Background. Erythropoietin deficiency and anemia occur in Chronic Kidney Disease (CKD) and may be treated with Erythropoietin Stimulating Agents (ESAs). The optimal hemoglobin, in non-End Stage Renal Disease CKD, is controversial.Methods. We review three recent randomized trials in anemia in CKD: CHOIR, CREATE, and TREAT.Results. CHOIR (N=1432) was terminated early with more frequent death and cardiovascular outcomes in the higher Hb group (HR 1.34: 95% C.I. 1.03–1.74,P=.03). CREATE (N=603) showed no difference in primary cardiovascular endpoints. Stroke was more common in the higher Hb group (HR 1.92; 95% C.I. 1.38–2.68;P<.001) in TREAT (N=4038).Conclusions. There is no benefit to an Hb outside the 10–12 g/dL range in this population. To avoid transfusions and improve Quality of Life, ESAs should be used cautiously, especially in patients with Diabetes, CKD, risk factors for stroke, and ESA resistance.
Implementation of an Agency to Improve Chronic Kidney Disease Care in Ontario: Lessons Learned by the Ontario Renal Network
