Clinical trials of erythropoiesis-stimulating agents to increase hemoglobin to different targets in chronic kidney disease
| Trial | Normal HCT21 | CHOIR22 | CREATE23 | TREAT24 |
|---|---|---|---|---|
| Population | Patients with chronic heart failure and end stage kidney disease on dialysis (N = 1,233) | Chronic kidney disease (N = 1,432) | Chronic kidney disease (N = 603) | Chronic kidney disease with diabetes (N = 4,038) |
| Hemoglobin targets | 10 vs 14 g/dL | 13.5 vs 11.3 g/dL | > 13 vs 11 g/dL | > 13 vs 9 g/dL |
| Target achieved? | No | No | Yes | No |
| Primary outcomes | Time to death or first myocardial infarction | Composite of death, myocardial infarction, hospitalization for chronic heart failure, stroke | Time to first cardiovascular event | Composite of death or a cardiovascular event, or Composite of death or end-stage kidney disease |
| Results with higher outcome hemoglobin target | Higher risk of primary outcomea | Higher risk of primary outcomeb | Trend toward higher risk of primary outcome (not statistically significant) | No increase or reduction in risk of primary outcome |
| Other results with higher target | Higher rate of thrombosis | Improved quality of life | Higher rates of stroke and malignancy- associated mortality; less need for blood transfusions |
↵a Risk ratio 1.28, 95% confidence interval 1.06–1.56, P = .01.
↵b Hazard ratio 1.34, 95% confidence interval 1.03–1.74, P = .03.
CHOIR = Correction of Hemoglobin and Outcomes in Renal Insufficiency trial; CREATE = Cardiovascular Risk Reduction by Early Anemia Treatment With Epoetin Beta trial; HCT = hematocrit; TREAT = Trial to Reduce Cardiovascular Events With Aranesp Therapy
Adapted from Nakhoul G, Simon JF. Anemia of chronic kidney disease: treat it, but not too aggressively [published correction appears in Cleve Clin J Med 2016; 83(10):739]. Cleve Clin J Med 2016; 83(8):613–624. doi:10.3949/ccjm.83a.15065 with permission from the Cleveland Clinic Foundation © 2016.