KDIGO Clinical Practice Guideline for ... - KIDNEY DISEASE

OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF NEPHROLOGY

KDIGO Clinical Practice Guideline for Anemia in Chronic Kidney Disease

VOLUME 2 | ISSUE 4 | AUGUST 2 2012



KDIGO Clinical Practice Guideline for Anemia in Chronic Kidney Disease

KDIGO gratefully acknowledges the following consortium of sponsors that make our initiatives possible: Abbott, Amgen, Bayer Schering Pharma, Belo Foundation, Bristol-Myers Squibb, Chugai Pharmaceutical, Coca-Cola Company, Dole Food Company, Fresenius Medical Care, Genzyme, Hoffmann-LaRoche, JC Penney, Kyowa Hakko Kirin, NATCO--The Organization for Transplant Professionals, NKF-Board of Directors, Novartis, Pharmacosmos, PUMC Pharmaceutical, Robert and Jane Cizik Foundation, Shire, Takeda Pharmaceutical, Transwestern Commercial Services, Vifor Pharma, and Wyeth. Sponsorship Statement: KDIGO is supported by a consortium of sponsors and no funding is accepted for the development of specific guidelines.

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contents VOL 2 | ISSUE 4 | AUGUST (2) 2012

KDIGO Clinical Practice Guideline for Anemia in Chronic Kidney Disease

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Tables and Figures

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KDIGO Board Members

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Reference Keys

viii Abbreviations and Acronyms

279 Notice

280 Foreword

281 Work Group Membership

282 Abstract

283 Summary of Recommendation Statements

288 Chapter 1: Diagnosis and evaluation of anemia in CKD

292 Chapter 2: Use of iron to treat anemia in CKD

299 Chapter 3: Use of ESAs and other agents to treat anemia in CKD

311 Chapter 4: Red cell transfusion to treat anemia in CKD

317 Methods for Guideline Development

324 Biographic and Disclosure Information

330 Acknowledgments

331 References

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contents

TABLES

289 Table 1. Hb levels in children between 1?19 years for initiation of anemia workup 289 Table 2. Hb levels in children between birth and 24 months for initiation of anemia workup 307 Table 3. Potentially correctable versus non correctable factors involved in the anemia of CKD, in addition to ESA

deficiency 308 Table 4. Practical approach in presence of ESA hyporesponsiveness 312 Table 5. Estimated risk associated with blood transfusions per unit transfused 312 Table 6. Estimated risk of transfusion-related infections per unit transfused 314 Table 7. Indications for blood transfusions 318 Table 8. Systematic review topics and screening criteria 318 Table 9. Hierarchy of importance of outcomes 319 Table 10. Literature search yield of primary articles for systematic review topics 319 Table 11. Classification of study quality 320 Table 12. GRADE system for grading quality of evidence 320 Table 13. Final grade for overall quality of evidence 321 Table 14. Balance of benefits and harm 321 Table 15. KDIGO nomenclature and description for grading recommendations 321 Table 16. Determinants of strength of recommendation 322 Table 17. The Conference on Guideline Standardization (COGS) checklist for reporting clinical practice guidelines

FIGURES

293 Figure 1. Receiver operating characteristic (ROC) curves, examining the utility of iron status tests to distinguish iron deficient from nondeficient study patients

294 Figure 2. Sensitivity and specificity of TSAT and serum ferritin and their combination (TSAT + ferritin) and bone marrow iron (BM iron) to identify correctly a positive erythropoietic response (Z1-g/dl [Z10-g/l] increase in Hb [DHb]) to intravenous iron in 100 nondialysis patients with CKD (areas under the ROCs)

313 Figure 3. Lymphocytotoxic antibody reactivity against random donor test panel in relation to the number of blood transfusions

315 Figure 4. Algorithms for red cell transfusion use in CKD patients

Additional information in the form of supplementary materials can be found online at

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KDIGO Board Members

Garabed Eknoyan, MD Norbert Lameire, MD, PhD Founding KDIGO Co-Chairs

Kai-Uwe Eckardt, MD Immediate Past Co-Chair

Bertram L Kasiske, MD KDIGO Co-Chair

David C Wheeler, MD, FRCP KDIGO Co-Chair

Omar I Abboud, MD, FRCP Sharon Adler, MD, FASN Rajiv Agarwal, MD Sharon P Andreoli, MD Gavin J Becker, MD, FRACP Fred Brown, MBA, FACHE Daniel C Cattran, MD, FRCPC Allan J Collins, MD, FACP Rosanna Coppo, MD Josef Coresh, MD, PhD Ricardo Correa-Rotter, MD Adrian Covic, MD, PhD Jonathan C Craig, MBChB, MM (Clin Epi), DCH, FRACP, PhD Angel de Francisco, MD Paul de Jong, MD, PhD Ana Figueiredo, RN, MSc, PhD Mohammed Benghanem Gharbi, MD Gordon Guyatt, MD, MSc, BSc, FRCPC David Harris, MD Lai Seong Hooi, MD Enyu Imai, MD, PhD Lesley A Inker, MD, MS, FRCP

Michel Jadoul, MD Simon Jenkins, MBE, FRCGP Suhnggwon Kim, MD, PhD Martin K Kuhlmann, MD Nathan W Levin, MD, FACP Philip K-T Li, MD, FRCP, FACP Zhi-Hong Liu, MD Pablo Massari, MD Peter A McCullough, MD, MPH, FACC, FACP Rafique Moosa, MD Miguel C Riella, MD Adibul Hasan Rizvi, MBBS, FRCP Bernardo Rodriquez-Iturbe, MD Robert Schrier, MD Justin Silver, MD, PhD Marcello Tonelli, MD, SM, FRCPC Yusuke Tsukamoto, MD Theodor Vogels, MSW Angela Yee-Moon Wang, MD, PhD, FRCP Christoph Wanner, MD Elena Zakharova, MD, PhD

NKF-KDIGO GUIDELINE DEVELOPMENT STAFF Kerry Willis, PhD, Senior Vice-President for Scientific Activities Michael Cheung, MA, Guideline Development Director Sean Slifer, BA, Guideline Development Manager

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