Treating anemia early in renal failure patients slows the decline of renal function: a randomized controlled trial.


BACKGROUND:Erythropoietin is known to improve outcomes in patients with anemia from chronic renal disease. However, there is uncertainty about the optimal timing of initiation of erythropoietin treatment in predialysis patients with non-severe anemia. METHODS:We conducted a randomized controlled trial of early versus deferred initiation of erythropoietin in nondiabetic predialysis patients with serum creatinine 2 to 6 mg/dL and hemoglobin 9 to 11.6 g/dL. The early treatment arm was immediately started on 50 U/kg/wk of erythropoietin alpha with appropriate titration aiming for hemoglobin of > or =13 g/dL. The deferred treatment arm would start erythropoietin only when hemoglobin decreased to <9 g/dL. The primary end point was a composite of doubling of creatinine, renal replacement, or death. RESULTS:Eighty-eight patients were randomized (early treatment N= 45, deferred treatment N= 43) and followed for a median of 22.5 months. During follow-up, 13 versus 23 patients reached the primary end point in the two arms, respectively (log-rank P= 0.0078). The relative hazard for reaching an end point was 0.42 (P= 0.012). Adjusting for baseline serum creatinine, the adjusted relative hazard was 0.37 (P= 0.004), while the risk increased 2.23-fold (P < 0.001) per 1 mg/dL higher creatinine at baseline. The benefit was similar regardless of the baseline hemoglobin and proteinuria. No patients had any severe adverse events. CONCLUSION:Early initiation of erythropoietin in predialysis patients with non-severe anemia significantly slows the progression of renal disease and delays the initiation of renal replacement therapy.


Kidney Int


Kidney international


Gouva C,Nikolopoulos P,Ioannidis JP,Siamopoulos KC




Has Abstract


2004-08-01 00:00:00














  • Canonical Wnt/β-catenin signaling mediates transforming growth factor-β1-driven podocyte injury and proteinuria.

    abstract::Transforming growth factor-β1 (TGF-β1) upregulation occurs in virtually all chronic kidney diseases and is associated with podocyte injury and proteinuria; however, the mechanisms contributing to this in vivo are ambiguous. In vitro, incubation of podocytes with TGF-β1 induced Wnt1 expression, β-catenin activation, an...

    journal_title:Kidney international

    pub_type: 杂志文章


    authors: Wang D,Dai C,Li Y,Liu Y

    更新日期:2011-12-01 00:00:00

  • Adrenergic modulation of extrarenal potassium disposal in men with end-stage renal disease.

    abstract::In normal subjects, beta-adrenergic stimulation lowers the serum potassium, whereas alpha-stimulation raises it. Epinephrine, a mixed alpha and beta agonist, acutely lowers the blood potassium in normal subjects, but not in patients with end-stage renal disease. This study was designed to determine whether the resista...

    journal_title:Kidney international

    pub_type: 杂志文章


    authors: Allon M,Shanklin N

    更新日期:1991-12-01 00:00:00

  • Effect of chronic uremia in the rat on cerebral mitochondrial calcium concentrations.

    abstract::Whole cerebral and isolated mitochondrial calcium levels were determined in normal and chronically uremic Sprague-Dawley rats. Uremia was induced by a two-stage 5/6 nephrectomy 4 weeks prior to study. Serum was obtained for urea, calcium, magnesium, phosphate, and i-PTH. Mitochondria were isolated by gradient centrifu...

    journal_title:Kidney international

    pub_type: 杂志文章


    authors: Adler AJ,Berlyne GM

    更新日期:1985-03-01 00:00:00

  • Soluble fibronectin induces chemokine gene expression in renal tubular epithelial cells.

    abstract:BACKGROUND:Increasing proteinuria in kidney disease is associated with an increased risk of renal failure. Urinary proteins such as albumin induce inflammatory signaling and gene expression in tubular epithelial cells (TECs). Fibronectin is an extracellular matrix protein that can exist in soluble form and is excreted ...

