Hemoglobin targets for the anemia in patients with dialysis-dependent chronic kidney disease: a meta-analysis of randomized, controlled trials

Background: Anemia is extremely common among dialysis patients and underlies some of the symptoms associated with reduced kidney function, including fatigue, depression, reduced exercise tolerance, and dyspnea. Objectives: A clearer cognition of the prognosistic impact of hemoglobin (Hb) or hematocrit (Hct) target for the outcomes of dialysis patients is urgent. This article aims to establish the suitable hemoglobin in order to provide clinical guidance. Methods: MEDLINE, EmBase, the Cochrane Library and other databases were searched with both MeSH terms and keywords to gather randomized controlled trials that assessed all-cause mortality, cardiovascular events, fistula thrombosis, infectious diseases and transfusion among dialysis-dependent patients using erythropoiesis-stimulating agents. The meta-analysis was accomplished via Revman 5.3 version. Findings: Totally, nine eligible studies were included, with study subjects involving 3228 patients. There was a significantly higher risk of fistula thrombosis without heterogeneity (RR 1.34, 95% CI 1.15–1.55; p < 0.05) in the higher Hb target group than in the lower Hb target group in the fixed effects model. However, no significant difference was found in all-cause mortality in the fixed effects model (RR 1.09, 95% CI 0.93–1.27; p = 0.30), cardiovascular events (RR 0.77, 95% CI 0.31–1.92; p = 0.58), infectious diseases (RR 0.69, 95% CI 0.24–1.96; p = 0.49) and transfusion (RR 0.92, 95% CI 0.42–1.99; p = 0.82) in the random effects model between the higher Hb target group and the lower Hb target group. Discussion: The results favor lower Hb target. To target lower Hb target when treating dialysis patients with anemia may decrease the risk of fistula thrombosis without increasing the risk of death, cardiovascular events, infectious diseases and transfusion.