{"corpus_id":205089095,"paper_sha":"ec2c2fb10ba7a37e48395388a7e91b008d17c417","doi":"10.1056/NEJMOA062276","arxiv_id":null,"pmid":17108342,"pmcid":null,"mag_id":2134487085,"dblp_id":null,"acl_id":null,"title":"Normalization of hemoglobin level in patients with chronic kidney disease and anemia.","year":2006,"publication_date":"2006-11-16","venue":"New England Journal of Medicine","journal":{"name":"The New England journal of medicine","pages":"\n          2071-84\n        ","volume":"355 20"},"journal_issn":null,"journal_title":null,"publication_types":["Study","JournalArticle"],"pubmed_pub_types":["Journal Article","Multicenter Study","Randomized Controlled Trial","Research Support, Non-U.S. Gov't"],"s2_fields_of_study":["Medicine"],"reference_count":53,"citation_count":2106,"influential_citation_count":82,"is_open_access":true,"arxiv_categories":null,"arxiv_license":null,"arxiv_journal_ref":null,"mesh_headings":[{"d":"Anemia","mj":false,"qs":[{"q":"blood","mj":false,"ui":"Q000097"},{"q":"complications","mj":false,"ui":"Q000150"},{"q":"drug therapy","mj":true,"ui":"Q000188"}],"ui":"D000740"},{"d":"Cardiovascular Diseases","mj":false,"qs":[{"q":"epidemiology","mj":false,"ui":"Q000453"},{"q":"etiology","mj":false,"ui":"Q000209"},{"q":"prevention & control","mj":true,"ui":"Q000517"}],"ui":"D002318"},{"d":"Disease Progression","mj":false,"ui":"D018450"},{"d":"Erythropoietin","mj":false,"qs":[{"q":"adverse effects","mj":false,"ui":"Q000009"},{"q":"therapeutic use","mj":true,"ui":"Q000627"}],"ui":"D004921"},{"d":"Female","mj":false,"ui":"D005260"},{"d":"Follow-Up Studies","mj":false,"ui":"D005500"},{"d":"Glomerular Filtration Rate","mj":false,"ui":"D005919"},{"d":"Hematinics","mj":false,"qs":[{"q":"adverse effects","mj":false,"ui":"Q000009"},{"q":"therapeutic use","mj":true,"ui":"Q000627"}],"ui":"D006397"},{"d":"Hemoglobins","mj":false,"qs":[{"q":"analysis","mj":true,"ui":"Q000032"}],"ui":"D006454"},{"d":"Humans","mj":false,"ui":"D006801"},{"d":"Hypertrophy, Left Ventricular","mj":false,"qs":[{"q":"etiology","mj":false,"ui":"Q000209"}],"ui":"D017379"},{"d":"Male","mj":false,"ui":"D008297"},{"d":"Middle Aged","mj":false,"ui":"D008875"},{"d":"Quality of Life","mj":false,"ui":"D011788"},{"d":"Recombinant Proteins","mj":false,"ui":"D011994"},{"d":"Renal Dialysis","mj":false,"ui":"D006435"},{"d":"Renal Insufficiency, Chronic","mj":false,"qs":[{"q":"blood","mj":false,"ui":"Q000097"},{"q":"complications","mj":true,"ui":"Q000150"},{"q":"mortality","mj":false,"ui":"Q000401"}],"ui":"D051436"},{"d":"Survival Analysis","mj":false,"ui":"D016019"}],"chemicals":[{"n":"Hematinics","ui":"D006397","reg":"0"},{"n":"Hemoglobins","ui":"D006454","reg":"0"},{"n":"Recombinant Proteins","ui":"D011994","reg":"0"},{"n":"epoetin beta","ui":"C103998","reg":"0"},{"n":"Erythropoietin","ui":"D004921","reg":"11096-26-7"}],"comments_corrections":null,"source_flags":5,"s2_open_access_pdf_url":"https://www.nejm.org/doi/pdf/10.1056/NEJMoa062276?articleTools=true","s2_open_access_landing_url":"https://www.semanticscholar.org/paper/ec2c2fb10ba7a37e48395388a7e91b008d17c417","s2_open_access_license":null,"s2_open_access_status":"BRONZE","pmc_open_access_pdf_url":null,"pmc_open_access_landing_url":null,"pmc_open_access_license":null,"pmc_open_access_status":null,"unpaywall_open_access_pdf_url":null,"unpaywall_open_access_landing_url":null,"unpaywall_open_access_license":null,"unpaywall_open_access_status":null,"abstract":"BACKGROUND: Whether correction of anemia in patients with stage 3 or 4 chronic kidney disease improves cardiovascular outcomes is not established. METHODS: We randomly assigned 603 patients with an estimated glomerular filtration rate (GFR) of 15.0 to 35.0 ml per minute per 1.73 m2 of body-surface area and mild-to-moderate anemia (hemoglobin level, 11.0 to 12.5 g per deciliter) to a target hemoglobin value in the normal range (13.0 to 15.0 g per deciliter, group 1) or the subnormal range (10.5 to 11.5 g per deciliter, group 2). Subcutaneous erythropoietin (epoetin beta) was initiated at randomization (group 1) or only after the hemoglobin level fell below 10.5 g per deciliter (group 2). The primary end point was a composite of eight cardiovascular events; secondary end points included left ventricular mass index, quality-of-life scores, and the progression of chronic kidney disease. RESULTS: During the 3-year study, complete correction of anemia did not affect the likelihood of a first cardiovascular event (58 events in group 1 vs. 47 events in group 2; hazard ratio, 0.78; 95% confidence interval, 0.53 to 1.14; P=0.20). Left ventricular mass