, Volume 14, Issue 3, pp 298-299
Date: 19 Mar 2010

The target hemoglobin in non-dialysis CKD: still a matter for debate?

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To the Editor,

Determining the target hemoglobin (Hb) level through randomized control trials (RCTs) is of particular interest. The four RCTs performed recently in non-dialysis CKD patients suggested that there was no benefit concerning cardiovascular risks in the high Hb target groups [13]. Notably, there were detrimental outcomes in the high Hb groups (Table 1). As a result, some practitioners have been uncertain about the use of ESAs for renal anemia.

Therefore, it is a good time to reconsider the target Hb levels. The target Hb levels in the low arm was roughly 11 g/dl, and those in the high arm 13 g/dl. At the end of the studies, the achieved Hb levels in the low or placebo arm were 10.6 g/dl in TREAT, 11.4 g/dl in CHOIR and 12.1 g/dl in ACORD, and those in the high arm were 12.5 g/dl in TREAT, 12.6 g/dl in CHOIR and 13.5 g/dl in the ACORD. These figures indicate that all four studies were performed in the actual Hb range of 10.6–13.5 g/dl. Does this mean that Hb 10.6 g/dl may be e ...