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KDOQI Clinical Practice Guideline and Clinical Practice Recommendations for Anemia in Chronic Kidney Disease: 2007 Update of Hemoglobin Target

        These Clinical Practice Guideline (CPG) and Clinical Practice Recommendations (CPRs) are designed to provide information and assist decision making. They are not intended to define a standard of care and should not be construed as one. Neither should they be interpreted as prescribing an exclusive course of management.
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        References

          • Drueke T.B.
          • Locatelli F.
          • Clyne N.
          • et al.
          Normalization of hemoglobin level in patients with chronic kidney disease and anemia.
          N Engl J Med. 2006; 355: 2071-2084
          • Singh A.K.
          • Szczech L.
          • Tang K.L.
          • et al.
          Correction of anemia with epoetin alfa in chronic kidney disease.
          N Engl J Med. 2006; 355: 2085-2098
          • Rossert J.
          • Levin A.
          • Roger S.D.
          • et al.
          Effect of early correction of anemia on the progression of CKD.
          Am J Kidney Dis. 2006; 47: 738-750
          • Macdougall I.C.
          • Temple R.M.
          • Kwan J.T.
          Is early treatment of anaemia with epoetin-{alpha} beneficial to pre-dialysis chronic kidney disease patients?.
          Nephrol Dial Transplant. 2007; 22: 784-793
          • Ritz E.
          • Laville M.
          • Bilous R.W.
          • et al.
          Target level for hemoglobin correction in patients with diabetes and CKD: Primary results of the Anemia Correction in Diabetes (ACORD) Study.
          Am J Kidney Dis. 2007; 49: 194-207
          • Gouva C.
          • Nikolopoulos P.
          • Ioannidis J.P.
          • Siamopoulos K.C.
          Treating anemia early in renal failure patients slows the decline of renal function: A randomized controlled trial.
          Kidney Int. 2004; 66: 753-760
        1. Epogen (Epoetin alfa) for injection: Prescribing information. Silver Spring, MD, US Food and Drug Administration (USFDA), March 2007

        2. Procrit (Epoetin alfa) for injection: Prescribing information. Silver Spring, MD, US Food and Drug Administration (USFDA), March 2007

        3. Aranesp (darbepoetin alfa) for injection: Prescribing information. Silver Spring, MD, US Food and Drug Administration (USFDA), March 2007

          • World Health Organization
          WHOQOL: Measuring Quality of Life.
          The World Health Organization Quality of Life Instruments, Geneva, Switzerland1997 (WHO/MSA/MNH/PSF/97.4)
        4. Hahn EA, Cella D, Chassany O, et al: A comparison of the precision of health-related quality of life data relative to other clinical measures. Mayo Clin Proc (in press)