index remained stable in both groups. The mean estimated GFR was 24.9 ml per minute in group 1 and 24.2 ml per minute in group 2 at baseline and decreased by 3.6 and 3.1 ml per minute per year, respectively (P=0.40). Dialysis was required in more patients in group 1 than in group 2 (127 vs. 111, P=0.03). General health and physical function improved significantly (P=0.003 and P<0.001, respectively, in group 1, as compared with group 2). There was no significant difference in the combined incidence of adverse events between the two groups, but hypertensive episodes and headaches were more prevalent in group 1. CONCLUSIONS: In patients with chronic kidney disease, early complete correction of anemia does not reduce the risk of cardiovascular events. (ClinicalTrials.gov number, NCT00321919 [ClinicalTrials.gov].).","claims":[{"public_id":"cl_572129b42ff6d733821d32bf8fd59ae1","status":"active","text":"Complete correction of anemia to a normal-range target hemoglobin value did not significantly reduce first cardiovascular events compared with a subnormal-range target hemoglobin value over 3 years.","confidence":0.97,"contributors":[{"id":35,"public_id":"b2adb6bfad","public_label":"Anonymous (b2adb6bfad)","roles":["extraction"],"url":"https://sah.borca.ai/u/b2adb6bfad"},{"id":2,"public_id":"4715169a40","public_label":"AK (4715169a40)","roles":["review"],"url":"https://sah.borca.ai/u/4715169a40"},{"id":17,"public_id":"322360f1c1","public_label":"Killer Whale (322360f1c1)","roles":["review"],"url":"https://sah.borca.ai/u/322360f1c1"}],"url":"https://sah.borca.ai/claims/cl_572129b42ff6d733821d32bf8fd59ae1"},{"public_id":"cl_b7f62dc7e57661ddff85b62470ae690e","status":"active","text":"Dialysis was required by more patients assigned to the normal-range target hemoglobin value than by patients assigned to the subnormal-range target hemoglobin value.","confidence":0.96,"contributors":[{"id":35,"public_id":"b2adb6bfad","public_label":"Anonymous (b2adb6bfad)","roles":["extraction"],"url":"https://sah.borca.ai/u/b2adb6bfad"},{"id":2,"public_id":"4715169a40","public_label":"AK (4715169a40)","roles":["review"],"url":"https://sah.borca.ai/u/4715169a40"},{"id":17,"public_id":"322360f1c1","public_label":"Killer Whale (322360f1c1)","roles":["review"],"url":"https://sah.borca.ai/u/322360f1c1"}],"url":"https://sah.borca.ai/claims/cl_b7f62dc7e57661ddff85b62470ae690e"},{"public_id":"cl_c8b77e3ab4619facd9ffeec5a13d9ee8","status":"active","text":"General health and physical function improved significantly in the normal-range target hemoglobin group, while hypertensive episodes and headaches were more prevalent in that group despite no significant difference in combined adverse events.","confidence":0.94,"contributors":[{"id":35,"public_id":"b2adb6bfad","public_label":"Anonymous (b2adb6bfad)","roles":["extraction"],"url":"https://sah.borca.ai/u/b2adb6bfad"},{"id":2,"public_id":"4715169a40","public_label":"AK (4715169a40)","roles":["review"],"url":"https://sah.borca.ai/u/4715169a40"},{"id":17,"public_id":"322360f1c1","public_label":"Killer Whale (322360f1c1)","roles":["review"],"url":"https://sah.borca.ai/u/322360f1c1"}],"url":"https://sah.borca.ai/claims/cl_c8b77e3ab4619facd9ffeec5a13d9ee8"},{"public_id":"cl_6880730cb91d99a97f8007a86a03e5fc","status":"active","text":"In 603 patients with estimated glomerular filtration rate of 15.0 to 35.0 ml per minute per 1.73 m2 and mild-to-moderate anemia, participants were randomly assigned to normal-range or subnormal-range target hemoglobin values, with epoetin beta started immediately in the normal-range group or after hemoglobin fell below 10.5 g per deciliter in the subnormal-range group.","confidence":0.98,"contributors":[{"id":35,"public_id":"b2adb6bfad","public_label":"Anonymous (b2adb6bfad)","roles":["extraction"],"url":"https://sah.borca.ai/u/b2adb6bfad"},{"id":2,"public_id":"4715169a40","public_label":"AK (4715169a40)","roles":["review"],"url":"https://sah.borca.ai/u/4715169a40"},{"id":17,"public_id":"322360f1c1","public_label":"Killer Whale (322360f1c1)","roles":["review"],"url":"https://sah.borca.ai/u/322360f1c1"}],"url":"https://sah.borca.ai/claims/cl_6880730cb91d99a97f8007a86a03e5fc"},{"public_id":"cl_fbc465bb102ebce1881aa57f85ab1d4b","status":"active","text":"Left ventricular mass index remained stable in both target hemoglobin groups, and annual estimated glomerular filtration rate decline was not significantly different between the groups.","confidence":0.94,"contributors":[{"id":35,"public_id":"b2adb6bfad","public_label":"Anonymous 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