EMMANUEL DE ALMEIDA BURDMANN

(Fonte: Lattes)
Índice h a partir de 2011
29
Lattes
ResearcherID
ORCID
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Clínica Médica, Faculdade de Medicina - Docente
LIM/12 - Laboratório de Pesquisa Básica em Doenças Renais, Hospital das Clínicas, Faculdade de Medicina - Líder

Filtros

Mostrar mais
Limpar filtros

Configurações

Autor: REMUZZI, Giuseppe ×

Resultados de Busca

Agora exibindo 1 - 9 de 9
  • article 77 Citação(ões) na Scopus
    Metformin use and cardiovascular events in patients with type 2 diabetes and chronic kidney disease
    (2019) CHARYTAN, David M.; SOLOMON, Scott D.; IVANOVICH, Peter; REMUZZI, Giuseppe; COOPER, Mark E.; MCGILL, Janet B.; PARVING, Hans-Henrik; PARFREY, Patrick; SINGH, Ajay K.; BURDMANN, Emmanuel A.; LEVEY, Andrew S.; ECKARDT, Kai-Uwe; MCMURRAY, John J. V.; WEINRAUCH, Larry A.; LIU, Jiankang; CLAGGETT, Brian; LEWIS, Eldrin F.; PFEFFER, Marc A.
    AimsMetformin could have benefits on cardiovascular disease and kidney disease progression but is often withheld from individuals with diabetes and chronic kidney disease (CKD) because of a concern that it may increase the risk of lactic acidosis. Materials and methodsAll-cause mortality, cardiovascular death, cardiovascular events (death, hospitalization for heart failure, myocardial infarction, stroke or myocardial ischemia), end stage renal disease (ESRD) and the kidney disease composite (ESRD or death) were compared in metformin users and non-users with diabetes and CKD enrolled in the Trial to Reduce Cardiovascular Events with Aranesp (darbepoeitin-alfa) Therapy (TREAT) (NCT00093015). Outcomes were compared after propensity matching of users and non-users and in multivariable proportional hazards models. ResultsThere were 591 individuals who used metformin at baseline and 3447 non-users. Among propensity-matched users, the crude incidence rate for mortality, cardiovascular mortality, cardiovascular events and the combined endpoint was lower in metformin users than in non-users, but ESRD was marginally higher (4.0% vs 3.6%). Metformin use was independently associated with a reduced risk of all-cause mortality (HR, 0.49; 95% CI, 0.36-0.69), cardiovascular death (HR, 0.49; 95% CI, 0.32-0.74), the cardiovascular composite (HR, 0.67, 95% CI, 0.51-0.88) and the kidney disease composite (HR, 0.77; 95% CI, 0.61-0.98). Associations with ESRD (HR, 1.01; 95% CI, 0.65-1.55) were not significant. Results were qualitatively similar in adjusted analyses of the full population. Two cases of lactic acidosis were observed. ConclusionsMetformin may be safer for use in CKD than previously considered and may lower the risk of death and cardiovascular events in individuals with stage 3 CKD.
  • article 281 Citação(ões) na Scopus
    Recognition and management of acute kidney injury in the International Society of Nephrology 0by25 Global Snapshot: a multinational cross-sectional study
    (2016) MEHTA, Ravindra L.; BURDMANN, Emmanuel A.; CERDA, Jorge; FEEHALLY, John; FINKELSTEIN, Fredric; GARCIA-GARCIA, Guillermo; GODIN, Melanie; JHA, Vivekanand; LAMEIRE, Norbert H.; LEVIN, Nathan W.; LEWINGTON, Andrew; LOMBARDI, Raul; MACEDO, Etienne; ROCCO, Michael; ARONOFF-SPENCER, Eliah; TONELLI, Marcello; ZHANG, Jing; REMUZZI, Giuseppe
