Therapeutic Targets for the Anemia of Predialysis Chronic Kidney Disease: A Meta-Analysis of Randomized, Controlled Trials. (August 2019)

• Record Type: Journal Article
• Authors: Liu, Hongyong; Ye, Yuqiu; Chen, Yanbing; Zhang, Yunqiang; Li, Shaomin; Hu, Wentao; Yang, Rongqian; Zhang, Zhesi; Peng, Hongquan; Lv, Linsheng; Liu, Xun
• Is Part Of: Journal of investigative medicine. Volume 67:Number 6(2019)
• Page Start: 1002
• Page End: 1008
• Publication Date: 2019-08
• Subjects: anemia -- prognosis -- kidney diseases; Clinical medicine -- Periodicals; Medicine -- Research -- Periodicals; Medicine; Research -- United States; Clinical medicine; Medicine -- Research; Periodicals; 616.075
• DOI: 10.1136/jim-2018-000915
• Languages: English
• ISSNs: 1081-5589

Abstract

Anemia is one of the major complications in predialysis patients with chronic kidney disease (CKD). A clearer cognition of the prognostic impact of hemoglobin (Hb) or hematocrit (Hct) target on the outcomes of predialysis patients with CKD is significant. This article aims to establish the suitable hemoglobin target to provide clinical guidance. MEDLINE, EmBase, the Cochrane Library and other databases were searched with both MeSH terms and keywords to gather researches that assessed all-cause mortality, stroke, treatment of renal replacement, and transfusion. The meta-analysis was accomplished via Revman 5.3 version. Totally, 13 eligible studies involving 7606 patients were included. There was a significantly lower risk of transfusion (risk ratio (RR) 0.59, 95% CI 0.52 to 0.67; p<0.00001) in the higher hemoglobin group than in the lower one. However, no significant difference was found in all-cause mortality (RR 1.10, 95% CI 0.98 to 1.23; p=0.11), stroke (RR 1.32, 95% CI 0.82 to 2.10; p=0.25) and treatment of renal replacement including hemodialysis, peritoneal dialysis and renal transplant (RR 1.08, 95% CI 0.95 to 1.22; p= 0.23) between the higher hemoglobin group and the lower one. The results favor the higher hemoglobin target. To target the higher hemoglobin when treating predialysis patients with CKD may decrease the risk of transfusion without increasing the risk of death, stoke, and treatment of renal replacement.