TY  - JOUR
A1  - Schneider, Andreas
A1  - Gutjahr-Lengsfeld, Lena
A1  - Ritz, Eberhard
A1  - Scharnagl, Hubert
A1  - Gelbrich, Götz
A1  - Pilz, Stefan
A1  - Macdougall, Iain C.
A1  - Wanner, Christoph
A1  - Drechsler, Christiane
T1  - Longitudinal Assessments of Erythropoietin-Stimulating Agent Responsiveness and the Association with Specific Clinical Outcomes in Dialysis Patients
JF  - Nephron Clinical Practice
N2  - Background: Dose requirements of erythropoietin-stimulating agents (ESAs) can vary considerably over time and may be associated with cardiovascular outcomes. We aimed to longitudinally assess ESA responsiveness over time and to investigate its association with specific clinical end points in a time-dependent approach. Methods: The German Diabetes and Dialysis study (4D study) included 1,255 diabetic dialysis patients, of whom 1,161 were receiving ESA treatment. In those patients, the erythropoietin resistance index (ERI) was assessed every 6 months during a median follow-up of 4 years. The association between the ERI and cardiovascular end points was analyzed by time-dependent Cox regression analyses with repeated ERI measures. Results: Patients had a mean age of 66 ± 8.2 years; 53% were male. During follow-up, a total of 495 patients died, of whom 136 died of sudden death and 102 of infectious death. The adjusted and time-dependent risk for sudden death was increased by 19% per 5-unit increase in the ERI (hazard ratio, HR = 1.19, 95% confidence interval, CI = 1.07-1.33). Similarly, mortality increased by 25% (HR = 1.25, 95% CI = 1.18-1.32) and infectious death increased by 27% (HR = 1.27, 95% CI = 1.13-1.42). Further analysis revealed that lower 25-hydroxyvitamin D levels were associated with lower ESA responsiveness (p = 0.046). Conclusions: In diabetic dialysis patients, we observed that time-varying erythropoietin resistance is associated with sudden death, infectious complications and all-cause mortality. Low 25-hydroxyvitamin D levels may contribute to a lower ESA responsiveness.
KW  - dialysis
KW  - erythropoietin
KW  - diabetes
KW  - epidemiology
Y1  - 2014
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-196511
SN  - 1660-2110
N1  - This publication is with permission of the rights owner freely accessible due to an Alliance licence and a national licence (funded by the DFG, German Research Foundation) respectively.
VL  - 128
IS  - 1-2
ER  - 
TY  - JOUR
A1  - Perkovic, Vlado
A1  - Agarwal, Rajiv
A1  - Fioretto, Paola
A1  - Hemmelgarn, Brenda R.
A1  - Levin, Adeera
A1  - Thomas, Merlin C.
A1  - Wanner, Christoph
A1  - Kasiske, Bertram L.
A1  - Wheeler, David C.
A1  - Groop, Per-Henrik
T1  - Management of patients with diabetes and CKD: conclusions from a "Kidney Disease: Improving Global Outcomes" (KDIGO) controversies conference
JF  - Kidney International
N2  - The prevalence of diabetes around the world has reached epidemic proportions and is projected to increase to 642 million people by 2040. Diabetes is already the leading cause of end-stage kidney disease (ESKD) in most developed countries, and the growth in the number of people with ESKD around the world parallels the increase in diabetes. The presence of kidney disease is associated with a markedly elevated risk of cardiovascular disease and death in people with diabetes. Several new therapies and novel investigational agents targeting chronic kidney disease patients with diabetes are now under development. This conference was convened to assess our current state of knowledge regarding optimal glycemic control, current antidiabetic agents and their safety, and new therapies being developed to improve kidney function and cardiovascular outcomes for this vulnerable population.
KW  - stage renal-disease
KW  - converting enzyme-inhibition
KW  - dietary sodium restriction
KW  - intensive glucose control
KW  - albumin excretion rate
KW  - blood pressure
KW  - cardiovascular outcomes
KW  - randomized trial
KW  - glycemic control
KW  - receptor
KW  - antidiabetic agents
KW  - cardiovascular disease
KW  - chronic kidney disease
KW  - diabetes
KW  - renoprotection
KW  - antagonist
Y1  - 2016
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-186599
VL  - 90
IS  - 6
ER  -