    Background Epidemiological data for acute kidney injury are scarce, especially in low-income countries (LICs) and lower-middle-income countries (LMICs). We aimed to assess regional differences in acute kidney injury recognition, management, and outcomes. Methods In this multinational cross-sectional study, 322 physicians from 289 centres in 72 countries collected prospective data for paediatric and adult patients with confirmed acute kidney injury in hospital and non-hospital settings who met criteria for acute kidney injury. Signs and symptoms at presentation, comorbidities, risk factors for acute kidney injury, and process-of-care data were obtained at the start of acute kidney injury, and need for dialysis, renal recovery, and mortality recorded at 7 days, and at hospital discharge or death, whichever came earlier. We classified countries into high-income countries (HICs), upper-middle-income countries (UMICs), and combined LICs and LMICs (LLMICs) according to their 2014 gross national income per person. Findings Between Sept 29 and Dec 7, 2014, data were collected from 4018 patients. 2337 (58%) patients developed community-acquired acute kidney injury, with 889 (80%) of 1118 patients in LLMICs, 815 (51%) of 1594 in UMICs, and 663 (51%) of 1241 in HICs (for HICs vs UMICs p = 0.33; p < 0.0001 for all other comparisons). Hypotension (1615 [40%] patients) and dehydration (1536 [38%] patients) were the most common causes of acute kidney injury. Dehydration was the most frequent cause of acute kidney injury in LLMICs (526 [46%] of 1153 vs 518 [32%] of 1605 in UMICs vs 492 [39%] of 1260 in HICs) and hypotension in HICs (564 [45%] of 1260 vs 611 [38%%] of 1605 in UMICs vs 440 [38%] of 1153 LLMICs). Mortality at 7 days was 423 (11%) of 3855, and was higher in LLMICs (129 [12%] of 1076) than in HICs (125 [10%] of 1230) and UMICs (169 [11%] of 1549). Interpretation We identified common aetiological factors across all countries, which might be amenable to a standardised approach for early recognition and treatment of acute kidney injury. Study limitations include a small number of patients from outpatient settings and LICs, potentially under-representing the true burden of acute kidney injury in these areas. Additional strategies are needed to raise awareness of acute kidney injury in community healthcare settings, especially in LICs.
  • article 756 Citação(ões) na Scopus
    International Society of Nephrology's 0by25 initiative for acute kidney injury (zero preventable deaths by 2025): a human rights case for nephrology
    (2015) MEHTA, Ravindra L.; CERDA, Jorge; BURDMANN, Emmanuel A.; TONELLI, Marcello; GARCIA-GARCIA, Guillermo; JHA, Vivekanand; SUSANTITAPHONG, Paweena; ROCCO, Michael; VANHOLDER, Raymond; SEVER, Mehmet Sukru; CRUZ, Dinna; JABER, Bertrand; LAMEIRE, Norbert H.; LOMBARDI, Raul; LEWINGTON, Andrew; FEEHALLY, John; FINKELSTEIN, Fredric; LEVIN, Nathan; PANNU, Neesh; THOMAS, Bernadette; ARONOFF-SPENCER, Eliah; REMUZZI, Giuseppe
  • article 14 Citação(ões) na Scopus
    ESRD After Heart Failure, Myocardial Infarction, or Stroke in Type 2 Diabetic Patients With CKD
    (2017) CHARYTAN, David M.; SOLOMON, Scott D.; IVANOVICH, Peter; REMUZZI, Giuseppe; COOPER, Mark E.; MCGILL, Janet B.; PARVING, Hans-Henrik; PARFREY, Patrick; SINGH, Ajay K.; BURDMANN, Emmanuel A.; LEVEY, Andrew S.; ZEEUW, Dick de; ECKARDT, Kai-Uwe; MCMURRAY, John J. V.; CLAGGETT, Brian; LEWIS, Eldrin F.; PFEFFER, Marc A.
