NDT Advance Access originally published online on April 9, 2007
Nephrology Dialysis Transplantation 2007 22(7):1806-1810; doi:10.1093/ndt/gfm185
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© The Author [2007]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Anaemia of CKD—the CHOIR study revisited
1Renal Division, Brigham and Women's Hospital and Harvard Medical School, Boston, USA 2Renal Division, Duke University Medical Center and Duke Clinical Research Institute, Durham, USA 3Ortho Biotech Clinical Affairs, Bridgewater, NJ, USA 4Department of Biostatistics and Bioinformatics, Duke University, Durham, USA 5Department of Medicine, University College Galway, Ireland
Correspondence and offprint requests to: Dr A. K. Singh, Renal Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA. Email: asingh@partners.org
Keywords: anaemia; CKD; epoetin; haemoglobin; kidney disease
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Introduction |
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Anaemia is a common complication of kidney disease and is treated with erythropoietin. However, the optimal target haemoglobin (Hb) in treating CKD anaemia has become quite controversial. There have been several randomized controlled studies of erythropoietin among kidney patients published over the past several years. The Normal Hematocrit study (NHS), a study of high-risk dialysis patients [1], was published in 1998 and was controversial at the time, as it appeared to contradict conventional wisdom by suggesting that aggressive anaemia correction may not be beneficial to haemodialysis patients with pre-existing cardiovascular disease. More recently, two studies of pre-dialysis CKD patients, the Correction of Hemoglobin Outcomes in Renal Insufficiency (CHOIR) study [2] and the Cardiovascular Risk Reduction by Early Anemia Treatment with Epoetin Beta (CREATE) study [3], focused on patients at early stages of CKD. The publication of these two studies has again attracted much discussion
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The CHOIR study |
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CHOIR-related questions |
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Why were the Hb targets of 11.3 and 13.5 g/dl chosen as targets and why were these targets changed from the initial targets?
Why 10 000 units subcutaneously of epoetin-alpha as the initial dose used in the study?
Imbalance in key baseline covariates
High rate of withdrawal in CHOIR
Did the DSMB follow RCT convention with regards to stopping the study?
Quality of Life measurements in the CHOIR study
Patients who dropped out of the study did not add clinical information
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Conclusions |
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