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Volume 2011, Article ID 623673, 5 pages
Review Article

An Update on the Controversies in Anemia Management in Chronic Kidney Disease: Lessons Learned and Lost

1Department of Medicine, Division of Nephrology, Lankenau Medical Center, Suite 130 MOBW, 100 Lancaster Avenue, Wynnewood, PA 19096, USA
2Lankenau Institute for Medical Research, 100 Lancaster Avenue, Wynnewood, PA 19096, USA

Received 8 September 2010; Accepted 27 January 2011

Academic Editor: Maria Tsironi

Copyright © 2011 Geoffrey Teehan and Robert L. Benz. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Background. Erythropoietin deficiency and anemia occur in Chronic Kidney Disease (CKD) and may be treated with Erythropoietin Stimulating Agents (ESAs). The optimal hemoglobin, in non-End Stage Renal Disease CKD, is controversial. Methods. We review three recent randomized trials in anemia in CKD: CHOIR, CREATE, and TREAT. Results. CHOIR ( ) was terminated early with more frequent death and cardiovascular outcomes in the higher Hb group (HR 1.34: 95% C.I. 1.03–1.74, ). CREATE ( ) showed no difference in primary cardiovascular endpoints. Stroke was more common in the higher Hb group (HR 1.92; 95% C.I. 1.38–2.68; ) in TREAT ( ). Conclusions. There is no benefit to an Hb outside the 10–12 g/dL range in this population. To avoid transfusions and improve Quality of Life, ESAs should be used cautiously, especially in patients with Diabetes, CKD, risk factors for stroke, and ESA resistance.