Evidence map›Paper›PMID 18596733›Full record

Trial reportKidney international2008

Secondary analysis of the CHOIR trial epoetin-alpha dose and achieved hemoglobin outcomes.

Lynda A Szczech, Huiman X Barnhart, Jula K Inrig, Donal N Reddan, Shelly Sapp, Robert M Califf, Uptal D Patel, Ajay K Singh

Open access · bronzeAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Kidney international, 2008. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 227 papers, 11 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
227citing papers in PubMed, 11 pooled it
24.7field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

227 citing papers in PubMed, 11 syntheses or guidelines pooled it, 520 citations in OpenAlex.

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  10. Interventions for erythropoietin-resistant anaemia in dialysis patients.The Cochrane database of systematic reviews · 2013
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  11. Dose of erythropoiesis-stimulating agents and adverse outcomes in CKD: a metaregression analysis.American journal of kidney diseases : the official journal of the National Kidney Foundation · 2013
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167 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

8 authors at 5 institutions in 2 countries.

Lynda A SzczechDepartment of Medicine, The Renal Division, Duke University Medical Center, Durham, North Carolina, USA. szcze001@mc.duke.edu
Huiman X Barnhart
Jula K Inrig
Donal N Reddan
Shelly Sapp
Robert M Califf
Uptal D Patel
Ajay K Singh
Clinical Research Institute · USDuke Medical Center · USDuke University · USHarvard University · USOllscoil na Gaillimhe – University of Galway · IE

Funding

Duke CTSIKL2RR024127 · NCRR · DUKE UNIVERSITY · PI CALIFF, ROBERT M · 2006 to 2011
$3.9M
Barriers to Optimal Cardiovascular Medication Use in Diabetes and Renal DiseaseK23DK075929 · NIDDK · DUKE UNIVERSITY · PI PATEL, UPTAL D · 2006 to 2010
$677k
Analysis of associations between anemia correction in CKD and mortality: CHOIRR01DK080094 · NIDDK · DUKE UNIVERSITY · PI BARNHART, HUIMAN X · 2008 to 2010
$485k
NCRR NIH HHS 1KL2 RR024127NCRR NIH HHS KL2 RR024127NIDDK NIH HHS K23 DK075929NIDDK NIH HHS K23DK075929NIDDK NIH HHS R01 DK080094
6 · The paper itself

Abstract

Trials of anemia correction in chronic kidney disease have found either no benefit or detrimental outcomes of higher targets. We did a secondary analysis of patients with chronic kidney disease enrolled in the Correction of Hemoglobin in the Outcomes in Renal Insufficiency trial to measure the potential for competing benefit and harm from achieved hemoglobin and epoetin dose trials. In the 4 month analysis, significantly more patients in the high-hemoglobin compared to the low-hemoglobin arm were unable to achieve target hemoglobin and required high-dose epoetin-alpha. In unadjusted analyses, the inability to achieve a target hemoglobin and high-dose epoetin-alpha were each significantly associated with increased risk of a primary endpoint (death, myocardial infarction, congestive heart failure or stroke). In adjusted models, high-dose epoetin-alpha was associated with a significant increased hazard of a primary endpoint but the risk associated with randomization to the high hemoglobin arm did not suggest a possible mediating effect of higher target via dose. Similar results were seen in the 9 month analysis. Our study demonstrates that patients achieving their target had better outcomes than those who did not; and among subjects who achieved their randomized target, no increased risk associated with the higher hemoglobin goal was detected. Prospective studies are needed to confirm this relationship and determine safe dosing algorithms for patients unable to achieve target hemoglobin.

Indexed as

AgedAnemiaChronic DiseaseDose-Response Relationship, DrugEpoetin AlfaErythropoietinFemaleHemoglobinsHumansKidney DiseasesMaleMiddle AgedRecombinant ProteinsRenal InsufficiencyRiskTreatment OutcomeEpoetin AlfaErythropoietinHemoglobinsRecombinant Proteins

Identifiers

PMID18596733
PMCPMC2902279
OpenAlexW2005973637

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.