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What are the adverse effects of anemia?
Anemia leads to decreased oxygen-carrying capacity of the blood and decreased delivery of oxygen to tissues.
This results in fatigue (both with exercise and at rest), decreased cognitive function, loss of libido, and decreased sense of well-being.
The increased workload on the heart may lead to left ventricular hypertrophy.
Observational studies of dialysis patients in the 1990s demonstrated decreased hospitalizations and mortality among patients with higher hemoglobin (Hb) levels, but these may have been confounded by comorbidities that decreased Hb levels and also led to poorer outcomes.
Randomized controlled trials (RCTs) of erythropoiesis-stimulating agents (ESAs) to raise Hb levels have not led to improved outcomes or consistently improved quality-of-life.
Large Randomized Studies in Patients With Anemia and Chronic Kidney Disease Not Receiving Dialysis
CHOIR | CREATE | TREAT | |
|---|---|---|---|
| Location | United States | Europe | International |
| ESA | Epoetin alfa | Epoetin beta | Darbepoetin alfa |
| Number of patients | 1432 | 603 | 4038, type 2 diabetics |
| High Hb target g/dL | 13.5 | 13–15 | 13 |
| Low Hb target g/dL | 11.3 | 10.5–11.5 | Placebo control, ESA rescue for Hb <9 |
| Cardiovascular endpoints | Higher in high Hb group | No difference | No difference except higher stroke and lower coronary revascularization in high Hb group |
| Progression of CKD | No difference | More in high Hb group | No difference |
| Cancer deaths | Not noted | Not noted | Higher in high Hb group among patients with prior cancer |
| Quality of life | No difference | Better in high Hb group | No difference except less fatigue in high Hb group |
CHOIR , Correction of Hemoglobin and Outcomes in Renal Insufficiency; CKD , chronic kidney disease; CREATE , Cardiovascular Risk Reduction of Early Anemia Treatment with Epoetin Beta; ESA , erythrocyte-stimulating agent; Hb , hemoglobin; TREAT , Trial to Reduce Cardiovascular Events with Aranesp Therapy.
