Haemoglobin and haematocrit targets for the anaemia of chronic kidney disease

Abstract

Lower Hb targets of 100 g/L were associated with a lower risk of death in the population with cardiovascular impairment and chronic renal disease as compared to Hb 140 g/L. Lower Hb targets (Hb < 100 g/L) were also significantly associated with an increased risk for seizures and a reduced risk of hypertension compared to Hb > 100 g/L. There is a need of more adequately powered, well-designed and reported trials in this area. In particular, randomised controlled trials comparing the benefits and harms of low (Hb < 100 g/L) versus intermediate (Hb 130 g/L) and high (Hb 140 g/L) targets in the pre-dialysis population with chronic renal disease are necessary. In fact, there is a large deficiency of trials in the pre-dialysis population. The new trials should focus on hard outcomes and also look at outcomes which were previously not studied adequately, such as seizures and quality of life, which is to be assessed with validated measures.

Hemoglobin Targets for the Anemia of Chronic Kidney Disease

“…Two Cochrane systematic reviews of randomized trials of EPO use or Hb targets for anemia of CKD are consistent with the present larger analysis that includes the most recently published trials (53,54). Our study's findings are also consistent with the results of an Agency for Healthcare Research and Quality report on EPO use for anemia of CKD (55).…”

Hemoglobin Targets for the Anemia of Chronic Kidney Disease

“…Two Cochrane systematic reviews of randomized trials of EPO use or Hb targets for anemia of CKD are consistent with the present larger analysis that includes the most recently published trials (53,54). Our study's findings are also consistent with the results of an Agency for Healthcare Research and Quality report on EPO use for anemia of CKD (55).…”

Course of Vascular Access and Relationship with Treatment of Anemia

“…Other authors have reported findings similar to ours (7,18). Foley et al (20) investigated the role of anemia in patients with left ventricular hypertrophy and reported as an ancillary finding that normalization of Hb levels (13.0 to 14.0 g/dl) did not increase the risk for thrombosis compared with a group of patients with low Hb levels (9.5 to 10.5 g/dl).…”

Body mass index and resistance to recombinant human erythropoietin therapy in maintenance hemodialysis patients

“…In fact, predialysis levels of hemoglobin higher than 11-12 g/dL are not desirable, due to the risk associated with the effects arising from post-dialysis hemoconcentration and its related complications. 17 Our HD patients under rhEPO therapy presented a decrease in hemoglobin concentration, hematocrit and erythrocyte counts, associated with a decreased in erythrocyte hemoglobinization (lower MCHC) and with an increased in erythrocyte size (higher MCV). Furthermore, HD patients also presented lymphopenia (Table 1).…”

Hemoglobin Targets for the Anemia of Chronic Kidney Disease

“…Two Cochrane systematic reviews of randomized trials of EPO use or Hb targets for anemia of CKD are consistent with the present larger analysis that includes the most recently published trials (53,54). Our study's findings are also consistent with the results of an Agency for Healthcare Research and Quality report on EPO use for anemia of CKD (55).…”

Course of Vascular Access and Relationship with Treatment of Anemia

“…Other authors have reported findings similar to ours (7,18). Foley et al (20) investigated the role of anemia in patients with left ventricular hypertrophy and reported as an ancillary finding that normalization of Hb levels (13.0 to 14.0 g/dl) did not increase the risk for thrombosis compared with a group of patients with low Hb levels (9.5 to 10.5 g/dl).…”

Body mass index and resistance to recombinant human erythropoietin therapy in maintenance hemodialysis patients

“…In fact, predialysis levels of hemoglobin higher than 11-12 g/dL are not desirable, due to the risk associated with the effects arising from post-dialysis hemoconcentration and its related complications. 17 Our HD patients under rhEPO therapy presented a decrease in hemoglobin concentration, hematocrit and erythrocyte counts, associated with a decreased in erythrocyte hemoglobinization (lower MCHC) and with an increased in erythrocyte size (higher MCV). Furthermore, HD patients also presented lymphopenia (Table 1).…”

Hemoglobin Targets for the Anemia of Chronic Kidney Disease

“…Two Cochrane systematic reviews of randomized trials of EPO use or Hb targets for anemia of CKD are consistent with the present larger analysis that includes the most recently published trials (53,54). Our study's findings are also consistent with the results of an Agency for Healthcare Research and Quality report on EPO use for anemia of CKD (55).…”

Course of Vascular Access and Relationship with Treatment of Anemia

“…Other authors have reported findings similar to ours (7,18). Foley et al (20) investigated the role of anemia in patients with left ventricular hypertrophy and reported as an ancillary finding that normalization of Hb levels (13.0 to 14.0 g/dl) did not increase the risk for thrombosis compared with a group of patients with low Hb levels (9.5 to 10.5 g/dl).…”

Body mass index and resistance to recombinant human erythropoietin therapy in maintenance hemodialysis patients

“…In fact, predialysis levels of hemoglobin higher than 11-12 g/dL are not desirable, due to the risk associated with the effects arising from post-dialysis hemoconcentration and its related complications. 17 Our HD patients under rhEPO therapy presented a decrease in hemoglobin concentration, hematocrit and erythrocyte counts, associated with a decreased in erythrocyte hemoglobinization (lower MCHC) and with an increased in erythrocyte size (higher MCV). Furthermore, HD patients also presented lymphopenia (Table 1).…”