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A Point-of-Care Method with Integrated Decision Support Tool to Estimate Anemia at Population Level
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Hemoglobin targets for chronic kidney disease patients with anemia: a systematic review and meta-analysis

Zhou Jing1, Yuan Wei-jie, Zhu Nan

  • 1Department of Nephrology The First People's Hospital, Shanghai Jiaotong University, Shanghai, People's Republic of China.

Plos One
|September 7, 2012
PubMed

Insights

Targeting lower hemoglobin (Hb) levels in chronic kidney disease (CKD) patients may reduce mortality and adverse events like hypertension and stroke. Higher Hb targets are associated with increased risks, suggesting caution in anemia treatment.

Area of Science:

  • Nephrology
  • Hematology
  • Clinical Trials

Background:

  • A known association exists between hemoglobin (Hb) levels and mortality in chronic kidney disease (CKD) patients.
  • This has led to concerns regarding optimal Hb targets for anemia correction in CKD.
  • This study investigates the impact of different Hb targets on clinical outcomes in CKD patients.

Purpose of the Study:

  • To evaluate the effects of high versus low hemoglobin targets on clinical outcomes in patients with anemia and CKD.
  • To provide evidence-based recommendations for the management of renal anemia.

Main Methods:

  • A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted.
  • Searches were performed in Medline, Embase, and Cochrane Database of Systematic Reviews up to February 2012.
  • Data from 24 RCTs involving 10,361 CKD patients were analyzed using RevMan software.

Main Results:

  • Higher Hb targets (around 13.0 g/dL) were associated with a statistically significant increased risk of mortality (RR 1.18; 95% CI 1.02 to 1.37) compared to lower targets (around 10.0 g/dL) when treated with erythropoiesis-stimulating agents (ESAs).
  • High Hb targets also increased the 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).
  • No significant differences were observed in the risk of non-fatal myocardial infarction or renal replacement therapy between high and low Hb target groups.

Conclusions:

  • Targeting lower Hb levels appears beneficial for CKD patients, particularly in the predialysis population.
  • The optimal Hb targets and the specific Hb level at which adverse event risks increase remain unclear.
  • Further research is necessary to definitively establish optimal Hb targets for managing renal anemia in CKD.
Abstract

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