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Does correction of anemia slow the progression of chronic kidney disease?

Nature Clinical Practice Nephrology volume 3, pages 638–639 (2007)Cite this article

Since the publication of the CHOIR1 and CREATE2 study results (and those of the earlier Normal Hematocrit Study in dialysis patients3), tremendous attention has been focused on the effect of anemia correction on mortality and cardiovascular complications. Less publicized has been the finding from CREATE of a higher rate of progression to end-stage renal disease (ESRD) among patients assigned to a higher hemoglobin target. CHOIR reinforced the CREATE results by implying a trend toward increased renal risk with complete (as opposed to partial) correction of anemia.

Proponents of normalizing hemoglobin in patients with non-dialysis-dependent chronic kidney disease (CKD) postulate that anemia results in hypoxia-induced kidney injury.4 Treatment with erythropoietin, they argue, increases hemoglobin level and thereby increases oxygen delivery to the kidneys. Tubular injury and the development of interstitial fibrosis are thus prevented. Additionally, erythropoietin protects against oxidative stress and apoptosis, and could have direct protective effects on tubular cells.

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  1. Renal Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA asingh@partners.org

Authors and Affiliations

  1. AK Singh is Clinical Chief of the Renal Division, Director of Dialysis Services and a Physician at the Brigham and Women's Hospital, and an Associate Professor of Medicine at Harvard Medical School, Boston, MA, USA.,

    Ajay K Singh

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  1. Ajay K Singh
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Competing interests

The author has received grant/research support and speakers bureau honoraria from Amgen, Janssen–Cilag, Roche and Watson, and has acted as a consultant for these companies. He has also received speakers bureau honoraria from Genzyme and has acted as a consultant for Merck and Wyeth.

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Singh, A. Does correction of anemia slow the progression of chronic kidney disease?. Nat Rev Nephrol 3, 638–639 (2007). https://doi.org/10.1038/ncpneph0637

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