Haemoglobin and haematocrit targets for the anaemia of chronic kidney disease

Low haemoglobin (Hb) concentrations (< 120 g/l) in patients with chronic kidney disease appear not to be associated with increased mortality as compared to higher Hb concentrations (> 133 g/l). Lower Hb targets appear to be associated with an increased risk for seizures but a reduced risk of hypertension.

A Cochrane review included 22 studies with a total of 3 707 subjects. Hb ≥ 133 g/l was not associated with a reduction in the risk of all-cause mortality compared with 120 g/l in dialysis and pre-dialysis patients. In pre-dialysis patients, there was a significantly lower end of treatment creatinine clearance with Hb < 120 g/l compared to > 130 g/l (MD –4.17, 95% CI –6.33 to –2.02) but no significant difference in the risk of end-stage kidney disease (ESKD; RR 1.05, 95% CI 0.50 to 2.22). Lower Hb targets resulted in an increased risk for seizures (RR 5.25, 95% CI 1.13 to 24.34) and a reduced risk of hypertensive episodes (RR 0.50, 95% CI 0.33 to 0.76). There were no significant differences in the risk of vascular access thrombosis.

Comment: The quality of evidence is downgraded by limitations in study quality (inadequate or unclear allocation concealment, lack of blinding, more than 20% loss to follow up).

Ədəbiyyat

1. Strippoli GFM, Navaneethan SD, Craig JC. Haemoglobin and haematocrit targets for the anaemia of chronic kidney disease. Cochrane Database Syst Rev. 2006;(4):CD003967.