Chapter 8 Renal anaemia

8.1 Erythropoetin

One small RCT suggested that conservative Hb targets might be associated with better hard outcomes. (See commentary from Daniel Coyne.)

Normal Haematocrit Trial (1998): - target HCT 0.42 vs. 0.30. Higher rates of death and non-fatal MI in the higher target group.

Three large RCTs of erythorpoetin therapy established that conservative Hb targets are associated with better hard outcomes.

CREATE (2006): - target Hb 10.5–11.5 vs. 13.0–15.0 in CKD3–4. No difference in rates of cardiovascular events.

CHOIR (2006): - target Hb 11.3 vs. 13.5. Higher rates of composite end-point (death, MI, stroke, CCF) in the higher-target group.

TREAT (2009): - darbepoetin vs. placebo to target Hb 13 vs. 9 in CKD with T2DM. Increased risk of stroke in the higher-target group.

8.2 Iron

FIND-CKD (2014): - IV iron targeting lower vs. higher ferritin vs oral iron in non-dialysis CKD. IV iron targeting higher ferritin (400–600 mcg/L) was more effective than oral iron at delaying the need for other anaemia management. Adverse events similar between groups.

REVOKE (2015): - oral vs. IV iron in CKD 3–4. Trial terminated early due to high numbers of adverse events (infections / CVS) in the IV iron group.

PIVOTAL (2018): - high-dose proactive vs. low-dose reactive IV iron sucrose in HD patients. Iron given unless ferritin > 700 or Tsats \(\geq\) 40% in high-dose group or if ferritin < 200 or Tsats <20% in low-dose group. Primary CVS end-point (MI, stroke, CCF, death). Fewer patients in the high-dose group reached primary end-point; mean ESA dose lower in high-dose group.