Cited by 1,930Erythropoietin and Anemia TreatmentDialysis and Renal Disease ManagementBlood transfusion and management

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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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Besarab, Anatole, Bolton, W. Kline, Browne, Jeffrey K., Egrie, Joan C., Nissenson, Allen R., Okamoto, Douglas M., Schwab, Steve J., Goodkin, David A.·1998·New England Journal of Medicine

DOI 10.1056/nejm199808273390903

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Abstract

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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Renal insufficiency and anemia are independent risk factors for death among patients with acute myocardial infarction1,21As published material, the contents of this manuscript may not be cited, quoted, reproduced or published without the consent of the authors.2The analyses upon which this publication is based were performed under Contract Number 500-96-P704, entitled “Operation Utilization and Quality Control Peer Review Organization (PRO) for the State of Georgia” and sponsored by the Centers for Medicare and Medicaid Services (CMS), Department of Health and Human Services. The conclusions and opinions expressed, and methods used herein are those of the authors. They do not necessarily reflect CMS policy. The authors assume full responsibility for the accuracy and completeness of the ideas presented. This article is a direct result of the Health Care Quality Improvement Program initiated by CMS, which has encouraged identification of quality improvement projects derived from analysis of patterns of care, and therefore required no special funding on the part of this Contractor. Ideas and contributions to the authors concerning experience in engaging with issues presented are welcomed.
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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)
ORCID: Bolton, W. Kline
Goodkin, David A.
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
DOI: 10.1056/nejm199808273390903
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 › Hematology › 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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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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