          • Furuland H.
          • Linde T.
          • Ahlmen J.
          • et al.
          A randomized controlled trial of haemoglobin normalization with epoetin alfa in pre-dialysis and dialysis patients.
          Nephrol Dial Transplant. 2003; 18: 353-361
          • Foley R.N.
          • Parfrey P.S.
          • Morgan J.
          • et al.
          Effect of hemoglobin levels in hemodialysis patients with asymptomatic cardiomyopathy.
          Kidney Int. 2000; 58: 1325-1335
          • Besarab A.
          • Bolton W.K.
          • Browne J.K.
          • et al.
          The effects of normal as compared with low hematocrit values in patients with cardiac disease who are receiving hemodialysis and epoetin.
          N Engl J Med. 1998; 339: 584-590
          • Parfrey P.S.
          • Foley R.N.
          • Wittreich B.H.
          • et al.
          Double-blind comparison of full and partial anemia correction in incident hemodialysis patients without symptomatic heart disease.
          J Am Soc Nephrol. 2005; 16: 2180-2189
          • Pisoni R.L.
          • Bragg-Gresham J.L.
          • Young E.W.
          • et al.
          Anemia management and outcomes from 12 countries in the Dialysis Outcomes and Practice Patterns Study (DOPPS).
          Am J Kidney Dis. 2004; 44: 94-111
          • Ofsthun N.
          • Labrecque J.
          • Lacson E.
          • Keen M.
          • Lazarus J.M.
          The effects of higher hemoglobin levels on mortality and hospitalization in hemodialysis patients.
          Kidney Int. 2003; 63: 1908-1914
          • Levin A.
          • Djurdjev O.
          • Duncan J.
          • Rosenbaum D.
          • Werb R.
          Haemoglobin at time of referral, prior to dialysis predicts survival: An association of haemoglobin with long-term outcomes.
          Nephrol Dial Transplant. 2006; 21: 370-377
          • Regidor D.L.
          • Kopple J.D.
          • Kovesdy C.P.
          • et al.
          Associations between changes in hemoglobin and administered erythropoiesis-stimulating agent and survival in hemodialysis patients.
          J Am Soc Nephrol. 2006; 17: 1181-1191
          • Roberts T.L.
          • Foley R.N.
          • Weinhandl E.D.
          • Gilbertson D.T.
          • Collins A.J.
          Anaemia and mortality in haemodialysis patients: Interaction of propensity score for predicted anaemia and actual haemoglobin levels.
          Nephrol Dial Transplant. 2006; 21: 1652-1662
          • Lacson E.
          • Ofsthun N.
          • Lazarus J.M.
          Effect of variability in anemia management on hemoglobin outcomes in ESRD.
          Am J Kidney Dis. 2003; 41: 111-124
          • Ofsthun N.J.
          • Lazarus J.M.
          Impact of the change in CMS billing rules for erythropoietin on hemoglobin outcomes in dialysis patients.
          Blood Purif. 2007; 25: 31-35
          • Fishbane S.
          • Berns J.S.
          Hemoglobin cycling in hemodialysis patients treated with recombinant human erythropoietin.
          Kidney Int. 2005; 68: 1337-1343
          • Berns J.S.
          • Elzein H.
          • Lynn R.I.
          • et al.
          Hemoglobin variability in epoetin-treated hemodialysis patients.
          Kidney Int. 2003; 64: 1514-1521
          • Greenwood R.N.
          • Ronco C.
          • Gastaldon F.
          • et al.
          Erythropoietin dose variation in different facilities in different countries and its relationship to drug resistance.
          Kidney Int Suppl. 2003; : S78-S86
          • Levin A.
          • Djurdjev O.
          • Thompson C.
          • et al.
          Canadian randomized trial of hemoglobin maintenance to prevent or delay left ventricular mass growth in patients with CKD.
          Am J Kidney Dis. 2005; 46: 799-811
          • Roger S.D.
          • McMahon L.P.
          • Clarkson A.
          • et al.
          Effects of early and late intervention with epoetin alpha on left ventricular mass among patients with chronic kidney disease (stage 3 or 4): Results of a randomized clinical trial.
          J Am Soc Nephrol. 2004; 15: 148-156
          • Phrommintikul A.
          • Haas S.J.
          • Elsik M.
          • Krum H.
          Mortality and target haemoglobin concentrations in anaemic patients with chronic kidney disease treated with erythropoietin: A meta-analysis.
          Lancet. 2007; 369: 381-388
          • Kuriyama S.
          • Tomonari H.
          • Yoshida H.
          • et al.
          Reversal of anemia by erythropoietin therapy retards the progression of chronic renal failure, especially in nondiabetic patients.
          Nephron. 1997; 77: 176-185
          • Roth D.
          • Smith R.D.
          • Schulman G.
          • et al.
          Effects of recombinant human erythropoietin on renal function in chronic renal failure predialysis patients.
          Am J Kidney Dis. 1994; 24: 777-784
          • Richardson D.
          • Bartlett C.
          • Will E.J.
          Optimizing erythropoietin therapy in hemodialysis patients.
          Am J Kidney Dis. 2001; 38: 109-117
          • Tolman C.
          • Richardson D.
          • Bartlett C.
          • Will E.
          Structured conversion from thrice weekly to weekly erythropoietic regimens using a computerized decision-support system: A randomized clinical study.
          J Am Soc Nephrol. 2005; 16: 1463-1470
          • Locatelli F.
          • Olivares J.
          • Walker R.
          • et al.
          Novel erythropoiesis stimulating protein for treatment of anemia in chronic renal insufficiency.
          Kidney Int. 2001; 60: 741-747
          • Nissenson A.R.
          • Swan S.K.
          • Lindberg J.S.
          • et al.
          Randomized, controlled trial of darbepoetin alfa for the treatment of anemia in hemodialysis patients.
          Am J Kidney Dis. 2002; 40: 110-118
          • Abraham P.A.
          • Opsahl J.A.
          • Rachael K.M.
          • et al.
          Renal function during erythropoietin therapy for anemia in predialysis chronic renal failure patients.
          Am J Nephrol. 1990; 10: 128-136