    Background: How cardiovascular (CV) events affect progression to end-stage renal disease (ESRD), particularly in the setting of type 2 diabetes, remains uncertain. Study Design: Observational study. Setting & Participants: 4,022 patients with type 2 diabetes, anemia, and chronic kidney disease from the Trial to Reduce Cardiovascular Events With Aranesp Therapy (TREAT). Predictor: Postrandomization CV events. Outcomes: ESRD (defined as initiation of dialysis for > 30 days, kidney transplantation, or refusal or nonavailability of renal replacement therapy) and post-ESRD mortality within 30 days and during overall follow-up after an intercurrent CV event. Limitations: Population limited to clinical trial participants with diabetes and anemia. Results: 155 of 652 (23.8%) ESRD cases occurred after an intercurrent CV event; 110 (16.9%) cases followed heart failure, 28 (4.3%) followed myocardial infarction, 12 (1.84%) followed stroke, and 5 (0.77%) followed multiple CV events. ESRD rate was higher within 30 days in individuals with an intercurrent CV event compared with those without an intercurrent event (HR, 22.2; 95% CI, 17.0-29.0). Compared to no intercurrent CV events, relative risks for ESRD were higher after the occurrence of heart failure overall (HR, 3.4; 95% CI, 2.7-4.2) and at 30 days (HR, 20.1; 95% CI, 14.5-27.9) than after myocardial infarction or stroke (P < 0.001). Compared with individuals without pre-ESRD events, those with ESRD following intercurrent CV events were older, were more likely to have prior CV disease, and had higher (24.4 vs 23.1 mL/min/1.73 m(2); P = 0.01) baseline estimated glomerular filtration rates (eGFRs) and higher eGFRs at last measurement before ESRD (18.6 vs 15.2 mL/min/1.73 m(2); P < 0.001), whereas race, sex, and medication use were similar. Post-ESRD mortality was similar (P = 0.3) with and without preceding CV events. Conclusions: Most ESRD cases occurred in individuals without intercurrent CV events who had lower eGFRs than individuals with intercurrent CV events, but similar post-ESRD mortality. Nevertheless, intercurrent CV events, particularly heart failure, are strongly associated with risk for ESRD. These findings underscore the need for kidney-specific therapies in addition to treatment of CV risk factors to lower ESRD incidence in diabetes. (C) 2017 by the National Kidney Foundation, Inc.
  • article 25 Citação(ões) na Scopus
    Recognition and management of community-acquired acute kidney injury in low-resource settings in the ISN 0by25 trial: A multi-country feasibility study
    (2021) MACEDO, Etienne; HEMMILA, Ulla; SHARMA, Sanjib Kumar; GRANADO, Rolando Claure-Del; MZINGANJIRA, Henry; BURDMANN, Emmanuel A.; CERDA, Jorge; FEEHALLY, John; FINKELSTEIN, Fredric; GARCIA-GARCIA, Guillermo; JHA, Vivekanand; LAMEIRE, Norbert H.; LEE, Euyhyun; LEVIN, Nathan W.; LEWINGTON, Andrew; LOMBARDI, Raul; ROCCO, Michael V.; ARONOFF-SPENCER, Eliah; TONELLI, Marcello; YEATES, Karen; REMUZZI, Giuseppe; MEHTA, Ravindra L.
    Background Acute kidney injury (AKI) is increasingly encountered in community settings and contributes to morbidity, mortality, and increased resource utilization worldwide. In low-resource settings, lack of awareness of and limited access to diagnostic and therapeutic interventions likely influence patient management. We evaluated the feasibility of the use of point-of-care (POC) serum creatinine and urine dipstick testing with an education and training program to optimize the identification and management of AKI in the community in 3 low-resource countries. Methods and findings Patients presenting to healthcare centers (HCCs) from 1 October 2016 to 29 September 2017 in the cities Cochabamba, Bolivia; Dharan, Nepal; and Blantyre, Malawi, were assessed utilizing a symptom-based risk score to identify patients at moderate to high AKI risk. POC testing for serum creatinine and urine dipstick at enrollment were utilized to classify these patients as having chronic kidney disease (CKD), acute kidney disease (AKD), or no kidney disease (NKD). Patients were followed for a maximum of 6 months with repeat POC testing. AKI development was assessed at 7 days, kidney recovery at 1 month, and progression to CKD and mortality at 3 and 6 months. Following an observation phase to establish baseline data, care providers and physicians in the HCCs were trained with a standardized protocol utilizing POC tests to evaluate and manage patients, guided by physicians in referral hospitals connected via mobile digital technology. We evaluated 3,577 patients, and 2,101 were enrolled: 978 in the observation phase and 1,123 in the intervention phase. Due to the high number of patients attending the centers daily, it was not feasible to screen all patients to assess the actual incidence of AKI. Of enrolled patients, 1,825/2,101 (87%) were adults, 1,117/2,101 (53%) were females, 399/2,101 (19%) were from Bolivia, 813/2,101 (39%) were from Malawi, and 889/2,101 (42%) were from Nepal. The age of enrolled patients ranged from 1 month to 96 years, with a mean of 43 years (SD 21) and a median of 43 years (IQR 27-62). Hypertension was the most common comorbidity (418/2,101; 20%). At enrollment, 197/2,101 (9.4%) had CKD, and 1,199/2,101 (57%) had AKD. AKI developed in 30% within 7 days. By 