K.;Reddan, Donal N.;Sapp, Shelly;Califf, Robert M.;Patel, Uptal D.;Singh, Ajay K.
在慢性肾脏疾病中进行的贫血纠正试验发现，更高的目标没有益处或有害的结果。我们对参加肾功能不全结局中血红蛋白纠正试验的慢性肾脏病患者进行了二次分析，以衡量血红蛋白和依泊洛沙姆剂量试验的潜在竞争性获益和损害。在4个月分析中，与低血红蛋白组相比，高血红蛋白组中有更多患者无法达到目标血红蛋白，需要高剂量依泊苷-α。在未校正的分析中，无法达到目标血红蛋白和高剂量的依泊苷-α均与主要终点（死亡、心肌梗死、充血性心力衰竭或卒中）的风险增加显著相关。在调整后的模型中，高剂量依泊苷-α与主要终点的风险显著增加相关，但与随机分配至高血红蛋白组相关的风险并未表明通过剂量增加靶点的可能介导作用。在9个月分析中观察到类似结果。我们的研究表明，达到目标的患者比未达到目标的患者有更好的结局;在达到随机目标的受试者中，未检测到与较高血红蛋白目标相关的风险增加。需要前瞻性研究来证实这种关系，并确定无法达到目标血红蛋白的患者的安全给药算法。
Trials of anemia correction in chronic kidney disease have found either no benefit or detrimental outcomes of higher targets. We did a secondary analysis of patients with chronic kidney disease enrolled in the Correction of Hemoglobin in the Outcomes in Renal Insufficiency trial to measure the potential for competing benefit and harm from achieved hemoglobin and epoetin dose trials. In the 4 month analysis, significantly more patients in the high-hemoglobin compared to the low-hemoglobin arm were unable to achieve target hemoglobin and required high-dose epoetin-α. In unadjusted analyses, the inability to achieve a target hemoglobin and high-dose epoetin-α were each significantly associated with increased risk of a primary endpoint (death, myocardial infarction, congestive heart failure or stroke). In adjusted models, high-dose epoetin-α was associated with a significant increased hazard of a primary endpoint but the risk associated with randomization to the high hemoglobin arm did not suggest a possible mediating effect of higher target via dose. Similar results were seen in the 9 month analysis. Our study demonstrates that patients achieving their target had better outcomes than those who did not; and among subjects who achieved their randomized target, no increased risk associated with the higher hemoglobin goal was detected. Prospective studies are needed to confirm this relationship and determine safe dosing algorithms for patients unable to achieve target hemoglobin.
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影响因子：
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