CKD: Anemia (2001)
Anemia and CKD (2001)
What is the evidence regarding anemia in chronic kidney disease? (2001 CD)
Anemia of chronic kidney disease is more prevalent at GFR <60 ml/min as a consequence of loss of erythropoietin synthesis by the kidney. Target goals for treatment are hemoglobin levels of 12 g/dL for males and 11 g/dL for females. One randomized controlled trial in patients with chronic kidney disease without dialysis comparing erythropoietin treatment vs. placebo reported significant improvement in energy levels and work capacity in the treatment group. Iron supplementation is necessary for effective erythropoiesis; when there is inadequate response to rHu-EPO, folate and vitamin B-12 status should also be evaluated. There are limited long term studies of the benefits of rHu-EPO in chronic kidney disease (non-dialysis).
- Grade I means there is Good/Strong evidence supporting the statement;
- Grade II is Fair;
- Grade III is Limited/Weak;
- Grade IV is Expert Opinion Only;
- Grade V is Not Assignable.
- High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
- Moderate (B) means we are moderately confident in the effect estimate;
- Low (C) means our confidence in the effect estimate is limited;
- Very Low (D) means we have very little confidence in the effect estimate.
- Ungraded means a grade is not assignable.
Evidence Summary: Anemia in Chronic Kidney Disease (2001)
- Quality Rating Summary
For a summary of the Quality Rating results, click here.
- Austrian Multicenter Study Group of r-HuEPO in Predialysis Patients. Effectiveness and safety of recombinant human erythropoietin in predialysis patients. Nephron. 1992; 61:399-403.
- Cavill I. Iron status as measured by serum ferritin: the marker and its limitations. Am J Kidney Diseases 1999; 34: (suppl 2): S12-S17.
- Drueke T. Hyporesponsiveness to recombinant human erythropoietin. Nephrol Dial Transplant. 2001; 16 (Suppl 7) 25-28.
- Jungers P, Choukroun G, Oualim Z, Robino C, Nguyen A and Man N. Beneficial influence of recombinanat human erythropoietin therapy on the rate of progression of chronic renal failure in predialysis patients. Nephrology Dialysis Transplantation 2001;16:307-312.
- Kausz AT, Obrador GT, Pereira BJG. Anemia management in patients with chronic renal insufficiency. Am J Kidney Dis. 2000; 36 (suppl 3):S39-S51.
- National Kidney Foundation. K/DOQI Clinical Practice Guidelines for Anemia of Chronic Kidney Disease, 2000. Am J Kidney Dis 2001; 37(Suppl 1):S182-S288.
- Pronai W, Riegler-Keil M, Silberbauer K, Stockenhuber F. Folic acid supplementation improves erythropoietin response. Nephron 1995; 71:395-400.
- US Recombinant Human Erythropoietin Predialysis Study Group. Double-blind, placebo-controlled study of the therapeutic use of recombinant human erythropoietin for anemia associated with chronic renal failure in predialysis patients. Am J Kidney Disease. 1991; 18: 50-59.