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KDOQI US commentary on the 2012 KDIGO Clinical Practice Guideline for Anemia in CKD.
Am J Kidney Dis. 2013 Nov; 62(5):849-59.AJ

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+Show Affiliations

Yale School of Medicine and Yale-New Haven Hospital, New Haven, CT. Electronic address: alan.kliger@ynhh.org.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

23891356

Citation

Kliger, Alan S., et al. "KDOQI US Commentary On the 2012 KDIGO Clinical Practice Guideline for Anemia in CKD." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 62, no. 5, 2013, pp. 849-59.
Kliger AS, Foley RN, Goldfarb DS, et al. KDOQI US commentary on the 2012 KDIGO Clinical Practice Guideline for Anemia in CKD. Am J Kidney Dis. 2013;62(5):849-59.
Kliger, A. S., Foley, R. N., Goldfarb, D. S., Goldstein, S. L., Johansen, K., Singh, A., & Szczech, L. (2013). KDOQI US commentary on the 2012 KDIGO Clinical Practice Guideline for Anemia in CKD. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 62(5), 849-59. https://doi.org/10.1053/j.ajkd.2013.06.008
Kliger AS, et al. KDOQI US Commentary On the 2012 KDIGO Clinical Practice Guideline for Anemia in CKD. Am J Kidney Dis. 2013;62(5):849-59. PubMed PMID: 23891356.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - KDOQI US commentary on the 2012 KDIGO Clinical Practice Guideline for Anemia in CKD. AU - Kliger,Alan S, AU - Foley,Robert N, AU - Goldfarb,David S, AU - Goldstein,Stuart L, AU - Johansen,Kirsten, AU - Singh,Ajay, AU - Szczech,Lynda, Y1 - 2013/07/25/ PY - 2013/06/24/received PY - 2013/06/24/accepted PY - 2013/7/30/entrez PY - 2013/7/31/pubmed PY - 2014/2/15/medline SP - 849 EP - 59 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am J Kidney Dis VL - 62 IS - 5 N2 - 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. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/23891356/full_citation L2 - https://linkinghub.elsevier.com/retrieve/pii/S0272-6386(13)00978-5 DB - PRIME DP - Unbound Medicine ER -