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

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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.

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Acknowledgment

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

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Authors and Affiliations

  1. Fukuoka Red Cross Hospital, 3-1-1 Ogusu Minami-ku, Fukuoka, Fukuoka, 815-8555, Japan

    Hideki Hirakata

  2. Osaka General Medical Center, Osaka, Japan

    Yoshiharu Tsubakihara

  3. Niigata University Medical and Dental Hospital, Niigata, Japan

    Fumitake Gejyo & Shinichi Nishi

  4. Nippon Medical University Hospital, Tokyo, Japan

    Yasuhiko Iino

  5. Kasugai Municipal Hospital, Kasugai, Japan

    Yuzou Watanabe

  6. Shinrakuen Hospital, Niigata, Japan

    Masashi Suzuki

  7. Tokai University Hospital, Tokyo, Japan

    Akira Saito

  8. Tokyo Women’s Medical University, Tokyo, Japan

    Takashi Akiba

  9. Tosei General Hospital, Aichi, Japan

    Daijo Inaguma

  10. Kyoto University Graduate School of Medicine, Kyoto, Japan

    Shunichi Fukuhara

  11. Yokohama City University General Medical Center, Yokohama, Japan

    Satoshi Morita

  12. International Medical Center of Japan, Tokyo, Japan

    Michiaki Hiroe

  13. Sakakibara Memorial Clinic, Tokyo, Japan

    Yoshiyuki Hada

  14. Ohashi Medical Center, Toho University, Tokyo, Japan

    Makoto Suzuki

  15. Kitasato Institute Hospital, Kitasato University, Tokyo, Japan

    Makoto Akaishi

  16. Tsukuba University Hospital, Tsukuba, Japan

    Kazutaka Aonuma

  17. Showa University School of Medicine, Tokyo, Japan

    Tadao Akizawa

Authors
  1. Hideki Hirakata
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  2. Yoshiharu Tsubakihara
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  3. Fumitake Gejyo
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  4. Shinichi Nishi
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  7. Masashi Suzuki
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  8. Akira Saito
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  9. Takashi Akiba
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  10. Daijo Inaguma
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  11. Shunichi Fukuhara
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  12. Satoshi Morita
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  13. Michiaki Hiroe
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  14. Yoshiyuki Hada
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  15. Makoto Suzuki
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  16. Makoto Akaishi
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  17. Kazutaka Aonuma
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  18. Tadao Akizawa
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Corresponding author

Correspondence to Hideki Hirakata.

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Hirakata, H., Tsubakihara, Y., Gejyo, F. et al. Maintaining high hemoglobin levels improved the left ventricular mass index and quality of life scores in pre-dialysis Japanese chronic kidney disease patients. Clin Exp Nephrol 14, 28–35 (2010). https://doi.org/10.1007/s10157-009-0212-4

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  • DOI: https://doi.org/10.1007/s10157-009-0212-4

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