title: KDOQI US commentary on the 2012 KDIGO Clinical Practice Guideline for Anemia in CKD.
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.
authors.affiliation: Yale School of Medicine and Yale-New Haven Hospital, New Haven, CT. Electronic address: alan.kliger@ynhh.org.
authors.forename: Alan S
authors.initials: AS
authors.lastname: Kliger
authors.forename: Robert N
authors.initials: RN
authors.lastname: Foley
authors.forename: David S
authors.initials: DS
authors.lastname: Goldfarb
authors.forename: Stuart L
authors.initials: SL
authors.lastname: Goldstein
authors.forename: Kirsten
authors.initials: K
authors.lastname: Johansen
authors.forename: Ajay
authors.initials: A
authors.lastname: Singh
authors.forename: Lynda
authors.initials: L
authors.lastname: Szczech
mesh_terms: D000740:Anemia / Q000097:blood / Q000209:etiology* / Q000628:therapy*; D001803:Blood Transfusion; D019317:Evidence-Based Medicine; D006397:Hematinics / Q000627:therapeutic use; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007501:Iron / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D011788:Quality of Life; D006435:Renal Dialysis / Q000009:adverse effects*; D051436:Renal Insufficiency, Chronic / Q000628:therapy*; D018570:Risk Assessment; D014481:United States
chemical_list: D006397:Hematinics; D006454:Hemoglobins; D007501:Iron