A prospective observational study of early intervention with erythropoietin therapy and renal survival in non-dialysis chronic kidney disease patients with anemia: JET-STREAM Study

作者：Akizawa Tadao; Tsubakihara Yoshiharu; Hirakata Hideki; Watanabe Yuzo; Hase Hiroki; Nishi Shinichi; Babazono Tetsuya; Kumagai Michiko^*; Katakura Shingo; Uemura Yukari; Ohashi Yasuo

来源：Clinical and Experimental Nephrology, 2016, 20(6): 885-895.

DOI：10.1007/s10157-015-1225-9

• Anemia
• Chronic kidney disease
• Erythropoiesis-stimulating agents
• Non-dialysis
• Renal survival

There is limited data showing that early treatment for anemia could prolong renal survival in non-dialysis chronic kidney disease (CKD) patients. We therefore investigated the relationship between hemoglobin (Hb) levels at initiation of epoetin beta therapy and renal outcome in non-dialysis CKD patients with anemia.
In this prospective, multi-center, observational study, non-dialysis CKD patients with anemia who were na < ve to erythropoiesis-stimulating agents (ESAs) were divided into three groups based on their Hb levels at initiation of epoetin beta therapy (Group I: 10 ae<currency> Hb < 11 g/dL, Group II: 9 ae<currency> Hb < 10 g/dL, and Group III: Hb < 9 g/dL). The primary endpoint was time to first occurrence of any renal event. For the primary analysis, an inverse probability weighted Cox regression model was used to adjust time-dependent selection bias in the artificially censored data.
A total of 1113 patients were eligible for primary endpoint analysis. Risk of renal events was significantly higher in Group III compared with Group I (HR, 2.52; 95 % CI, 1.98-3.21; P < 0.0001); although not significant, the risk was also higher in Group II compared with Group I (HR, 1.48; 95 % CI, 0.91-2.40; P = 0.11).
Initiation of ESA therapy when Hb levels decreased below 11 g/dL but not below 10 g/dL could be more effective at reducing the risk of renal events in non-dialysis CKD patients with anemia compared with initiation of ESA therapy at below 9 g/dL or even 10 g/dL.

• 出版日期2016-12