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Clinical and Experimental Nephrology

, Volume 14, Issue 1, pp 28–35 | Cite as

Maintaining high hemoglobin levels improved the left ventricular mass index and quality of life scores in pre-dialysis Japanese chronic kidney disease patients

  • Hideki HirakataEmail author
  • Yoshiharu Tsubakihara
  • Fumitake Gejyo
  • Shinichi Nishi
  • Yasuhiko Iino
  • Yuzou Watanabe
  • Masashi Suzuki
  • Akira Saito
  • Takashi Akiba
  • Daijo Inaguma
  • Shunichi Fukuhara
  • Satoshi Morita
  • Michiaki Hiroe
  • Yoshiyuki Hada
  • Makoto Suzuki
  • Makoto Akaishi
  • Kazutaka Aonuma
  • Tadao Akizawa
Original Article

Abstract

Background

Anemia is common among patients with chronic kidney disease (CKD). The introduction of erythropoietin treatment has changed anemia management, but the therapeutic hemoglobin (Hb) target is still under debate, and clinical evidence for its effect on cardiac functions and QOL is sparse.

Methods

A 16-week dose–response study and a 32-week follow-Up study were combined. After correcting anemia of less than 10 g/dl in pre-dialysis Japanese CKD patients, a higher Hb target (12–13 g/dl) by darbepoetin alfa (DPO) was compared with the conventional Hb target by epoetin alfa (EPO). Outcomes were anemia correction, management of the left ventricular mass index (LVMI) and QOL scores.

Results

No significant difference was seen in Hb at baseline and week 16, but a significant difference was recorded at week 34 (12.34 ± 0.93 g/dl for DPO and 10.43 ± 0.90 g/dl for EPO). In both groups, LVMI decreased similarly until week 16, but the decrease of EPO was retarded, and a significant difference between LVMI was seen only in DPO at week 34 (100.7 ± 16.6 g/m2 for DPO and 110.9 ± 25.2 g/m2 for EPO). Relationships between Hb and LVMI change at week 34 were examined by stratifying Hb into four groups (Hb <10 g/dl, 10 g/dl ≤ Hb <11 g/dl, 11 g/dl ≤ Hb <12 g/dl and 12 g/dl ≤ Hb), and a decrease of LVMI was prominent in the 12 g/dl ≤ Hb group. Correction of anemia to 11 g/dl or more led to improved QOL scores. No safety difference was observed among the treatments.

Conclusions

Targeting a higher Hb around 12 g/dl was more beneficial than targeting conventional Hb in terms of reduction of LVMI and QOL. Further studies to determine the appropriate Hb target are necessary.

Keywords

Anemia Cardiac functions Chronic kidney disease Erythropoietin Quality of life 

Notes

Acknowledgment

The dose–response and follow-up studies were sponsored by Kirin Pharma Company, Ltd.

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Copyright information

© Japanese Society of Nephrology 2009

Authors and Affiliations

  • Hideki Hirakata
    • 1
    Email author
  • Yoshiharu Tsubakihara
    • 2
  • Fumitake Gejyo
    • 3
  • Shinichi Nishi
    • 3
  • Yasuhiko Iino
    • 4
  • Yuzou Watanabe
    • 5
  • Masashi Suzuki
    • 6
  • Akira Saito
    • 7
  • Takashi Akiba
    • 8
  • Daijo Inaguma
    • 9
  • Shunichi Fukuhara
    • 10
  • Satoshi Morita
    • 11
  • Michiaki Hiroe
    • 12
  • Yoshiyuki Hada
    • 13
  • Makoto Suzuki
    • 14
  • Makoto Akaishi
    • 15
  • Kazutaka Aonuma
    • 16
  • Tadao Akizawa
    • 17
  1. 1.Fukuoka Red Cross HospitalFukuokaJapan
  2. 2.Osaka General Medical CenterOsakaJapan
  3. 3.Niigata University Medical and Dental HospitalNiigataJapan
  4. 4.Nippon Medical University HospitalTokyoJapan
  5. 5.Kasugai Municipal HospitalKasugaiJapan
  6. 6.Shinrakuen HospitalNiigataJapan
  7. 7.Tokai University HospitalTokyoJapan
  8. 8.Tokyo Women’s Medical UniversityTokyoJapan
  9. 9.Tosei General HospitalAichiJapan
  10. 10.Kyoto University Graduate School of MedicineKyotoJapan
  11. 11.Yokohama City University General Medical CenterYokohamaJapan
  12. 12.International Medical Center of JapanTokyoJapan
  13. 13.Sakakibara Memorial ClinicTokyoJapan
  14. 14.Ohashi Medical CenterToho UniversityTokyoJapan
  15. 15.Kitasato Institute HospitalKitasato UniversityTokyoJapan
  16. 16.Tsukuba University HospitalTsukubaJapan
  17. 17.Showa University School of MedicineTokyoJapan

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