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Impact of chronic kidney disease on hemoglobin among patients with peripheral artery disease treated with P2Y12 inhibitors: Insights from the EUCLID trial

Impact of chronic kidney disease on hemoglobin among patients with peripheral artery disease treated with P2Y12 inhibitors: Insights from the EUCLID trial

Authors :
Jeffrey S. Berger
Marc P. Bonaca
Brian G. Katona
Judith Hsia
Kenneth W. Mahaffey
Iris Baumgartner
W. Schuyler Jones
Charles W. Hopley
Sarah Kavanagh
Manesh R. Patel
William R. Hiatt
Juuso I. Blomster
Frank W. Rockhold
Gerry Fowkes
Lars Norgren
Source :
Vascular Medicine. 26:608-612
Publication Year :
2021
Publisher :
SAGE Publications, 2021.

Abstract

Patients with chronic kidney disease may develop new or more severe anemia when treated with antiplatelet agents due to blood loss in conjunction with impaired erythropoiesis. Because anemia independently predicts limb amputation and mortality among patients with peripheral artery disease (PAD), we evaluated the relationship between estimated glomerular filtration rate (eGFR) and hemoglobin (Hb) levels in the EUCLID trial in which patients with symptomatic PAD were randomized to ticagrelor or clopidogrel. At baseline, 9025, 1870, and 1000 patients had eGFR ⩾ 60, 45–59, and < 45 mL/min/1.73 m2, respectively. The mean fall in Hb during the trial was 0.46 ± 1.68 g/dL and did not differ by baseline eGFR category, although Hb fall ⩾ 10% was more frequent among patients with lower eGFR ( p for trend < 0.0001). On-study treatment with iron, erythropoiesis-stimulating agents, and/or red blood cell transfusion was reported for 479 (5.3%), 165 (8.8%), and 129 (12.9%) patients in the three eGFR categories, respectively ( p for trend < 0.0001). After adjustment for baseline and post-randomization effects, those not receiving anemia treatment had a smaller reduction in Hb from baseline than those receiving anemia treatment ( p < 0.0001). Other determinants of Hb reduction included absence of on-study myocardial infarction, coronary or peripheral revascularization, residence outside North America, male sex, and baseline eGFR. We conclude that among patients with PAD treated with P2Y12 inhibitors, lower baseline eGFR was associated with a greater reduction in Hb. ClinicalTrials.gov Identifier: NCT01732822

Details

ISSN :
14770377 and 1358863X
Volume :
26
Database :
OpenAIRE
Journal :
Vascular Medicine
Accession number :
edsair.doi...........f1f1bdd567c3dc6c868ef74532742965
Full Text :
https://doi.org/10.1177/1358863x211017641