Nephrology Dialysis Transplantation, Vol 14, Issue 90002 75-79, Copyright © 1999 by Oxford University Press
C Jacobs
It has been suggested that normalization of haemoglobin with epoetin in
anaemic chronic renal failure (CRF) patients might result in even greater
benefits than those currently achieved with partial haemoglobin correction.
Four prospective randomized trials recently examined this hypothesis. The
Scandinavian Multicentre Trial, which was completed in February 1998,
included 416 haemodialysis, continuous ambulatory peritoneal dialysis and
predialysis patients. Preliminary analysis of The data found no differences
with respect to safety between patients treated to achieve subnormal
haemoglobin (9.0-12.0 g/dl) and those in whom haemoglobin was normalized
(13.5-16.0 g/dl). The Canadian Multicentre Trial included 159 haemodialysis
patients with asymptomatic left ventricular (LV) dysfunction. In patients
with a normal LV cavity volume at enrolment, The change in LV cavity volume
at 48 weeks was significantly greater in The control group (target
haemoglobin 9.5-10.5 g/dl) than in The intervention group (target
haemoglobin 13.0-14.0 g/dl). The Normal Haematocrit Cardiac Trial in The US
included 1233 haemodialysis patients with clinically evident ischaemic
heart disease or congestive heart failure. The trial was stopped in 1996
after an interim analysis showed increased mortality in The intervention
group (target haematocrit 42%) compared with The control group (target
haematocrit 30%). The higher haematocrit values themselves, however, did
not appear to be responsible for The differences in mortality, as The
mortality rates within each group decreased with increasing haematocrit.
Nonetheless, until evidence is available from other trials demonstrating a
benefit of normalizing haemoglobin, it has been recommended that a target
haematocrit value of 42% be avoided in haemodialysis patients with
clinically evident ischaemic heart disease or congestive heart failure.
Further studies are also required to determine whether increasing
haemoglobin to normal may prove to be beneficial in other patient groups.
The Spanish Quality of Life Study of 152 haemodialysis patients found a
significant improvement in all quality-of-life parameters when haemoglobin
was increased to a mean of 12.8 g/dl. The investigators suggested that in
patients without severe co-morbidity, The target haemoglobin should be as
close to normal as possible. Keywords: anaemia;
cardiac disease; chronic renal failure; epoetin; haemoglobin; quality of
life
ORIGINAL ARTICLES
Chairman's workshop report. Normalization of haemoglobin: why not?
Department of Nephrology, Hopital de la Pitie Salpetriere, 83 Boulevard de l'Hopital, 75013 Paris, France
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