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Evidence does not support using erythropoietin-stimulating agents (ESAs) to obtain higher hemoglobin targets in patients with anemia and CKD

According to an evidence review published in Annals of Internal Medicine, treating anemia with erythropoietin-stimulating agents (ESAs) to obtain higher hemoglobin targets does not seem to improve health-related quality of life for patients with chronic kidney disease (CKD), even for younger, healthier patients.

Anemia is common in CKD and is often treated with ESAs. The optimal hemoglobin targets for treating anemia with ESAs is an ongoing source of controversy, with some clinicians aiming for higher hemoglobin targets for younger patients as a way to improve health-related quality of life. They argue that cardiovascular risks associated with ESAs may be limited to older patients.

Researchers reviewed 17 published studies to determine the effect of ESAs on health-related quality of life at different hemoglobin targets in adults with dialysis-dependent or -independent CKD. They found that randomization to a higher hemoglobin target resulted in no clinically or statistically significant improvement in any measure of health-related quality of life. These findings support current guidelines for achieving lower hemoglobin targets in patients requiring treatment for anemia, but do not support using ESAs to achieve individualized hemoglobin targets.