Increase in hemoglobin targets may benefit certain patients with CKD, anemia
Click Here to Manage Email Alerts
An analysis of published studies showed relief of fatigue for patients with chronic kidney disease and anemia when treatment with erythropoietin stimulating agents led to hemoglobin levels higher than currently recommended targets.
Further findings indicated younger patients and those without diabetes may experience the most benefits.
“Anemia is found in up to 40% of patients with advanced [nondialysis-dependent CKD] ND-CKD and has been associated to higher mortality and morbidity,” Murilo Guedes, MD, MSc, of Pontifícia Universidade Católica do Paraná in Brazil, and colleagues wrote. “In fact, lower hemoglobin (Hb) has been shown to be one of the potential modifiable causal factors for CKD associated fatigue, which is a multidimensional concept with diverse causes, ranging from social, psychological and clinical factors, that is perceived as one of the most important outcomes for CKD patients and caregivers.”
Adding that recommendations on hemoglobin targets differ between medical societies – and that it could be advantageous to tailor targets to individual patients – the researchers sought to determine the impact of different achieved hemoglobin levels on physical health-related quality of life and functionality by reviewing the existing literature on the topic. A total of 15 randomized controlled trials and five observational studies were included for the systematic review, with 11 RCTs also included in the meta-analysis, in which patients in the control groups achieved Hb between 10 g/dL and 11.5 g/dL and active groups achieved Hb greater than 11.5 g/dL.
While no impact was seen on physical function or physical role with higher hemoglobin targets, researchers found that achieved hemoglobin within 11.7 g/dL to 13.5 g/dL was associated with a clinically significant benefit for fatigue compared to current recommended target ranges of 10 g/dL to 11.5 g/dL.
“The subgroups of RCTs reporting achieved Hb [greater than] 13 g/dL on follow-up demonstrated higher effect sizes for changes in fatigue, suggesting that incremental benefits in fatigue could be associated with higher Hb values, although the effects are modest in magnitude,” Guedes and colleagues wrote.
The analysis also showed older age and the proportion of patients with long-term diabetes were associated with lower effect sizes for Hb differences on fatigue.
“The current boundaries for hemoglobin values are defined for safety reasons that were specifically based on the ESA trials,” the researchers concluded. “However, along with the development of new drugs for treatment of CKD anemia, such as the recently published trials on the [hypoxia-inducible factor] HIF-stabilizers, and the advances in characterizing distinct populations at risk, a renewed approach toward flexible targets could lead to modest, but important benefits for patients on fatigue outcomes.”
Collapse
Read more about
Click Here to Manage Email Alerts