The strategy to improve health related quality of life (HRQOL) not only renal survival is crucial for chronic kidney disease (CKD) patients. Pathophysiology of anemia is closely associated with heart failure, malnutrition and inflammation which deteriorate HRQOL. Kidney Disease: Improving Global Outcome recommended that the erythropoiesis-stimulating agent (ESA) not be used to maintain Hb concentration above 11.5 g/dL in 2012. Updated systematic reviews for the treatment of anemia and HRQOL outcome mentioned that comparison between baseline Hb < 10 g/dL and partial correction over ≥ 10 g/dL showed the improvement of physical components of HRQOL in dialysis dependent CKD patients. In pre-dialysis CKD patients, aiming for lower Hb target with ESAs not only resulted in better HRQOL but lower healthcare resource utilization than control. However, higher Hb target above 12 g/dL lead to modest improvement of HRQOL with uncertain clinical significance. Further investigations are required to individualize of the patients that 11.5- 13.0 g/dL Hb target is effective for clinically meaningful HRQOL improvement without increasing the risks.
- Cardio-renal-anemia syndrome
- Erythropoiesis-stimulating agent
- Health related quality of life
- Hemoglobin target
- Malnutrition-inflammation- anemia syndrome
- Minimal clinically important difference