Individualizing target haemoglobin concentrations--tailoring treatment for renal anaemia

Despite the publication of National Kidney Foundation and European Best Practice Guidelines, there is still uncertainty among nephrologists regarding the optimum target haemoglobin (Hb) concentration for patients treated with erythropoietin. For most patients, the target Hb concentration is 11-12 g/dl, resulting in only partial correction of anaemia. However, there is a link between subnormal Hb concentration and the development of cardiovascular disease. Thus, it may be more beneficial to normalize Hb, although this has to be balanced against the concern that full correction of anaemia may result in adverse effects, such as hypertension and progression of renal disease. There is increasing evidence that it may be appropriate to treat each patient individually, and to tailor treatment according to a number of physiological and lifestyle variables, avoiding higher Hb concentrations in certain patient groups (such as those with cardiac problems). This was supported by the results of a survey of nephrologists and specialists in the field of renal anaemia. It was generally agreed that a higher target Hb concentration (12-14 g/dl) might be appropriate for a fit, young patient with no significant co-morbidity, whereas a lower target Hb (10-12 g/dl) might be appropriate for an elderly patient with multiple medical problems. In conclusion, guidelines for target Hb in the US and Europe are probably not applicable to all patients. It is important that renal anaemia patients are considered as individuals, and their treatment tailored accordingly. It is time to establish evidence-based criteria for individualizing renal anaemia treatment.