Restrictive vs. liberal transfusion strategy in patients with chronic kidney disease: A retrospective cohort study

Chronic kidney disease (CKD) is associated with anemia, a common complication that, in severe cases, requires red blood cell (RBC) transfusion. The optimal hemoglobin (Hb) threshold for deciding when to transfuse remains a matter of debate. This study aimed to compare the effects of a restrictive transfusion strategy (Hb≤7g/dl) versus a liberal strategy (Hb>7g/dl) in hospitalized patients with CKD.

A single-center retrospective cohort study was conducted between December 2022 and December 2023, including adult patients with CKD stages G3b, G4, and G5 who received RBC transfusions. Demographic data, comorbidities, clinical, laboratory, and prognostic variables were analyzed, including admission to the Intensive Care Unit (ICU), hospital length of stay, pulmonary complications, and transfusion-related adverse events.

Of 934 patients evaluated, 682 met the inclusion criteria. The restrictive transfusion group (n=341) showed a lower ICU admission rate (6.5 vs. 14.7%; P<.001) and fewer transfusion-related adverse events (P<.001). A prolonged hospital stay (>10 days) was more frequent in the liberal group (32 vs. 10.5%; P<.001).

The restrictive strategy was associated with fewer complications and a shorter hospital stay, which appears to support a restrictive transfusion approach in patients with chronic kidney disease (CKD).