Journal Article

Target haemoglobin to aim for with erythropoiesis-stimulating agents: a position statement by ERBP following publication of the Trial to Reduce Cardiovascular Events with Aranesp<sup>®</sup> Therapy (TREAT) Study

Francesco Locatelli, Pedro Aljama, Bernard Canaud, Adrian Covic, Angel De Francisco, Iain C. Macdougall, Andrzej Wiecek and Raymond Vanholder

in Nephrology Dialysis Transplantation

Published on behalf of European Renal Association - European Dialysis and Transplant Assoc

Volume 25, issue 9, pages 2846-2850
Published in print September 2010 | ISSN: 0931-0509
Published online June 2010 | e-ISSN: 1460-2385 | DOI: http://dx.doi.org/10.1093/ndt/gfq336
Target haemoglobin to aim for with erythropoiesis-stimulating agents: a position statement by ERBP following publication of the Trial to Reduce Cardiovascular Events with Aranesp® Therapy (TREAT) Study

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The European Renal Best Practice (ERBP), which are issued by ERA–EDTA, are suggestions for clinical practice in areas in which evidence is lacking or weak, together with position statements on recently published randomized controlled trials, or on existing guidelines and recommendations. In 2009, the Anaemia Working Group of ERBP published its first position statement about the haemoglobin target to aim for with erythropoietin-stimulating agents (ESA) and on issues that were not covered by K-DOQI in 2006–07. This second position paper of the group follows the publication of the Trial to Reduce Cardiovascular Events with Aranesp® Therapy (TREAT) Study. This multi-centre, placebo-controlled trial compared cardiovascular and renal outcomes in 4038 patients with type 2 diabetes, chronic kidney disease not on dialysis, and anaemia who were randomized to complete anaemia correction (haemoglobin target of 13 g/dL using darbepoetin alfa) or placebo (with a haemoglobin rescue value of 9 g/dL).

Following the findings of the TREAT study, the Anaemia Working Group of ERBP maintains its view that ‘Hb values of 11–12 g/dL should be generally sought in the CKD population without intentionally exceeding 13 g/dL’ and that the doses of ESA therapy to achieve the target haemoglobin should also be considered. More caution is suggested when treating anaemia with ESA therapy in patients with type 2 diabetes not undergoing dialysis (and probably in diabetics at all CKD stages). In those with ischaemic heart disease or with a previous history of stroke, possible benefits should be weighed up against an increased risk of stroke recurrence, when deciding which Hb level to aim for.

These recommendations are not intended to represent a new guideline as they are not the result of a systematic review of the evidence.

Keywords: anemia; chronic kidney disease; diabetes; erythropoiesis stimulating agents; stroke

Journal Article.  3269 words. 

Subjects: Nephrology

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