New Target Hemoglobin for Anemia of Kidney Disease

A recent article in the New York Times discussed a paper in the New England Journal of Medicine which showed higher rates of cardiovascular events in patients with chronic kidney disease who were treated to a target hemoglobin of 13.5 g/dL rather than 11.3 g/dL :

A total of 222 composite events occurred: 125 events in the high-hemoglobin group, as compared with 97 events in the low-hemoglobin group (hazard ratio, 1.34; 95% confidence interval, 1.03 to 1.74; P=0.03). There were 65 deaths (29.3%), 101 hospitalizations for congestive heart failure (45.5%), 25 myocardial infarctions (11.3%), and 23 strokes (10.4%). Seven patients (3.2%) were hospitalized for congestive heart failure and myocardial infarction combined, and one patient (0.5%) died after having a stroke. Improvements in the quality of life were similar in the two groups. More patients in the high-hemoglobin group had at least one serious adverse event.

A few important points:

• Treating anemia in patients with chronic kidney disease is beneficial. This study does not suggest that erythropoetin (epoetin alfa, Procrit) is itself a harmful medication. Prior to the introduction of erythropoetin, many patients with kidney disease required frequent transfusions and were often fatigued.
• The new target hemoglobin for patients with CKD treated with epoetin is 11 g/dL (not 11 - 12). New guidelines from the National Kidney Foundation are here.

Anemia and kidney disease is also discussed at Clinical Cases and Images.

Related Link: Medications for Anemia