102,604 research outputs found
Haemoglobin targets: we were wrong, time to move on
No full textBACKGROUND: The current 3rd edition of the Italian Society of Nephrology guidelines has been drawn up to summarize evidence of key intervention issues on the basis of systematic reviews (SR) of randomized trials (RCT) or RCT data only. In the present guideline, evidence of optimal haemoglobin (Hb) target levels in chronic kidney disease (CKD), either for pre-dialysis, dialysis or renal transplanted patients, is presented.
METHODS: SR of RCT and RCT on different Hb target levels in patients with CKD were identified, referring to a Cochrane Library and Renal Health Library search (2005 update). Quality of SR and RCT was assessed according to current methodological standards.
RESULTS: Four SR (19 RCT) were found addressing the point. Methodological quality of available trials was suboptimal. In CKD patients (non-dialysis patients) Hb targets of 11.3 g/dL should be preferred to Hb >13.5 g/dL (evidence from RCT). A Hb target of 11.0-11.5 g/dL should be preferred in CKD patients receiving dialysis treatment without significant cardiac disease, since no survival benefits has been showed with Hb >14 g/dL (evidence from RCT). The optimal Hb target in haemodialysis patients with severe cardiac disease should be 10.0-10.5 g/dL (evidence from SR). Increases in Hb target lev-els are associated with improved quality of life, although this was mainly noticed in observational studies and in few RCT often relying on unvalidated quality of life assessment scales.
CONCLUSION: In CKD patients current available evidence supports the hypothesis that optimal Hb targets should be low to subnormal
Effects of statins in patients with chronic kidney disease: meta-analysis and meta-regression of randomised controlled trials (vol 336, pg 645, 2008)
No full textShould we shift toward higher blood pressure targets in patients with chronic kidney disease?
No full textHypertension is the leading cause of death worldwide and is responsible for a significantly increased burden of cardiovascular events and progression to endstage kidney disease in patients with chronic kidney disease (CKD). The fundamentals of therapeutics in patients with hypertension and CKD are both the use of specific renal protecting agents and the achievement of tight blood pressure control - i.e., blood pressure values below 130/80 mm Hg. When the evidence underpinning a "tight blood pressure target control" recommendation is analyzed, hypertension guidelines appear to be largely extrapolating to people with CKD the key findings of large trials conducted in the general population and other high cardiovascular risk populations, while renal societies guidelines are primarily influenced by observational data reporting renal outcomes and small-scale randomized studies, and have not always incorporated recent evidence from systematic reviews. In this narrative review, we present existing guidelines and evidence for 2 crucial clinical questions in the management of hypertension of CKD: (i) should we, and by how much should we, lower blood pressure in people with CKD and (ii) are there agents which are specifically beneficial in the CKD population, independent of blood pressure control? © 2011 Società Italiana di Nefrologia
Haemoglobin and haematocrit targets for the anaemia of chronic kidney disease
No full textBACKGROUND: Anaemia affects 60% to 80% of patients with chronic kidney disease (CKD) reduces quality of life and is a risk factor for early death. Treatment options are blood transfusion, erythropoietin (EPO) and darbepoetin alfa. Recently higher haemoglobin (Hb) and haematocrit (HCT) targets have been widely advocated because of positive associations with improved survival and quality of life from observational studies. OBJECTIVES: To assess the benefits and harms of different Hb or HCT targets in CKD patients receiving any treatment for anaemia. SEARCH STRATEGY: We searched The Cochrane Renal Group's specialised register, Cochrane Central Register of Controlled Trials (CENTRAL, in The Cochrane Library) MEDLINE (from 1966), EMBASE (from 1980) and reference lists of retrieved articles.Date of most recent search: April 2006 SELECTION CRITERIA: Randomised controlled trials (RCTs) and quasi-RCTs comparing different Hb/HCT targets in patients with the anaemia of CKD. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial quality and extracted data. Statistical analyses were performed using the random effects model and results expressed as relative risks (RR) for dichotomous outcomes and weighted mean difference (MD) for continuous outcomes, with 95% confidence intervals (CI). MAIN RESULTS: Twenty two trials (3707 patients) were included. Hb > or = 133 g/L was not associated with a reduction in the risk of all-cause mortality compared with 120 g/L in dialysis and pre-dialysis patients. In pre-dialysis patients, there was a significantly lower end of treatment creatinine clearance with Hb < 120 g/L compared to > 130 g/L (MD -4.17, 95% CI -6.33 to -2.02) but no significant difference in the risk of end-stage kidney disease (ESKD) (RR 1.05, 95% CI 0.50 to 2.22). Lower Hb targets resulted in an increased risk for seizures (RR 5.25, 95% CI 1.13 to 24.34) and a reduced risk of hypertensive episodes (RR 0.50, 95% CI 0.33 to 0.76). There were no significant differences in the risk of vascular access thrombosis. AUTHORS' CONCLUSIONS: There was no significant difference in the risk of death for low (< 120 g/L) versus higher Hb targets (>133 g/L). Lower Hb targets were significantly associated with an increased risk for seizures but a reduced risk of hypertension. In general study quality was poor. There is a need for more adequately powered, well-designed and reported trials. Trials should be pragmatic, focusing on hard end-points (mortality, ESKD, major side effects) or outcomes which were previously not studied adequately (e.g. seizures, quality of life)
A pegylated epoetin in anaemia of renal disease: non-inferiority for an unvalidated surrogate
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How to read critically a prognostic cohort study
No full textIn nephrology, cohort studies are an abundant source of information. They are the ideal study design to answer clinical questions about prevalence, prognosis and aetiology. In this study, the evaluation of a cohort study to guide decisions about prognosis in clinical nephrology is discussed. © 2010 The Authors. Nephrology © 2010 Asian Pacific Society of Nephrology
RISK FACTORS FOR THE DEVELOPMENT AND PROGRESSION OF RENAL DISEASES IN DISADVANTAGED POPULATIONS: ROLE OF THE RENIN-ANGIOTENSIN SYSTEM BLOCKADE
No full textChronic kidney disease is becoming a public health challenge due to the high risk of progression to end-stage kidney disease, the increased cardiovascular burden and management costs, especially among disadvantaged communities. Although the high prevalence of hypertension and diabetes in these populations are recognized risk factors and a leading cause of chronic kidney disease, ethnic populations show a greater likelihood of developing end-stage kidney disease regardless of these cardiovascular risk factors. The association between low socioeconomic status and the prevalence/progression of chronic kidney disease observed in population-based studies suggests that socioeconomic disadvantage could be a plausible reason for the increased burden of renal disease among minorities. Interventions for management and prevention of chronic kidney disease include angiotensin converting enzyme inhibitors and angiotensin receptor blockers. Few studies of these agents have been conducted in indigenous populations, but there is evidence that angiotensin converting enzyme inhibitors are effective in reducing premature deaths and progression of chronic kidney disease, as well as being highly cost-effective, especially in terms of renal replacement therapies avoided. It is plausible that these disadvantaged groups may benefit more than others from a renal and cardiovascular prevention program, but considerable under-recognition and under-treatment of these conditions still exist. (Ethn Dis. 2009 [Suppl 1];19: S1-86-S1-89
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