Four randomized controlled trials of hemoglobin-raising in chronic kidney disease

PopulationPatients with chronic heart failure and end-stage renal disease on dialysisChronic kidney diseaseChronic kidney diseaseChronic kidney disease with diabetes
Hemoglobin target10 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 and death or end-stage renal disease
Risks with higher hemoglobin levelTrend toward increased risk of primary outcome resulted in early study interruptionIncreased risk of primary outcomeTrend toward risk increase that was nonsignificant: no benefitsNo risk increase or reduction
Other resultsHigher rate of thrombosis in high-target groupImproved quality of lifeHigher rate of stroke
  • NHCT = Normal Hematocrit Study,52 CHOIR = Correction of Hemoglobin and Outcomes in Renal Insufficiency trial,53 CREATE = Cardiovascular Risk Reduction by Early Anemia Treatment trial,54 TREAT = Trial to Reduce Cardiovascular Events With Aranesp Therapy55