Peritoneal Dialysis - Target Hemoglobin

Guideline Organization

Recommendation (Evidence Level)

Evidence

Comments

CARI-Australia
2005

 - Hb ≤12g/dl for patients with proven or likely CV disease (Level I)
 - Hb ≥11g/dl recommended minimum (Level III-IV)
 - Hb between 12-14g/dl has beneficial effect when no CV disease (Level III-IV)
 

Biochemical and Haematological Targets

CSN-Canada
1999

11-12 g/dl  (Target Rationale) (Opinion)

Guideline 2.5 Assessing for Erythropoetin Therapy
PDF page S294

EBPG-Europe
2004

- Patients with chronic kidney disease (CKD)
should maintain a target haemoglobin (Hb) concentration of >11 g/dl [haematocrit (Hct) >33%]  (Level B) (Target Rationale)
- Exact target Hb concentrations >11 g/dl should be defined for individual patients, taking gender, age, ethnicity, activity and co-morbid conditions into account. In HD patients, pre-dialysis Hb concentrations above 14 g/dl are not desirable due to the risks associated with the effects arising from post-dialysis haemoconcentration. (Level C)
- Hb concentrations >12 g/dl are not recommended for patients with severe cardiovascular disease [defined as class III and above of the New York Heart Association Classification of Congestive Heart Failure (Table 2, Appendix C)] unless continuing severe symptoms (e.g. angina) dictate otherwise.
(Level A)
- Until data become available, it seems prudent to recommend a cautious approach to raising Hb concentrations to levels >12 g/dl in patients with diabetes, especially with concurrent peripheral vascular disease. (Level C)

II.1 What are the appropriate hemoglobin targets for anaemia treatment?

Not allowed to go higher than 12 g/dl in severe cardiovascular disease.  A global value in excess of 14 g/dL is not recommended.

KDOQI-US
2007

- In dialysis and nondialysis patients with
CKD receiving ESA therapy, the selected Hb target should generally be in the range of 11.0 to 12.0 g/dL. (Clinical Practice RECOMMENDATION)
- In dialysis and nondialysis patients with CKD receiving ESA therapy, the Hb target should not be greater than 13.0 g/dL. (Target Rationale) (Clinical Practice
GUIDELINE – MODERATELY STRONG EVIDENCE)

2007 Update of Hemoglobin Target
PDF Page 9 of 60 

Selection of the Hb target and selection of the Hb level at which ESA therapy is initiated in the individual patient should include consideration of potential benefits (including improvement in quality of life and avoidance of transfusion) and potential harms (including the risk of life threatening adverse events).

UK-Guidelines
2006

 - Patients with CKD should achieve an outcome distribution of haemoglobin of 10.5-12.5 g/dl. (Evidence)
 - Adjustments to ESA doses should be considered when Hb is <11 or >12g.dl.in order that the population distribution has the maximum proportion of patients in the range 10.5-12.5 as is possible (Target Rationale) (Evidence)

Complications of CKD: Section 3 Anemia