1 month, 268/978 (27%) patients in the observation phase and 203/1,123 (18%) in the intervention phase were lost to follow-up. In the intervention phase, more patients received fluids (observation 714/978 [73%] versus intervention 874/1,123 [78%]; 95% CI 0.63, 0.94; p = 0.012), hospitalization was reduced (observation 578/978 [59%] versus intervention 548/1,123 [49%]; 95% CI 0.55, 0.79; p < 0.001), and admitted patients with severe AKI did not show a significantly lower mortality during follow-up (observation 27/135 [20%] versus intervention 21/178 [11.8%]; 95% CI 0.98, 3.52; p = 0.057). Of 504 patients with kidney function assessed during the 6-month follow-up, de novo CKD arose in 79/484 (16.3%), with no difference between the observation and intervention phase (95% CI 0.91, 2.47; p = 0.101). Overall mortality was 273/2,101 (13%) and was highest in those who had CKD (24/106; 23%), followed by those with AKD (128/760; 17%), AKI (85/628; 14%), and NKD (36/607; 6%). The main limitation of our study was the inability to determine the actual incidence of kidney dysfunction in the health centers as it was not feasible to screen all the patients due to the high numbers seen daily. Conclusions This multicenter, non-randomized feasibility study in low-resource settings demonstrates that it is feasible to implement a comprehensive program utilizing POC testing and protocol-based management to improve the recognition and management of AKI and AKD in high-risk patients in primary care. Author summary Why was this study done? The study was designed to assess the feasibility of implementing interventions to optimize care of acute kidney injury (AKI). We used a comprehensive 5R approach-risk, recognition, response, renal support, and rehabilitation-to test the intervention in resource-constrained regions in Africa, Asia, and Latin America. What did the researchers do and find? Patients seen in community healthcare centers were screened and assigned a risk level for AKI based on their presenting signs and symptoms. Patients with moderate to high risk were approached for consent and enrolled in the study, underwent kidney function assessment, and were followed for their disposition and outcomes. Kidney function was assessed using point-of-care (POC) tests that included a test strip for measuring creatinine level in the blood using a portable device and a urine dipstick test to evaluate for proteinuria. What do these findings mean? The ISN 0by25 trial successfully demonstrated the utility of a symptom-based health assessment risk score coupled with a POC creatinine and urine dipstick test in early recognition of kidney disease and appropriate triaging and management of patients presenting to primary healthcare centers in low-income countries. Kidney dysfunction was associated with an increased risk of mortality, which was higher in patients with a moderate severity of AKI. Recognition and management of patients was facilitated by the combination of the POC test and guidance through teleconsultation.
  • article 28 Citação(ões) na Scopus
    C-Reactive Protein and Risk of ESRD: Results From the Trial to Reduce Cardiovascular Events With Aranesp Therapy (TREAT)
    (2016) CAUSLAND, Finnian R. Mc; CLAGGETT, Brian; BURDMANN, Emmanuel A.; ECKARDT, Kai-Uwe; KEWALRAMANI, Reshma; LEVEY, Andrew S.; MCMURRAY, John J. V.; PARFREY, Patrick; REMUZZI, Giuseppe; SINGH, Ajay K.; SOLOMON, Scott D.; TOTO, Robert D.; PFEFFER, Marc A.
    Background: To better understand a potential association of elevated C-reactive protein (CRP) level with progression of chronic kidney disease (CKD), we examined the relationship of CRP level with the development of end-stage renal disease (ESRD) in the Trial to Reduce Cardiovascular Events With Aranesp Therapy (TREAT). Study Design: Post hoc analysis of a randomized controlled trial. Setting & Participants: 4,038 patients with type 2 diabetes, CKD, and anemia in TREAT. Predictor: Baseline serum CRP concentrations. Outcomes: The primary outcome was development of ESRD; secondary outcomes included doubling of serum creatinine level, a composite of ESRD/serum creatinine doubling, and a composite of death or ESRD. Measurements: We fit unadjusted and adjusted Cox regression models to test the association of baseline CRP level with time to the development of the outcomes of interest. Results: Mean age of participants was 67 years, 43% were men, and 64% were white. Approximately half (48%) the patients had CRP levels. 3.0 mg/L; 668 patients developed ESRD, and 1,270 developed the composite outcome of death or ESRD. Compared with patients with baseline CRP levels #3.0 mg/L, those with moderately/markedly elevated CRP levels (>= 6.9 mg/L; 24% of patients) had a higher adjusted risk for ESRD (HR, 1.32; 95% CI, 1.07-1.63) and the composite outcome of death or ESRD (HR, 1.41; 95% CI, 1.21-1.64). Although nonsignificant, similar trends were noted in competing-risk models. Limitations: Results may not be generalizable to nondiabetic CKD or diabetic CKD in the absence of anemia. Conclusions: Elevated baseline CRP levels are common in type 2 diabetic patients with anemia and CKD and are associated with the future development of ESRD and the composite of death or ESRD. (C) 2016 by the National Kidney Foundation, Inc.