    journal_title:Kidney international

    pub_type: 杂志文章


    authors: Ren L,Blanchette JB,White LR,Clark SA,Heffner DJ,Tibbles LA,Muruve DA

    更新日期:2005-11-01 00:00:00

  • Role of diuretics in the preservation of residual renal function in patients on continuous ambulatory peritoneal dialysis.

    abstract:BACKGROUND:Patients on continuous ambulatory peritoneal dialysis (CAPD) are dependent on residual renal function for solute and water clearances, and this declines with time on dialysis. Loop diuretics have been postulated to slow this decline. METHODS:Sixty-one patients new to dialysis were randomly assigned to eithe...

    journal_title:Kidney international

    pub_type: 临床试验,杂志文章,随机对照试验


    authors: Medcalf JF,Harris KP,Walls J

    更新日期:2001-03-01 00:00:00

  • Novel inflammatory mechanisms of accelerated atherosclerosis in kidney disease.

    abstract::A substantial body of evidence has accumulated linking an increased incidence of cardiovascular disease in patients with acute kidney injury (AKI), chronic kidney disease (CKD), and end-stage renal disease (ESRD). A multitude of novel risk factors related to decreased kidney function might interact with the renal and ...

    journal_title:Kidney international

    pub_type: 杂志文章,评审


    authors: Swaminathan S,Shah SV

    更新日期:2011-09-01 00:00:00

  • A micromethod to measure ammonia.

    abstract::We have described a simple technique for the measurement of picomoles or nanomoles of ammonium. Samples can be easily processed on the day of an experiment. analysis of 14C-glutamate can be done at a later date by an accurate sensitive and reliable method. We can readily process 50 samples per day. The sensitivity can...

    journal_title:Kidney international

    pub_type: 杂志文章


    authors: Cheema-Dhadli S,Hamat R,Sonnenberg H,Halperin M

    更新日期:1981-01-01 00:00:00

  • Importance of angiogenic action of angiotensin II in the glomerular growth of maturing kidneys.

    abstract::We studied the effect of three antihypertensive drugs on the growth of glomeruli in four- to five-week-old Munich-Wistar rats (N = 24), which were undergoing rapid maturation processes. Young rats were given an angiotensin converting enzyme inhibitor (ACEI, enalapril, 50 mg/liter drinking water), verapamil (50 mg/lite...

    journal_title:Kidney international

    pub_type: 杂志文章


    authors: Fogo A,Yoshida Y,Yared A,Ichikawa I

    更新日期:1990-12-01 00:00:00

  • Streptococcal erythrogenic toxin B induces apoptosis and proliferation in human leukocytes.

    abstract:BACKGROUND:Previous reports have shown the presence of erythrogenic toxin type B (ETB), apoptosis, proliferation, and leukocyte infiltration in biopsies from patients with acute poststreptococcal glomerulonephritis (APSGN). METHODS:Attempting to correlate the apoptotic and proliferative events with the interaction of ...

    journal_title:Kidney international

    pub_type: 杂志文章


    authors: Viera NT,Romero MJ,Montero MK,Rincon J,Mosquera JA

    更新日期:2001-03-01 00:00:00

  • Role of vascular endothelial growth factor in the regulation of angiogenesis.

    abstract::Compelling evidence indicates that vascular endothelial growth factor (VEGF) is a fundamental regulator of normal and abnormal angiogenesis. The loss of a single VEGF allele results in defective vascularization and early embryonic lethality. VEGF plays also a critical role in kidney development, and its inactivation d...

    journal_title:Kidney international

    pub_type: 杂志文章,评审


    authors: Ferrara N

    更新日期:1999-09-01 00:00:00

  • Decreased renal α-Klotho expression in early diabetic nephropathy in humans and mice and its possible role in urinary calcium excretion.

    abstract::Hypercalciuria is one of the early manifestations of diabetic nephropathy. We explored here the role of α-Klotho, a protein expressed predominantly in distal convoluted tubules that has a role in calcium reabsorption. We studied 31 patients with early diabetic nephropathy and compared them with 31 patients with IgA ne...

