tag:blogger.com,1999:blog-4230162007222918868.post3438867947664116496..comments2023-09-19T05:50:03.130-04:00Comments on Renal Fellow Network: Epo: The honeymoon is not overGearoid McMahonhttp://www.blogger.com/profile/08049723797363526138noreply@blogger.comBlogger6125tag:blogger.com,1999:blog-4230162007222918868.post-55082431784528576112010-09-30T21:14:09.970-04:002010-09-30T21:14:09.970-04:00Thanks Trampy,
Exactly! I think that, as it stand...Thanks Trampy,<br /><br />Exactly! I think that, as it stands, TREAT challenges the very use of Epo in CKD. However, as untreated renal anemia is also independently associated with CV events, I personally believe there is a safe range of use - we just don't know what it is! I think we will need to thrash this issue out much like was done to determine a safe INR for CVA prevention in A. fib. Although you say you don't see the point of such a trial, Nephrologist's instincts have been wrong every time on this issue (Anemia-normalization, CHOIR, TREAT...) and i think further RCTs are the only way to proceed.<br /><br />It is very hard to know how to proceed in the interim (primum non nocerere) - that's why I currently will only l treat very symptomatic anemia, after first counselling the patient on the risk of CVA. <br /><br />Looking forward to your future comments!Conall O' Seaghdhahttps://www.blogger.com/profile/02591806942414088134noreply@blogger.comtag:blogger.com,1999:blog-4230162007222918868.post-23998388142727881262010-09-30T17:25:56.254-04:002010-09-30T17:25:56.254-04:00Conall-
Thank you for your response. Generally spo...Conall-<br />Thank you for your response. Generally spoken, I agree with you.<br /><br />But then, we will have the placebo arm (give ESA with Hb of 9) and an arm where you give ESA when the anemia becomes severe... Maybe I don't get the point, but the second arm will most likely have a much worse outcome and life quality (e.g. fatigue...). <br /><br />I think the idea of the TREAT study was to see whether aiming for a Hb of ~13 is favourable to a Hb of ~9-10 (moderate anemia)? Or do you think this study challenges the use of ESA in CKD in general because of the CV events, even in patients with severe anemia?<br /><br />I am excited for your response :-)Trampynoreply@blogger.comtag:blogger.com,1999:blog-4230162007222918868.post-42140033621181925542010-09-29T21:50:33.696-04:002010-09-29T21:50:33.696-04:00Thanks for the kind wishes and feedback Trampy! Pe...Thanks for the kind wishes and feedback Trampy! Personally, I don't see any ethical conflict. Patients in the treatment arm of TREAT on average derived no symptomatic benefit from Epo anyway, and TREAT is the best Epo trial we have. <br />I should point out that I will still treat very symptomatic anemia with Epo after counselling the patient on the CV risks. However, this has now become an evidence-free zone and I think a trial along the lines I have suggested will be necessary to give us some evidence-based guidance. I'm v. interested to hear your thoughts - it's feedback makes running the site worthwhile!Conall O' Seaghdhahttps://www.blogger.com/profile/02591806942414088134noreply@blogger.comtag:blogger.com,1999:blog-4230162007222918868.post-56293083134842779242010-09-29T05:25:07.046-04:002010-09-29T05:25:07.046-04:00congrats... do you think your idea is ethically ok...congrats... do you think your idea is ethically okay? you'll have to treat that anemia at some time point...Trampynoreply@blogger.comtag:blogger.com,1999:blog-4230162007222918868.post-13346334828353893232010-09-27T07:07:39.464-04:002010-09-27T07:07:39.464-04:00Congrats on your marriage.
Interesting that ur pro...Congrats on your marriage.<br />Interesting that ur proposing DIVORCE TRIAL soon after the marriage !!Amit Langotehttps://www.blogger.com/profile/18377319083887261181noreply@blogger.comtag:blogger.com,1999:blog-4230162007222918868.post-17972030405765712432010-09-22T15:08:57.098-04:002010-09-22T15:08:57.098-04:00Interesting post .Congrats for the mariage ...Interesting post .Congrats for the mariage ...AHhttps://www.blogger.com/profile/10183977998656631119noreply@blogger.com