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Published ahead of print on October 15, 2008
Clin J Am Soc Nephrol 3: 1669-1675, 2008
© 2008 American Society of Nephrology
doi: 10.2215/CJN.02100508
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Clinical Nephrology

Hemoglobin Targets and Blood Transfusions in Hemodialysis Patients without Symptomatic Cardiac Disease Receiving Erythropoietin Therapy

Robert N. Foley*, Bryan M. Curtis{dagger}, and Patrick S. Parfrey{dagger}

* Chronic Disease Research Group, University of Minnesota, Minneapolis, Minnesota; and {dagger} Memorial University of Newfoundland, St. John's, Newfoundland, Canada

Correspondence: Patrick Parfrey, Health Sciences Centre, Memorial University of Newfoundland, St. John's, Newfoundland, Canada A1B 3V6. Phone: 709-777-7261; Fax: 709-777-6995; E-mail: pparfrey{at}mun.ca

Background and objectives: Optimal hemoglobin targets for chronic kidney disease patients receiving erythropoiesis-stimulating agents remain controversial. The effects of different hemoglobin targets on blood transfusion requirements have not been well characterized, despite their relevance to clinical decision-making.

Design, setting, participants, & measurements: Five hundred ninety-six incident hemodialysis patients without symptomatic cardiac disease were randomly assigned to hemoglobin targets of 9.5 to 11.5 g/dl or 13.5 to 14.5 g/dl for 96 wk using epoetin alfa as primary therapy and changes in left ventricular structure as the primary outcome (previously reported). Patients were masked to treatment assignment. Blood transfusion data were prospectively collected at 4-wk intervals.

Results: The mean age and prior duration of dialysis therapy of the study population were 50.8 and 0.8 yr, respectively. Previously reported mortality was similar in low and high-target subjects, at 4.7 (95% confidence interval 3.0, 7.3) and 3.1 (1.8, 5.4) per hundred patient years, respectively. Transfusion rates were 0.66 (0.59, 0.74) units of blood per year in low and 0.26 (0.22, 0.32) in high-target subjects (P < 0.0001). Hemoglobin level at transfusion (7.7 [7.5, 7.9]) versus 8.1 [7.6, 8.5] g/dl) were similar with both groups. High hemoglobin target was a significant predictor of time to first transfusion independent of baseline associations (hazard ratio = 0.42; 95% confidence interval = 0.26 – 0.67).

Conclusions: In hemodialysis patients with comparatively low mortality risks, normal hemoglobin targets may reduce the need for transfusions.




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S. Hiremath, R. M. Holden, D. Fergusson, and D. L. Zimmerman
Antiplatelet Medications in Hemodialysis Patients: A Systematic Review of Bleeding Rates
Clin. J. Am. Soc. Nephrol., August 1, 2009; 4(8): 1347 - 1355.
[Abstract] [Full Text] [PDF]


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