    journal_title:Kidney international

    pub_type: 杂志文章


    authors: Asai O,Nakatani K,Tanaka T,Sakan H,Imura A,Yoshimoto S,Samejima K,Yamaguchi Y,Matsui M,Akai Y,Konishi N,Iwano M,Nabeshima Y,Saito Y

    更新日期:2012-03-01 00:00:00

  • Unfavorable course of minimal change nephrotic syndrome in children with intrauterine growth retardation.

    abstract:BACKGROUND:Intrauterine growth retardation (IUGR) is associated with higher morbidity and mortality not only in perinatal life but also in later life. The purpose of our study was to determine whether IUGR has any effect on the course of minimal change nephrotic syndrome (MCNS) in children. METHODS:Forty children who ...

    journal_title:Kidney international

    pub_type: 杂志文章


    authors: Zidar N,Avgustin Cavić M,Kenda RB,Ferluga D

    更新日期:1998-10-01 00:00:00

  • Positive antineutrophil cytoplasmic antibody serology in patients with lupus nephritis is associated with distinct histopathologic features on renal biopsy.

    abstract::Class IV-S lupus nephritis is often associated with more necrosis and fewer subendothelial immune deposits compared to class IV-G lupus nephritis, suggestive of necrotising glomerular inflammation found in antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis. ANCAs are present in a significant proportion o...

    journal_title:Kidney international

    pub_type: 杂志文章


    authors: Turner-Stokes T,Wilson HR,Morreale M,Nunes A,Cairns T,Cook HT,Pusey CD,Tarzi RM,Lightstone L

    更新日期:2017-11-01 00:00:00

  • Effect of dithiothreitol on mercuric chloride- and uranyl nitrate-induced acute renal failure in the rat.

    abstract::The current study was undertaken to examine the effects of dithiothreitol (DDT), a sulfhydryl-reducing agent and heavy metal chelator, on the course of heavy metal-induced acute renal failure in the rat. Groups of rats in metabolic cages received uranyl nitrate (UN) alone, UN plus DTT, mercuric chloride (HgCl2) alone,...

    journal_title:Kidney international

    pub_type: 杂志文章


    authors: Kleinman JG,McNeil JS,Schwartz JH,Hamburger RJ,Flamenbaum W

    更新日期:1977-08-01 00:00:00

  • Diverse diuretics regimens differentially enhance the antialbuminuric effect of renin-angiotensin blockers in patients with chronic kidney disease.

    abstract::The addition of spironolactone or hydrochlorothiazide enhances the antialbuminuric effect of renin-angiotensin blockers. However, comparative studies on the effect of different diuretics are lacking. We conducted a prospective randomized crossover study to compare the effects of spironolactone (25 mg/day), hydrochloro...

    journal_title:Kidney international

    pub_type: 杂志文章


    authors: Morales E,Caro J,Gutierrez E,Sevillano A,Auñón P,Fernandez C,Praga M

    更新日期:2015-12-01 00:00:00

  • Characterization of peanut-lectin (+) cells derived from the RCCT-28A cell line.

    abstract::Cells from RCCT-28A cell line, which exhibited the highest peanut-lectin binding capacity [RCCT-28A(P+)] were separated and cultured attempting to obtain a population of HCO3- secreting cells. The mechanisms of apical solution acid or base extrusion were studied in confluent monolayers. In RCCT-28A (P+) cells net H+ f...

    journal_title:Kidney international

    pub_type: 杂志文章


    authors: Bello-Reuss E

    更新日期:1993-01-01 00:00:00

  • Role of nitric oxide in renal tubular apoptosis of unilateral ureteral obstruction.

    abstract:BACKGROUND:The obstructed kidney in unilateral ureteral obstruction (UUO) is characterized by renal atrophy and tissue loss, which is mediated by renal tubular apoptosis. We sought to determine whether NO is involved in renal tubular apoptosis in vitro and in vivo. METHODS:Rat renal tubular epithelial cells (NRK-52E) ...

