title: Clinical impact of the ERBP Working Group 2010 Recommendations for the anemia management in chronic kidney disease not on dialysis: ACERCA study.
abstract: OBJECTIVE
  The Anemia Working Group of ERBP in 2010 recommended a target hemoglobin (Hb) level in the range of 11-12 g/dL, without intentionally exceeding 13 g/dL during the treatment with erythropoiesis stimulating agents (ESAs). This study evaluated if there was a clinical impact of this statement in the anemia management of chronic kidney disease (CKD) patients treated with ESAs not on dialysis in routine clinical practice in Spain.
  
  
  METHODS
  This was an observational and cross-sectional study carried out in CKD patients not on dialysis in Spain who initiated ESA treatment (naïve), or were shifted from a previous ESA to another ESAs (converted) since January 2011.
  
  
  RESULTS
  Of 441 patients evaluated, 67.6% were naïve and 32.4% were converted. At the study visit, 42.5% of naïve patients achieved the Hb target of 11-12 g/dL, with a mean Hb of 11.3±1.3 g/dL (vs 10.1±0.9 g/dL at the start of ESA therapy). Only 35.3% of converted patients maintained Hb levels within the recommended target at the study visit. Yet, 8.2% of naïve patients and 7.9% of those converted had Hb levels >13 g/dL. Hb levels were similar across subgroups of patients, regardless of the presence of significant comorbidities.
  
  
  CONCLUSIONS
  Anemia management in CKD patients treated with ESAs by Spanish nephrologists seems to be aimed at preventing Hb levels <11 g/dL, while <50% of patients were within the narrow recommended Hb target range. This, together with the lack of individualization in Hb targets according to patients' comorbidities show that there is still room for improvement in renal anemia management in the clinical setting.
authors: Servicio de Nefrología. Hospital Universitario de Bellvitge. IDIBELL. Hospitalet, Barcelona (Spain). Electronic address: albertomcastelao@gmail.com.
authors: Alberto
authors: A
authors: Martínez-Castelao
authors: Servicio de Nefrología. Hospital Clínic. Barcelona (Spain).
authors: Aleix
authors: A
authors: Cases
authors: Servicio de Nefrología. Hospital Universitario La Paz. Madrid (Spain).
authors: Alberto Torre
authors: AT
authors: Carballada
authors: Servicio de Nefrología. Hospital General Universitario de Alicante. Alicante (Spain).
authors: Javier Torralba
authors: JT
authors: Iranzo
authors: Servicio de Nefrología. Clínica Girona. Girona (Spain).
authors: Josep
authors: J
authors: Bronsoms
authors: Servicio de Nefrología. Hospital Universitario Dr. Josep Trueta. Girona (Spain).
authors: Martí
authors: M
authors: Vallès-Prats
authors: Servicio de Nefrologia. Hospital General de Jerez de la Frontera. Cádiz (Spain).
authors: Daniel Torán
authors: DT
authors: Monserrat
authors: Servicio de Nefrología. Hospital Clínic. Barcelona (Spain).
authors: Elisabet Masso
authors: EM
authors: Jimenez
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000097:blood / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D019468:Disease Management; D005260:Female; D019983:Guideline Adherence; D006397:Hematinics / Q000627:therapeutic use; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011364:Professional Practice; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000628:therapy; D013030:Spain / Q000453:epidemiology
chemical_list: D006397:Hematinics; D006454:Hemoglobins
keywords: Agentes estimuladores de la eritropoyesis; Anemia; Chronic kidney disease; Enfermedad renal crónica; Erythropoiesis-stimulating agents; Estudio observacional; Hemoglobin; Hemoglobina; Observational Study