(Level 2) CORAL trial   Chapter 7: Renal anemia Is treatment with

Cooper CJ, et al. Am Heart J. 2006;152:59–66. (Level 2) CORAL trial   Chapter 7: Renal anemia Is treatment with Erythropoiesis-Stimulating Agent (ESA) recommended

for renal anemia in non-dialysis CKD? ESA treatment is reasonable for renal anemia because a major cause of renal anemia is a deficiency of erythropoietin. Despite the unclear effects of ESA treatment on the progression of CKD and the incidence of CVD, many studies have demonstrated that ESA treatment for renal anemia in CKD improves Selleckchem HKI 272 the QOL. Therefore, we recommend ESA treatment for renal anemia in CKD. However, because some recent large RCTs, such as TREAT, CREATE and CHOIR, showed that CVD events increased in the group with a Sorafenib molecular weight higher Hb target (>13 g/dL) as compared to the group with a lower Hb target (9–11 g/dL), ESA treatment with a target Hb level exceeding 13.0 g/dL is not recommended for renal anemia in CKD patients. Bibliography 1. Pfeffer Cell Cycle inhibitor MA, et al. N Engl J Med. 2009;361:2019–32. (Level 2)   2. Drüeke TB, et al. N Engl J Med. 2006;355:2071–84.

(Level 2)   3. Singh AK,et al. N Engl J Med. 2006;355:2085–98. (Level 2)   4. Akizawa T, et al. Ther Apher Dial. 2011;15:431–40. (Level 2)   Is ESA treatment for renal anemia effective for preventing CKD progression and decreasing the incidence of CVD? Recent large RCTs conducted overseas demonstrated that groups with higher Hb levels did not show effectiveness in terms of preventing the progression of CKD and decreasing the incidence of CVD compared to groups with lower Hb levels. A meta-analysis including these RCTs concluded that targeting higher Hb levels (>12–13 g/dL) probably increases

the risk of death, serious cardiovascular events and end-stage renal disease. In contrast, a Japanese RCT demonstrated that groups with a higher Hb level (11–13 g/dL) treated with darbepoetin had a more favorable outcome in terms of preventing the progression Olopatadine of CKD and cardiac hypertrophy compared to groups with a lower Hb (9–11 g/dL) treated by rHuEPO. Further analysis is necessary to clarify this issue. Bibliography 1. Kuriyama S, et al. Nephron. 1997;77:176–85. (Level 2)   2. Tsubakihara Y, et al. Ther Apher Dial. 2012;16:529–40. (Level 2)   3. Gouva C,et al. Kidney Int. 2004;66:753–60. (Level 2)   4. Cody J,et al. Cochrane Database Syst Rev. 2005;3:CD003266. (Level 1)   5. Palmer SC, et al. Ann Intern Med. 2010;153:23–33. (Level 1)   6. Drüeke TB, et al. N Engl J Med. 2006;355:2071–84. (Level 2)   7. Singh AK,et al. N Engl J Med. 2006;355:2085–98. (Level 2)   8. Pfeffer MA, et al. N Engl J Med. 2009;361:2019–32. (Level 2)   9. Akizawa T, et al. Ther Apher Dial. 2011;15:431–40. (Level 2)   10. Roger SD, et al. J Am Soc Nephrol. 2004;15:148–56. (Level 2)   11. Levin A,et al. Am J Kidney Dis. 2005;46:799–811. (Level 2)   12. Rossert J, et al. Am J Kidney Dis. 2006;47:738–50.

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