What is the relationship between anemia and its management to the cardiovascular mortality in CKD?
Anemia is a cardinal manifestation of CKD and it generally is apparent when the eGFR is <30 mL/min per 1.73 m 2 .
Observational studies have shown that the greater the severity of anemia, the higher the risk for death. However, several randomized, controlled trials have failed to demonstrate a reduction in mortality risk with erythropoietin therapy, the cornerstone of anemia management in patients with CKD.
In fact, some of these studies have shown a higher risk for stroke and/or death when the treatment was targeted to achieve a hemoglobin level of 13 g/dL. Hence, erythropoietin therapy should not be started unless the hemoglobin level decreases to between 9.0 and 10.0 g/dL, and care should be exercised to prevent it from increasing to above 12.0 g/dL.
