KDOQI us commentary on the 2012 KDIGO clinical practice guideline for anemia in CKD

Alan S. Kliger, Robert N. Foley, David S. Goldfarb, Stuart L. Goldstein, Kirsten Johansen, Ajay Singh, Lynda Szczech

Research output: Contribution to journalArticlepeer-review

127 Scopus citations

Abstract

The 2012 KDIGO (Kidney Disease: Improving Global Outcomes) Clinical Practice Guideline for Anemia in Chronic Kidney Disease provides clinicians with comprehensive evidence-based recommendations to improve patient care. In this commentary, we review these recommendations and the underlying evidence. Most recommendations are well reasoned. For some, the evidence is unclear and recommendations require some qualification. While the KDIGO guideline stresses the potential risks of intravenous iron therapy, withholding iron might have its own risks. The recommendation to avoid hemoglobin levels falling below 9 g/dL sets a lower bound of "acceptability" that may increase blood transfusion. Given the lack of research supporting the optimal transfusion strategy for end-stage renal disease patients, it is difficult to weigh the risks and benefits of red blood cell transfusion. We find a paucity of evidence that hemoglobin concentration targeted between 11 and 11.5 g/dL is associated with a safety risk. Although the evidence that erythropoiesis-stimulating agent use improves patient quality of life is poor, it is possible that the instruments used to measure quality of life may not be well attuned to the needs of chronic kidney disease or dialysis patients. Our last section focuses specifically on the recommendations to treat anemia in children.

Original languageEnglish (US)
Pages (from-to)849-859
Number of pages11
JournalAmerican Journal of Kidney Diseases
Volume62
Issue number5
DOIs
StatePublished - Nov 2013

Bibliographical note

Funding Information:
Support: No financial support was required for the development of this commentary.

Copyright:
Copyright 2018 Elsevier B.V., All rights reserved.

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