A trial of darbepoetin alfa in type 2 diabetes and chronic kidney disease

Marc A. Pfeffer, Emmanuel A. Burdmann, Chao Yin Chen, Mark E. Cooper, Dick De Zeeuw, Kai Uwe Eckardt, Jan M. Feyzi, Peter Ivanovich, Reshma Kewalramani, Andrew S. Levey, Eldrin F. Lewis, Janet B. McGill, John J V McMurray, Patrick Parfrey, Hans Henrik Parving, Giuseppe Remuzzi, Ajay K. Singh, Scott D. Solomon, Robert Toto

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Abstract

BACKGROUND: Anemia is associated with an increased risk of cardiovascular and renal events among patients with type 2 diabetes and chronic kidney disease. Although darbepoetin alfa can effectively increase hemoglobin levels, its effect on clinical outcomes in these patients has not been adequately tested. METHODS: In this study involving 4038 patients with diabetes, chronic kidney disease, and anemia, we randomly assigned 2012 patients to darbepoetin alfa to achieve a hemoglobin level of approximately 13 g per deciliter and 2026 patients to placebo, with rescue darbepoetin alfa when the hemoglobin level was less than 9.0 g per deciliter. The primary end points were the composite outcomes of death or a cardiovascular event (nonfatal myocardial infarction, congestive heart failure, stroke, or hospitalization for myocardial ischemia) and of death or end-stage renal disease. RESULTS: Death or a cardiovascular event occurred in 632 patients assigned to darbepoetin alfa and 602 patients assigned to placebo (hazard ratio for darbepoetin alfa vs. placebo, 1.05; 95% confidence interval [CI], 0.94 to 1.17; P = 0.41). Death or end-stage renal disease occurred in 652 patients assigned to darbe poetin alfa and 618 patients assigned to placebo (hazard ratio, 1.06; 95% CI, 0.95 to 1.19; P = 0.29). Fatal or nonfatal stroke occurred in 101 patients assigned to darbepoetin alfa and 53 patients assigned to placebo (hazard ratio, 1.92; 95% CI, 1.38 to 2.68; P

Original languageEnglish
Pages (from-to)2019-2032
Number of pages14
JournalNew England Journal of Medicine
Volume361
Issue number21
DOIs
Publication statusPublished - Nov 19 2009

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ASJC Scopus subject areas

  • Medicine(all)

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Pfeffer, M. A., Burdmann, E. A., Chen, C. Y., Cooper, M. E., De Zeeuw, D., Eckardt, K. U., Feyzi, J. M., Ivanovich, P., Kewalramani, R., Levey, A. S., Lewis, E. F., McGill, J. B., McMurray, J. J. V., Parfrey, P., Parving, H. H., Remuzzi, G., Singh, A. K., Solomon, S. D., & Toto, R. (2009). A trial of darbepoetin alfa in type 2 diabetes and chronic kidney disease. New England Journal of Medicine, 361(21), 2019-2032. https://doi.org/10.1056/NEJMoa0907845