| [ Summary ] |
The 2012 Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guidelines for Anemia in Chronic Kidney Disease prioritize hard outcomes such as mortality, dialysis initiation, cardiovascular events, and quality of life (QOL) over surrogate outcomes when discussing the risks and benefits of intervention. However, in the Japanese guidelines for renal anemia in chronic kidney disease, such an outcome-based approach is not employed. Western hemodialysis patients have higher levels of ferritin than their Japanese counterparts, since they have a higher level of inflammation, as shown by their higher C-reactive protein levels. Therefore, sharp contrasts exist between the KDIGO and Japanese guidelines for the ranges of iron markers at which iron therapy is initiated. Based on many Western randomized controlled trials (RCTs), showing the harms of erythropoiesis-stimulating agents and some RCTs showing the benefit of iron therapy in terms of hard outcomes and QOL, an "iron first" approach was advocated in the KDIGO guidelines. Similarly, Japanese guidelines have somewhat liberalized the approach to iron administration. In the prior Japanese guidelines, iron was recommended only when transferrin saturation (TSAT) was <20 % AND ferritin was <100 ng/mL ; however, this criterion has been changed to TSAT <20 % OR ferritin <100 ng/mL in the absence of iron sequestration in the new guidelines. |