    journal_title:Kidney international

    pub_type: 杂志文章


    authors: Miyajima A,Chen J,Poppas DP,Vaughan ED Jr,Felsen D

    更新日期:2001-04-01 00:00:00

  • The use of contrast media in deceased kidney donors does not affect initial graft function or graft survival.

    abstract::Patients receiving cadaveric kidney transplants often experience delayed graft function. As iodinated contrast media injection (ICMI), necessary for cerebral angiography, which is often used to diagnose brain death, can be nephrotoxic, we compared renal function recovery (RFR) and 1-year and long-term graft survival a...

    journal_title:Kidney international

    pub_type: 杂志文章


    authors: Vigneau C,Fulgencio JP,Godier A,Chalem Y,El Metaoua S,Rondeau E,Tuppin P,Bonnet F

    更新日期:2006-09-01 00:00:00

  • Oral zeranol shortens the prolonged bleeding time of uremic rats.

    abstract::Intravenous conjugated estrogens reduce the prolonged bleeding time in uremic patients and in a rat model of uremia. However, estrogens have major side effects related to their hormonal activity. We investigated whether a beta-resorcylic acid lactone, zeranol (a compound with close spatial similarity to estrogens but ...

    journal_title:Kidney international

    pub_type: 杂志文章


    authors: Zoja C,Viganò G,Corna D,Salmona M,Remuzzi G,Garattini S

    更新日期:1990-07-01 00:00:00

  • Effects of contrast media and mannitol on renal medullary blood flow and red cell aggregation in the rat kidney.

    abstract::Hemodynamic factors may play a role in the development of acute renal failure following administration of contrast media (CM). In this study the effect of intravenous injection of contrast media and mannitol on red blood cell velocity (VRBC) and red blood cell aggregation in renal medullary vessels was studied in 58 r...

    journal_title:Kidney international

    pub_type: 杂志文章


    authors: Liss P,Nygren A,Olsson U,Ulfendahl HR,Erikson U

    更新日期:1996-05-01 00:00:00

  • Genetics of hypercalciuric stone forming diseases.

    abstract::With a lifetime incidence of up to 12% in man and 6% in woman, nephrolithiasis is a major health problem worldwide. Approximately, 80% of kidney stones are composed of calcium and hypercalciuria is found in up to 40% of stone-formers. Although the mechanisms resulting in precipitation and growth of calcium crystals in...

    journal_title:Kidney international

    pub_type: 杂志文章,评审


    authors: Devuyst O,Pirson Y

    更新日期:2007-11-01 00:00:00

  • Histone deacetylase inhibition attenuates diabetes-associated kidney growth: potential role for epigenetic modification of the epidermal growth factor receptor.

    abstract::Clinical trials and experimental studies have highlighted the importance of epigenetic processes in the development of diabetic complications. One of the earliest features of diabetic nephropathy is renal enlargement. The epidermal growth factor (EGF) has a pivotal role in the development of diabetic nephromegaly and ...

    journal_title:Kidney international

    pub_type: 杂志文章


    authors: Gilbert RE,Huang Q,Thai K,Advani SL,Lee K,Yuen DA,Connelly KA,Advani A

    更新日期:2011-06-01 00:00:00

  • Influence of continuous ambulatory peritoneal dialysis on the anemia of endstage renal disease.

    abstract::To evaluate the effect of continuous ambulatory peritoneal dialysis (CAPD) on the anemia of endstage renal disease, serial measurements of red cell mass and other hematological parameters were performed in 34 patients. Twenty-five patients were measured at the start and at 6 months (group 1), 13 at the start, at 6 and...

    journal_title:Kidney international

    pub_type: 杂志文章


    authors: De Paepe MB,Schelstraete KH,Ringoir SM,Lameire NH

    更新日期:1983-05-01 00:00:00

  • β-Lapachone ameliorates murine cisplatin nephrotoxicity: NAD⁺, NQO1, and SIRT1 at the crossroads of metabolism, injury, and inflammation.

