Clinical trials of erythropoiesis-stimulating agents to increase hemoglobin to different targets in chronic kidney disease

PopulationPatients 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 targets10 vs 14 g/dL13.5 vs 11.3 g/dL> 13 vs 11 g/dL> 13 vs 9 g/dL
Target achieved?NoNoYesNo
Primary outcomesTime to death or first myocardial infarctionComposite of death, myocardial infarction, hospitalization for chronic heart failure, strokeTime to first cardiovascular eventComposite of death or a cardiovascular event, or
Composite of death or end-stage kidney disease
Results with higher outcome hemoglobin targetHigher risk of primary outcomeaHigher risk of primary outcomebTrend toward higher risk of primary outcome (not statistically significant)No increase or reduction in risk of primary outcome
Other results with higher targetHigher rate of thrombosisImproved quality of lifeHigher 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.