Abstract
BackgroundNumerous studies have identified a relationship between hemoglobin (Hb) levels and mortality in patients with chronic kidney disease (CKD), which have raised concerns about the optimal Hb targets in correction of anemia. Our study is designed to investigate the potential effects of targeted Hb levels, aiming to give some evidence for therapy of renal anemia.Methodology/Principal FindingsA comprehensive search of Medline, Embase and the Cochrane Database of Systematic Reviews was performed in December 2011 and updated in February 2012 for any new trials. Randomized trials designed to evaluate effects of high (generally the Hb about 13.0 g/dL) and low Hb (generally the Hb about 10.0 g/dL) targets on clinical outcomes in CKD patients with anemia were collected. All statistical analysis was calculated using the RevMan software available free from the Cochrane Collaboration. 24 trials involving 10361 patients were identified. Our findings demonstrated a statistically significant increased risk of mortality in the high Hb levels (RR 1.18; 95% CI 1.02 to 1.37) while the high and low Hb groups were both treated with ESAs. Overall, compared with low Hb levels, high Hb levels are associated with increased risk of hypertension (RR 1.40; 95% CI 1.11 to 1.75), stroke (RR 1.73; 95% CI 1.31 to 2.29), and hospitalizations (RR 1.07; 95% CI 1.01 to 1.14). However, there are no significant differences in the risk of non-fatal myocardial infarction (RR 1. 13; 95% CI 0.79 to 1.61) and renal replacement therapy (RR 1. 00; 95% CI 0.85 to 1.18).Conclusions/SignificancesTargeting low Hb levels are beneficial to CKD patients especially in the predialysis population. The optimal Hb targets to aim for in CKD patients and at what Hb level the risks of adverse events begin to increase remain elusive. Future studies are still needed to elucidate these questions.
Highlights
Anemia, as an inevitable and frequent complication of chronic kidney disease (CKD), is often accompanied by a wide range of clinical symptoms, such as impaired physical capacity, decreased neurocognitive function and poor quality of life both in nondialysis and dialysis patients [1]
Based on the treatment modality, we divided these studies into two subgroups: the high and low Hb levels in 15 trials were obtained with Erythropoiesis-stimulating agents (ESAs) therapy, and in the rest 9 trials, the high Hb group were treated with ESAs while the low Hb group were given no treatment or treated with placebo
We observed an increased risk of mortality in patients having high Hb levels, as compared with patients having low Hb levels when both groups were treated with ESAs, though no significant difference was detected in the groups of ESAs treatment versus no ESAs treatment
Summary
As an inevitable and frequent complication of chronic kidney disease (CKD), is often accompanied by a wide range of clinical symptoms, such as impaired physical capacity, decreased neurocognitive function and poor quality of life both in nondialysis and dialysis patients [1]. The National Kidney Foundation-Kidney Disease Outcomes Quality Initiative (NKF-KDOQI) guidelines (2000) recommended that the selected Hb targets should generally be maintained in the range of 11.0 to 12.0 g/dL in patients with CKD, whether or not they were receiving dialysis [6]. Numerous studies have identified a relationship between hemoglobin (Hb) levels and mortality in patients with chronic kidney disease (CKD), which have raised concerns about the optimal Hb targets in correction of anemia. Our study is designed to investigate the potential effects of targeted Hb levels, aiming to give some evidence for therapy of renal anemia
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