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Positive Outcomes of High Hemoglobin Target in Patients With Chronic Kidney Disease Not on Dialysis: A Randomized Controlled Study
Article first published online: 25 MAY 2011
© 2011 The Authors. Therapeutic Apheresis and Dialysis © 2011 International Society for Apheresis
Therapeutic Apheresis and Dialysis
Volume 15, Issue 5, pages 431–440, October 2011
How to Cite
Akizawa, T., Gejyo, F., Nishi, S., Iino, Y., Watanabe, Y., Suzuki, M., Saito, A., Akiba, T., Hirakata, H., Fukuhara, S., Morita, S., Hiroe, M., Hada, Y., Suzuki, M., Akaishi, M., Iwasaki, M., Tsubakihara, Y. and KRN321 STUDY Group (2011), Positive Outcomes of High Hemoglobin Target in Patients With Chronic Kidney Disease Not on Dialysis: A Randomized Controlled Study. Therapeutic Apheresis and Dialysis, 15: 431–440. doi: 10.1111/j.1744-9987.2011.00931.x
- Issue published online: 22 SEP 2011
- Article first published online: 25 MAY 2011
- Received November 2010; revised February 2011.
- Cardiac function;
- Chronic kidney disease;
- Darbepoetin alfa;
- Quality of life
Correcting anemia in patients with chronic kidney disease (CKD) to higher hemoglobin (Hb) levels may be associated with increased risk. No optimal target for Hb has been established. This controlled study examined 321 patients with CKD who were not on dialysis, had a Hb level of <10 g/dL, and a serum creatinine of 2.0 to 6.0 mg/dL. They were randomized into two target Hb groups: 161 to high Hb (11.0–13.0 g/dL) to receive darbepoetin alfa and low Hb to 160 (9.0–11.0 g/dL) to receive recombinant erythropoietin. The study lasted 48 weeks. Of 154 and 153 patients with adverse events, cardiovascular adverse events developed in 42 and 51 patients in the high and low Hb groups, respectively, with no significant difference in the incidence. All quality of life scores improved in the high Hb group and vitality improved significantly more with high Hb (P = 0.025). The left ventricular mass index (LVMI) remained stable in the low Hb group, but there was a significant decrease in LVMI in the high group (P < 0.001). There were no safety concerns with targeting a higher Hb level during the 48 weeks of this study. Patients with a higher Hb target had comparatively better outcomes with respect to quality of life and LVMI.