The Pharmaceutical Journal
Vol 277 No 7429 p660
2 December 2006

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Full correction of anaemia in CRF poses risks

Correction of haemoglobin levels to within the normal range (13–15g/dL; known as full correction) with epoetin does not improve cardiovascular outcomes for patients with chronic renal failure, two studies published in The New England Journal of Medicine have shown.

The first study (2006;355:2071) randomised 603 patients with chronic kidney failure to receive epoetin beta to achieve either full correction of haemoglobin or partial correction (haemoglobin 10.5–11.5g/dL). The investigators found no difference in the risk of cardiovascular events between the two groups.

Furthermore, in the second study (ibid, p2085) of 1,432 patients treated with epoetin alfa, researchers found that aiming for a haemoglobin level of 13.5g/dL — compared with a lower level of 11.3g/dL — elicits a higher risk of adverse events (composite of death, myocardial infarction, admission to hospital for heart failure and stroke, 125 events versus 97 events, hazard ratio 1.34, 95 per cent confidence interval 1.03–1.74; P=0.03) without superior improvement in quality of life.