Canadian Society of Nephrology commentary on the 2012 KDIGO Clinical Practice Guideline for Anemia in CKD.
The KDIGO (Kidney Disease: Improving Global Outcomes) 2012 clinical practice guideline for anemia management in patients with chronic kidney disease provides the structural and evidence base for the Canadian Society of Nephrology commentary on this guideline's relevancy and application to the Canadian health care system. While in general agreement, we provide commentary on 11 of the 61 KDIGO guideline statements. Specifically, we agreed that a therapeutic trial of iron is appropriate in cases in which a reduction in erythropoiesis-stimulating agent (ESA) dosage or avoidance of ESA and transfusion is desired, transferrin saturations are >30%, and ferritin concentrations are >500 μg/L. However, we concluded that there is insufficient evidence to support an upper target or threshold for ferritin and transferrin saturation levels. We agree with the initiation of ESA treatment when hemoglobin (Hb) level is 90-100 g/L; however, we specifically state that an acceptable range for Hb level is 95-115 g/L, with a target of 100-110 g/L, and add caution to individualization above this range due to concerns regarding the safety of ESAs. We agree that ESAs should be used with considerable caution in patients with active malignancy, history of stroke, or history of malignancy, and we suggest initiating ESA therapy at Hb level of 90 g/L and to aim for a Hb level in the range of 90-105 g/L. The reader is encouraged to note the level of evidence and review the entire KDIGO anemia guideline to interpret the guideline statements and commentary appropriately.
Department of Medicine and Epidemiology, Kidney Clinical Research Unit Western University, London, Ontario, Canada. Electronic address: louise.moist@lhsc.on.ca.
Louise M
LM
Moist
Stéphan
S
Troyanov
Colin T
CT
White
Lori D
LD
Wazny
Jo-Anne
JA
Wilson
Phil
P
McFarlane
Lori
L
Harwood
Manish M
MM
Sood
Steven D
SD
Soroka
Adam
A
Bass
Braden J
BJ
Manns
D000740:Anemia / Q000097:blood / Q000209:etiology* / Q000628:therapy*; D001803:Blood Transfusion; D002170:Canada; 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
D006397:Hematinics; D006454:Hemoglobins; D007501:Iron
Anemia; Canadian Society of Nephrology (CSN); Kidney Disease: Improving Global Outcomes (KDIGO); chronic kidney disease (CKD); clinical practice guideline; commentary