    abstract::The clinical utility of cisplatin is limited by nephrotoxicity. Oh et al. report that β-lapachone prevents this nephrotoxicity but not cisplatin's cytotoxicity for cancers. In addition to its potential clinical importance, the beneficial effect of β-lapachone on cisplatin acute kidney injury may illustrate fundamental...

    journal_title:Kidney international

    pub_type: 评论,杂志文章


    authors: Lu CY

    更新日期:2014-03-01 00:00:00

  • Influence of initiation of maintenance hemodialysis on biomarkers of inflammation and oxidative stress.

    abstract:BACKGROUND:Chronic inflammation and oxidative stress are highly prevalent in patients with chronic kidney disease and end-stage renal disease (ESRD). These conditions contribute to high mortality rates associated with cardiovascular disease, the leading cause of death in this patient population. To our knowledge, no pr...

    journal_title:Kidney international

    pub_type: 杂志文章


    authors: Pupim LB,Himmelfarb J,McMonagle E,Shyr Y,Ikizler TA

    更新日期:2004-06-01 00:00:00

  • Renal growth hormone--insulin-like growth factor-I system in acute renal failure.

    abstract::The renal growth hormone--insulin-like growth factor-I system in acute ischemic renal failure. Recovery from acute tubular necrosis (ATN) is accelerated by IGF-I therapy. Furthermore, the local renal growth hormone-IGF-I system may participate in the natural repair. We examined the IGF-I system in rat kidneys subjecte...

    journal_title:Kidney international

    pub_type: 杂志文章


    authors: Tsao T,Wang J,Fervenza FC,Vu TH,Jin IH,Hoffman AR,Rabkin R

    更新日期:1995-06-01 00:00:00

  • The fetal environment: a critical phase that determines future renal outcomes in autosomal dominant polycystic kidney disease.

    abstract::Orskov and colleagues demonstrate the impact of birth weight on the mean age of end-stage renal disease (ESRD) in a large Danish ADPKD cohort. Each kilogram of birth weight extended the mean age of ESRD onset by 1.7 years. Placental insufficiency, activation of the renin-angiotensin-aldosterone system, increased fetal...

    journal_title:Kidney international

    pub_type: 评论,杂志文章


    authors: Chapman AB

    更新日期:2012-05-01 00:00:00

  • Acute tubular necrosis is characterized by activation of the alternative pathway of complement.

    abstract:BACKGROUND:Studies in animal models have shown that the alternative pathway of complement is activated in the kidney after ischemia/reperfusion. In addition, mice deficient in complement factor B, a necessary component of the alternative pathway, are protected from ischemic acute renal failure. The purpose of this stud...

    journal_title:Kidney international

    pub_type: 杂志文章


    authors: Thurman JM,Lucia MS,Ljubanovic D,Holers VM

    更新日期:2005-02-01 00:00:00

  • Effects of sex hormones on fluid and solute transport in Madin-Darby canine kidney cells.

    abstract::Polycystic kidney disease progresses more rapidly in men than in women. To investigate the basis for this sexual dimorphism, we exposed Madin-Darby canine kidney (MDCK) cells grown on collagen-coated cell culture inserts to control media, or to estradiol or testosterone (1 nM-1 microM). Compared to control and estradi...

    journal_title:Kidney international

    pub_type: 杂志文章


    authors: Sandhu S,Silbiger SR,Lei J,Neugarten J

    更新日期:1997-05-01 00:00:00

  • Signal regulatory protein-α interacts with the insulin receptor contributing to muscle wasting in chronic kidney disease.

    abstract::Insulin resistance from chronic kidney disease (CKD) stimulates muscle protein wasting but mechanisms causing this resistance are controversial. To help resolve this, we used microarray analyses to identify initiators of insulin resistance in the muscles of mice with CKD, glucose intolerance, and insulin resistance. C...

    journal_title:Kidney international

    pub_type: 杂志文章


    authors: Thomas SS,Dong Y,Zhang L,Mitch WE

    更新日期:2013-08-01 00:00:00