  • article 27 Citação(ões) na Scopus
    Rationale and population-based prospective cohort protocol for the disadvantaged populations at risk of decline in eGFR (CO-DEGREE)
    (2019) GONZALEZ-QUIROZ, Marvin; NITSCH, Dorothea; HAMILTON, Sophie; GORDO, Cristina O'Callaghan; SARAN, Rajiv; GLASER, Jason; CORREA-ROTTER, Ricardo; JAKOBSSON, Kristina; SINGH, Ajay; GUNAWARDENA, Nalika; LEVIN, Adeera; REMUZZI, Giuseppe; CAPLIN, Ben; PEARCE, Neil; BERNABE-ORTIZ, Antonio; BURDMANN, Emmanuel; JHA, Vivekanand; JOHNSON, Rick; KAUR, Phabdheep; KONGTIP, Pronpimolk; KROMHOUT, Hans; ROVALO, Magdalena Madero; NYIRENDA, Moffat; PEREL, Pablo; PRABHKARAN, Dorairaj; PRASAD, Narayan; SMEETH, Liam; VENUGOPAL, Vidhya
    Introduction A recently recognised form of chronic kidney disease (CKD) of unknown origin (CKDu) is afflicting communities, mostly in rural areas in several regions of the world. Prevalence studies are being conducted in a number of countries, using a standardised protocol, to estimate the distribution of estimated glomerular filtration rate (eGFR), and thus identify communities with a high prevalence of reduced glomerular filtration rate (GFR). In this paper, we propose a standardised minimum protocol for cohort studies in high-risk communities aimed at investigating the incidence of, and risk factors for, early kidney dysfunction. Methods and analysis This generic cohort protocol provides the information to establish a prospective population-based cohort study in low-income settings with a high prevalence of CKDu. This involves a baseline survey that included key elements from the DEGREE survey (eg, using the previously published DEGREE methodology) of a population-representative sample, and subsequent follow-up visits in young adults (without a pre-existing diagnosis of CKD (eGFR<60 mL/min/1.73m(2)), proteinuria or risk factors for CKD at baseline) over several years. Each visit involves a core questionnaire, and collection and storage of biological samples. Local capacity to measure serum creatinine will be required so that immediate feedback on kidney function can be provided to participants. After completion of follow-up, repeat measures of creatinine should be conducted in a central laboratory, using reference standards traceable to isotope dilution mass spectrometry (IDMS) quality control material to quantify the main outcome of eGFR decline over time, alongside a description of the early evolution of disease and risk factors for eGFR decline. Ethics and dissemination Ethical approval will be obtained by local researchers, and participants will provide informed consent before the study commences. Participants will typically receive feedback and advice on their laboratory results, and referral to a local health system where appropriate.