          • Abraham P.A.
          • Macres M.G.
          Blood pressure in hemodialysis patients during amelioration of anemia with erythropoietin.
          J Am Soc Nephrol. 1991; 2: 927-936
          • Bahlmann J.
          • Schoter K.H.
          • Scigalla P.
          • et al.
          Morbidity and mortality in hemodialysis patients with and without erythropoietin treatment: A controlled study.
          Contrib Nephrol. 1991; 88: 90-106
          • Berns J.S.
          • Rudnick M.R.
          • Cohen R.M.
          • et al.
          Effects of normal hematocrit on ambulatory blood pressure in epoetin-treated hemodialysis patients with cardiac disease.
          Kidney Int. 1999; 56: 253-260
          • Canadian Erythropoietin Study Group
          Association between recombinant human erythropoietin and quality of life and exercise capacity of patients receiving haemodialysis.
          BMJ. 1990; 300: 573-578
          • Canadian Erythropoietin Study Group
          Effect of recombinant human erythropoietin therapy on blood pressure in hemodialysis patients.
          Am J Nephrol. 1991; 11: 23-26
          • Clyne N.
          • Jogestrand T.
          Effect of erythropoietin treatment on physical exercise capacity and on renal function in predialytic uremic patients.
          Nephron. 1992; 60: 390-396
          • Furuland H.
          • Linde T.
          • Wikstrom B.
          • et al.
          Reduced hemodialysis adequacy after hemoglobin normalization with epoetin.
          J Nephrol. 2005; 18: 80-85
          • Kleinman K.S.
          • Schweitzer S.U.
          • Perdue S.T.
          • et al.
          The use of recombinant human erythropoietin in the correction of anemia in predialysis patients and its effect on renal function: A double-blind, placebo-controlled trial.
          Am J Kidney Dis. 1989; 14: 486-495
          • Laupacis A.
          Changes in quality of life and functional capacity in hemodialysis patients treated with recombinant human erythropoietin.
          Semin Nephrol. 1990; 10: S11-S19
          • Lim V.S.
          • DeGowin R.L.
          • Zavala D.
          • et al.
          Recombinant human erythropoietin treatment in pre-dialysis patients.
          Ann Intern Med. 1989; 110: 108-114
          • McMahon L.P.
          • McKenna M.J.
          • Sangkabutra T.
          • et al.
          Physical performance and associated electrolyte changes after haemoglobin normalization: A comparative study in haemodialysis patients.
          Nephrol Dial Transplant. 1999; 14: 1182-1187
          • McMahon L.P.
          • Mason K.
          • Skinner S.L.
          • et al.
          Effects of haemoglobin normalization on quality of life and cardiovascular parameters in end-stage renal failure.
          Nephrol Dial Transplant. 2000; 15: 1425-1430
          • Morris K.P.
          • Sharp J.
          • Watson S.
          • et al.
          Non-cardiac benefits of human recombinant erythropoietin in end stage renal failure and anaemia.
          Arch Dis Child. 1993; 69: 580-586
          • Nissenson A.R.
          • Korbet S.
          • Faber M.
          • et al.
          Multicenter trial of erythropoietin in patients on peritoneal dialysis.
          J Am Soc Nephrol. 1995; 5: 1517-1529
          • Revicki D.A.
          • Brown R.E.
          • Feeny D.H.
          • et al.
          Health-related quality of life associated with recombinant human erythropoietin therapy for predialysis chronic renal disease patients.
          Am J Kidney Dis. 1995; 25: 548-554
          • Sikole A.
          • Polenakovic M.
          • Spirovska V.
          • et al.
          Analysis of heart morphology and function following erythropoietin treatment of anemic dialysis patients.
          Artif Organs. 1993; 17: 977-984
          • Suzuki M.
          • Hirasawa Y.
          • Hirashima K.
          • et al.
          Dose-finding, double-blind, clinical trial of recombinant human erythropoietin (Chugai) in Japanese patients with end-stage renal disease.
          Contrib Nephrol. 1989; 76 (discussion, 212-218): 179-192
          • Watson A.J.
          • Gimenez L.F.
          • Cotton S.
          • et al.
          Treatment of the anemia of chronic renal failure with subcutaneous recombinant human erythropoietin.
          Am J Med. 1990; 89: 432-435
          • Moher D.
          • Tsertsvadze A.
          Systematic reviews: When is an update an update?.
          Lancet. 2006; 367: 881-883
          • Bucher H.C.
          • Guyatt G.H.
          • Cook D.J.
          • Holbrook A.
          • McAlister F.A.
          Users’ guides to the medical literature: XIX.
          JAMA. 1999; 282: 771-778
          • National Kidney Foundation
          KDOQI Clinical Practice Guidelines and Clinical Practice Recommendations for Anemia in Chronic Kidney Disease.
          Am J Kidney Dis. 2006; 47: S1-S145
          • Uhlig K.
          • Macleod A.
          • Craig J.
          • et al.
          Grading evidence and recommendations for clinical practice guidelines in nephrology.
          Kidney Int. 2006; 70: 2058-2065
          • Conlon P.J.
          • Kovalik E.
          • Schumm D.
          • Minda S.
          • Schwab S.J.
          Normalization of hematocrit in hemodialysis patients with cardiac disease does not increased blood pressure.
          Ren Fail. 2000; 22: 432-444
          • Coyne D.W.
          • Kapoian T.
          • Suki W.
          • et al.
          • DRIVE Study Group
          Ferric gluconate is highly efficacious in anemic hemodialysis patients with high serum ferritin and low transferrin saturation: Results of the Dialysis Patients’ Response to IV Iron with Elevated Ferritin (DRIVE) Study.
          J Am Soc Nephrol. 2007; 18: 975-984
          • GRADE Working Group
          Grading quality of evidence and strength of recommendations.
          BMJ. 2004; 328: 1490-1494
        5. Kunz K, Farquhar C: Grading and the GRADE instrument. Second Guidelines International Network Conference: Evidence in Action, Wellington, NZ, November, 2004