The Effects of Normal as Compared with Low Hematocrit Values in Patients with Cardiac Disease Who Are Receiving Hemodialysis and Epoetin
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BackgroundIn patients with end-stage renal dis- ease, anemia develops as a result of erythropoietin deficiency, and recombinant human erythropoietin (epoetin) is prescribed to correct the anemia partially.We examined the risks and benefits of normalizing the hematocrit in patients with cardiac disease who were undergoing hemodialysis. MethodsWe studied 1233 patients with clinical ev- idence of congestive heart failure or ischemic heart disease who were undergoing hemodialysis: 618 patients were assigned to receive increasing doses of epoetin to achieve and maintain a hematocrit of 42 percent, and 615 were assigned to receive doses of epoetin sufficient to maintain a hematocrit of 30 percent throughout the study.The median duration of treatment was 14 months.The primary end point was the length of time to death or a first nonfatal myocardial infarction. ResultsAfter 29 months, there were 183 deaths and 19 first nonfatal myocardial infarctions among the patients in the normal-hematocrit group and 150 deaths and 14 nonfatal myocardial infarctions among those in the low-hematocrit group (risk ratio for the normal-hematocrit group as compared with the lowhematocrit group, 1.3; 95 percent confidence interval, 0.9 to 1.9).Although the difference in event-free survival between the two groups did not reach the prespecified statistical stopping boundary, the study was halted.The causes of death in the two groups were similar.The mortality rates decreased with increasing hematocrit values in both groups.The patients in the normal-hematocrit group had a decline in the adequacy of dialysis and received intravenous iron dextran more often than those in the low-hematocrit group. ConclusionsIn patients with clinically evident congestive heart failure or ischemic heart disease who are receiving hemodialysis, administration of epoetin to raise their hematocrit to 42 percent is not recommended.(N
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The acute hemodynamic responses of EPO administration may result in impaired perfusion/oxygen supply to the tissues and contribute to acute adverse events such as enhanced PLT aggregation, thromboembolism, and myocardial ischemia.
“The acute hemodynamic responses of EPO administration may result in impaired perfusion/oxygen supply to the tissues and contribute to acute adverse events such as enhanced PLT aggregation, thromboembolism, and myocardial ischemia (17, 45).”
From Red Blood Cell Function and Dysfunction: Redox Regulation, Nitric Oxide Metabolism, Anemia (2017) · cites this paper as [17]
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- Authors
- Besarab, A., Bolton, W. K., Browne, J. K., Egrie, J. C., Nissenson, A. R., Okamoto, D. M., Schwab, S. J., & Goodkin, D. A.
- Affiliations
- Henry Ford Hospital (US)
- University of Virginia Health System (US)
- Amgen (United States) (US)
- University of California, Los Angeles (US)
- Duke University (US)
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 1998-08-27
- Volume
- 339
- Issue
- 9
- Pages
- 584-590
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2331665138
- Cited by
- 1,930
- References
- 28
- Citations by year
- 2026: 23 · 2025: 33 · 2024: 36 · 2023: 44 · 2022: 52 · 2021: 82 · 2020: 59 · 2019: 61 · 2018: 59 · 2017: 68 · 2016: 75 · 2015: 56 · 2014: 89 · 2013: 102 · 2012: 99
- FWCI
- 21.09
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- Topics
- Health Sciences › Medicine › Hematology › Erythropoietin and Anemia Treatment
- Health Sciences › Medicine › Nephrology › Dialysis and Renal Disease Management
- Health Sciences › Medicine › Biochemistry › Blood transfusion and management
- Keywords
- hematocrit, recombinant human erythropoietin, epoetin, hemodialysis, end-stage renal disease, anemia, congestive heart failure, ischemic heart disease, myocardial infarction, mortality, dialysis adequacy
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