Anemia

non-dialysis–dependent CKD -ESA

• CHOIR (2006): EPO in CKD with anemia

Erythropoietin therapy targeting a higher hemoglobin level of 13.5 g/dL, as compared with 11.3 g/dL, was associated with a higher risk of death and hospitalizations for CHF among patients with non-dialysis–dependent CKD and anemia.

• TREAT (2009): Darbepoetin in CKD and T2DM
  • Targeting a hemoglobin of >13 g/dL with erythrocyte-stimulating agents does not confer a survival benefit in T2DM with CKD, but does increase the risk of stroke.
• CREATE
  • higher hemoglobin targets were associated with more rapid progression to ESRD. ESAs did not appear to influence the rate of CV events

Iron Tx in HD

• PIVOTAL (2019) -IV iron in HD pts
  • Among patients undergoing hemodialysis, a high-dose intravenous iron regimen administered proactively was superior to a low-dose regimen administered reactively and resulted in lower doses of erythropoiesis-stimulating agent being administered.

hemodialysis patients.

• NHCT - The normal HCT trial
  • targeting normal or near-normal Hgb values confer no significant clinical benefit but may in fact be associated with increased harm.

Cardiovascular Disease

• AURORA (2009): Rosuvastatin in ESRD
  • Among patients with ESRD on HD, rosuvastatin doesn't reduce the incidence of CVD events when compared to placebo.
• CORAL (2014): Stenting vs. medical therapy in RAS
  • Renal artery stenting does not improve renal or cardiac clinical outcomes in patients with hypertension or chronic kidney disease due to atherosclerotic renal artery stenosis.
• EVOLVE (2012): Cinacalcet in ESRD
  • Cinacalcet did not reduce rates of death and cardiovascular events among ESRD patients receiving hemodialysis
  • randomized patients to either cinacalcet or placebo.
• ONTARGET (2008): Ramipril vs. telmisartan vs. both in CVD, stroke, PAD, or DM

In patients with cardiovascular disease or DM with complications, telmisartan is at least as good as ramipril in preventing death, MI, and stroke, and the combination of telmisartan plus ramipril had no increase in benefit but was associated with more adverse effects.

Management of Coronary Disease in Patients with Advanced Kidney Disease

ISCHEMIA-CKD (2020 NEJM)

Among patients with stable coronary disease, advanced chronic kidney disease, and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of death or nonfatal myocardial infarction.