NEW YORK (Reuters Health) – Among relatively healthy patients on hemodialysis, normalization of hemoglobin levels with epoetin-alfa, rather than partial correction, improves energy levels and reduces fatigue, investigators report in the Clinical Journal of the American Society of Nephrology for April.

Anemia is highly prevalent in patients with end stage renal disease, but concern has been raised that normalizing hemoglobin levels with erythropoiesis-stimulating agents may be linked with adverse outcomes, the authors of the report note. In fact, the revised product label for these agents for chronic kidney disease recommends a target hemoglobin range of 10 to 12 g/dL.

Nevertheless, Dr. Patrick S. Parfrey and co-authors hypothesized that “normal hemoglobin targets improve quality of life in comparatively ‘healthy’ incident hemodialysis patients.” They therefore prospectively studied the effects of different hemoglobin targets in such patients.

Their study cohort comprised 596 hemodialysis patients free of symptomatic cardiac disease; mean age was 50.8 years, and prior duration of dialysis therapy was 0.8 years. Randomly assigned hemoglobin targets were 9.5 to 11.5 g/dL (low target) or 13.5 to 14.5 g/dL (high target). The Kidney Disease Quality of Life questionnaire was used to assess the patients periodically during the 96-week trial.

The researchers note that mortality rates were low – 4.7 and 3.1 per 100 patient years in the low-target and high-target groups, respectively — reflecting the relatively good health of the patients.

“Energy/fatigue scores were significantly higher in the high hemoglobin group compared with the low hemoglobin group (p = 0.0066), and the differences were of clinical significance,” Dr. Parfrey’s team reports.

“Although current international guidelines for erythropoietin therapy are justified,” they conclude, “nonetheless, in a patient-centered paradigm of care, individuals who need to avoid blood transfusions, or those at low risk of adverse outcomes who value improved energy and vitality, should not be disadvantaged by strict adherence to guidelines.”

Reference:
Clin J Am Soc Nephrol 2009;4:726-733.