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Target Level for Hemoglobin Correction in Patients With Diabetes and CKD: Primary Results of the Anemia Correction in Diabetes (ACORD) Study

2007; Elsevier BV; Volume: 50; Issue: 4 Linguagem: Inglês

10.1053/j.ajkd.2007.07.028

1523-6838

Anjali Hooda, Susan Kim, Balavenkatesh Kanna,

Hemoglobinopathies and Related Disorders

In reference to the study by Ritz et al,1Ritz E. Laville M. Bilous R.W. et al.Target level for hemoglobin correction in patients with diabetes and CKD: Primary results of the Anemia Correction in Diabetes (ACORD) Study.Am J Kidney Dis. 2007; 49: 194-207Abstract Full Text Full Text PDF PubMed Scopus (140) Google Scholar we would like to discuss the following issues: The authors may have overestimated the effect size when compared to published literature regarding changes in left ventricular mass index (LVMI).2Suzuki K. Kato K. Soda S. Kamimura T. Aizawa Y. The effect of valsartan on regression of left ventricular hypertrophy in type 2 diabetic patients.Diabetes Obes Metab. 2004; 6: 195-199Crossref PubMed Scopus (4) Google Scholar A 1 g/dL (10 g/L) increase in hemoglobin concentration is associated with a 4.1 g/m2 decrease in LVMI over a 24-week period.3Anand I. McMurray J.J. Whitmore J. et al.Anemia and its relationship to clinical outcome in heart failure.Circulation. 2004; 110: 149-154Crossref PubMed Scopus (352) Google Scholar The predicted effect size of 20 g/m2 is comparatively large and may have underestimated the sample size required to detect a much smaller true difference over the study period.4Yusuf S. Collins R. Peto R. Why do we need some large, simple randomized trials?.Stat Med. 1984; 3: 409-420Crossref PubMed Scopus (589) Google Scholar The current guidelines require correction of anemia to a target of greater than 11 g/dL (> 110 g/L) of hemoglobin.5Panesar M. Parashar A. The 2006 K/DOQI anemia guidelines for CKD: Key updates.Dial Transplant. 2006; 35: 632-634Crossref Scopus (5) Google Scholar Over correction may lead to adverse outcomes.6Singh A. Szczech L. Tang K.L. et al.Correction of anemia with epoetin alfa in chronic kidney disease.N Engl J Med. 2006; 355: 2085-2098Crossref PubMed Scopus (2324) Google Scholar As the hemoglobin target levels among both the full anemia correction group and partial anemia correction group in the Ritz et al study were either at or higher than recommended target levels, the benefit of anemia therapy in these patients could be less than predicted. Letters to the Editor may be in response to an article that appeared in AJKD no more than 6 months previously, or may concern a topic of interest to current nephrology. The body of the letter should be as concise as possible and in general should not exceed 250 words. Up to 10 references and 1 figure or table may be included. There is no guarantee that letters will be published. Letters are subject to editing and abridgment without notice.Letters should be submitted via AJKD’s online manuscript handling site, www.editorialmanager.com/ajkd. More information, including details about how to contact the editorial staff for assistance, is available in the journal’s Information for Authors. Letters to the Editor may be in response to an article that appeared in AJKD no more than 6 months previously, or may concern a topic of interest to current nephrology. The body of the letter should be as concise as possible and in general should not exceed 250 words. Up to 10 references and 1 figure or table may be included. There is no guarantee that letters will be published. Letters are subject to editing and abridgment without notice. Letters should be submitted via AJKD’s online manuscript handling site, www.editorialmanager.com/ajkd. More information, including details about how to contact the editorial staff for assistance, is available in the journal’s Information for Authors. Target Level for Hemoglobin Correction in Patients With Diabetes and CKD: Primary Results of the Anemia Correction in Diabetes (ACORD) StudyAmerican Journal of Kidney DiseasesVol. 49Issue 2PreviewPatients with diabetes and anemia are at high risk of cardiovascular disease. The Anemia CORrection in Diabetes (ACORD) Study aimed to investigate the effect of anemia correction on cardiac structure, function, and outcomes in patients with diabetes with anemia and early diabetic nephropathy. Full-Text PDF ErratumAmerican Journal of Kidney DiseasesVol. 49Issue 4PreviewThe article “Target Level for Hemoglobin Correction in Patients With Diabetes and CKD: Primary Results of the Anemia Correction in Diabetes (ACORD) Study” (Ritz et al, American Journal of Kidney Diseases 49:194-207, 2007) contained errors in the list of participating investigators, which was provided in Appendix 3. Full-Text PDF