  • article 7 Citação(ões) na Scopus
    Change in Hemoglobin Trajectory and Darbepoetin Dose Approaching End-Stage Renal Disease: Data from the Trial to Reduce Cardiovascular Events with Aranesp Therapy Trial
    (2017) CAUSLAND, Finnian R. Mc; CLAGGETT, Brian; PFEFFER, Marc A.; BURDMANN, Emmanuel A.; ECKARDT, Kai-Uwe; LEVEY, Andrew S.; MCMURRAY, John J. V.; REMUZZI, Giuseppe; SINGH, Ajay K.; SOLOMON, Scott D.; TOTO, Robert D.; PARFREY, Patrick
    Background: The pathogenesis of chronic kidney disease associated anemia is multifactorial and includes decreased production of erythropoietin (EPO), iron deficiency, inflammation, and EPO resistance. To better understand the trajectory of these parameters, we described temporal trends in hemoglobin (Hb), ferritin, transferrin saturation, C-reactive protein (CRP), and darbepoetin dosing in the Trial to Reduce cardiovascular Events with Aranesp Therapy (TREAT). Methods: We performed a post hoc analysis of 4,038 participants in TREAT. Mixed effects linear regression models were used to determine the trajectory of parameters of interest prior to end-stage renal disease (ESRD). Likelihood ratio tests were used to determine the overall differences in biomarker values and differences in trajectories between those who did and did not develop ESRD. Results: Hb declined precipitously in the year prior to the development of ESRD (irrespective of treatment assignment), and was on average 1.15 g/dL (95% CI - 1.26 to - 1.04) lower in those who developed ESRD versus those who did not, at the time of ESRD/end of follow-up. Simultaneously, the mean darbepoetin dose and CRP concentration increased, while serum ferritin and transferrin saturations were >140 mu g/L and 20%, respectively. Conclusions: Our analyses provide descriptive insights regarding the temporal changes of Hb, darbepoetin dose, and related parameters as ESRD approaches in participants of TREAT. Hb declined as much as 1-2 years prior to the development of ESRD, without biochemical evidence of iron deficiency. The most precipitous decline occurred in the months immediately prior to ESRD, despite administration of escalating doses of darbepoetin and in parallel with an increase in CRP. (C) 2017 S. Karger AG, Basel
  • article 15 Citação(ões) na Scopus
    Treatment of Anemia With Darbepoetin Prior to Dialysis Initiation and Clinical Outcomes: Analyses From the Trial to Reduce Cardiovascular Events With Aranesp Therapy (TREAT)
    (2019) CAUSLAND, Finnian R. Mc; CLAGGETT, Brian; BURDMANN, Emmanuel A.; CHERTOW, Glenn M.; COOPER, Mark E.; ECKARDT, Kai-Uwe; IVANOVICH, Peter; LEVEY, Andrew S.; LEWIS, Eldrin F.; MCGILL, Janet B.; MCMURRAY, John J. V.; PARFREY, Patrick; PARVING, Hans-Henrik; REMUZZI, Giuseppe; SINGH, Ajay K.; SOLOMON, Scott D.; TOTO, Robert D.; PFEFFER, Marc A.
    Rationale & Objective: Evidence from clinical trials to guide patient preparation for maintenance dialysis therapy is limited. Although anemia is associated with mortality and cardiovascular (CV) disease in individuals initiating maintenance dialysis therapy, it is not known if treatment of anemia before dialysis therapy initiation with erythropoiesis-stimulating agents alters outcomes. Study Design: Post hoc analysis of a randomized controlled trial. Setting & Participants: Participants with type 2 diabetes and chronic kidney disease who progressed to dialysis therapy (n = 590) in the Trial to Reduce Cardiovascular Events With Aranesp Therapy (TREAT). Exposure: Randomized treatment assignment (darbepoetin vs placebo). Outcomes: All-cause mortality, CV mortality, nonfatal myocardial infarction, heart failure, and stroke within the first 180 days of dialysis therapy initiation. Analytical Approach: Proportional hazards regression. Results: Overall, 590 of 4,038 (14.6%) participants initiated dialysis therapy during the trial (n = 298 and 292 in the darbepoetin and placebo groups, respectively). Corresponding hemoglobin levels were 11.3 +/- 1.6 and 9.5 +/- 1.5 g/dL (P < 0.001). Death from any cause occurred in 31 (10.4%) participants assigned to darbepoetin and 28 (9.6%) assigned to placebo (HR, 1.16; 95% CI, 0.69-1.93), while death from CV causes occurred in 15 (5.0%) and 13 (4.5%) participants, respectively (HR, 1.21; 95% CI, 0.58-1.93). There were no differences in risk for nonfatal myocardial infarction or heart failure. Stroke occurred in 8 (2.8%) participants assigned to darbepoetin and 1 (0.3%) assigned to placebo (HR, 8.6; 95% CI, 1.1-68.7). Limitations: Post hoc analyses of a subgroup of study participants. Conclusions: Despite initiating dialysis therapy with a higher hemoglobin level, prior treatment with darbepoetin was not associated with a reduction in mortality, myocardial infarction, or heart failure in the first 180 days, but a higher frequency of stroke was observed. In the absence of more definitive data, this may inform decisions regarding the use of erythropoiesis-stimulating agents to treat mild to moderate anemia in patients with type 2 diabetes and chronic kidney disease nearing dialysis therapy initiation.