A 42-year-old woman with CKD stage 3b and anaemia (Hb 9.2 g/dL, serum ferritin 280 ng/mL, TSAT 28%) is started on erythropoiesis-stimulating agent (ESA) therapy. The Hb target according to KDIGO 2012 guidelines and updated guidance is:

• A Hb normalisation to 13–15 g/dL to match normal population
• B Hb 8–9 g/dL to minimise ESA dosing
• C No target; titrate only by symptoms
• D Hb 10–11.5 g/dL; avoid exceeding 13 g/dL ✓

Explanation

KDIGO 2012 guidelines and subsequent trial data (TREAT, CHOIR, CREATE trials) clearly demonstrate that targeting normal haemoglobin levels (≥13 g/dL) with ESAs in CKD patients increases the risk of stroke, hypertension, thromboembolism, and possibly death. The recommended Hb target is 10–11.5 g/dL in non-dialysis CKD patients, with a general recommendation to avoid exceeding 11.5 g/dL. This improves quality of life while minimising adverse cardiovascular events. Targeting 8–9 g/dL is unnecessarily low and symptomatic.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.