Authors' objectives:

In 1996, an estimated 74,116 patients developed endstage renal disease (ESRD); most had anemia as a result of their chronic renal failure (CRF). Epoetin offers patients with anemia of CRF the potential to increase hematocrit (Hct) to a level considered normal for a healthy individual; yet the benefits and risks of such a management strategy have not been well established.

This systematic review seeks primarily to compare outcomes of maintaining a target Hct above 36 percent with outcomes of maintaining a target Hct in the 33 to <=36 percent range in patients with CRF.

Authors' results and conclusions: The evidence is not sufficient to compare the outcomes of target Hct above 36 compared with 33 to <=36 percent in adults with CRF. More evidence is available to compare the outcomes of target Hct above 36 compared with 30 to 36 percent. However, the evidence does not provide strong or consistent support that maintaining target Hct above 36 percent is beneficial. In hemodialysis patients with documented ischemic cardiac disease or congestive heart failure, a randomized controlled trial (n=1,233) was halted because of increased mortality and because it was determined that a treatment benefit in the primary endpoint could not be demonstrated even if the trial was completed. No other studies reported on subpopulations of CRF patients with clinical characteristics thought to warrant target Hct above 36 percent.

Authors' recommendations: The published literature does not provide strong or consistent support that maintaining Hct above 36 percent is more beneficial to patients with CRF than maintaining Hct in the target range of 33 to 36 percent recommended by the National Kidney Foundation's Dialysis Outcomes Quality Initiatives. Limited data on physiologic measures suggest a possible benefit for selected patients when Hct is maintained above 36 percent. However, the potential for benefit should be tested in well-designed intervention studies.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.ahrq.gov/clinic/epcsums/epcrfsum.htm

Year Published: 2001

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: United States

Organisation Name: Agency for Healthcare Research and Quality

Contact Address: Center for Outcomes and Evidence Technology Assessment Program, 540 Gaither Road, Rockville, MD 20850, USA. Tel: +1 301 427 1610; Fax: +1 301 427 1639;

Contact Name: martin.erlichman@ahrq.hhs.gov

Contact Email: martin.erlichman@ahrq.hhs.gov

Copyright: Agency for Healthcare Research and Quality (AHRQ)