| [ Summary ] |
Treatment of renal anemia with recombinant human erythropoietin has contributed not only to improvements in quality of life (QOL) and mortality in patients with renal anemia, but also to elucidation of the pathophysiological role of anemia in chronic kidney disease (CKD). Recently, it has been suggested that anemia, CKD, and congestive heart failure create a vicious circle, which is known, as “Cardio Renal Anemia (CPA) Syndrome”. Active treatment of anemia is now recommended in CKD patients to terminate this circle. On the other hand, two large scale randomized controlled trials, the CREATE (cardiovascular risk reduction by early anemia treatment with epoetin beta) study and the CHOIR (correction of hemoglobin and outcomes in renal insufficiency) study, reported last year that benefits in lowering risk of cardiovascular event were not apparent when hemoglobin levels were targeted at high (normal levels) than at low (sub-normal levels) in CKD patients, although QOL scores were significantly higher in the high-Hb group in the CREATE study. While it is thought that the problem concerning the upper limits of target hemoglobin levels has been resolved, there seems to be controversy because some parts of the analytical methods in these trials have been criticized. Further evidence is required to resolve this argument. |