Background: The current 3rd edition of the Italian Society of Nephrology guidelines has been drawn up to summarize evidence of key intervention issues on the basis of Systematic Reviews (SR) of Randomized Trials (RCT) or RCT data only. The present guideline reports evidence of the use of Erythropoietins (EPO) and/or optimal haemoglobin (Hgb) targets to delay Chronic Kidney Disease (CKD) progression.
Methods: SR of RCT and RCT on EPO and different Hgb targets in CKD (pre-dialysis) were identified searching in the Cochrane Library and Renal Health Library (2005 update). Quality of SR and RCT was assessed according to current methodological standards.
Results: Two SR (15 RCT) and 5 further RCT were found addressing the intervention issue. No significant evidence supporting the use of EPO compared with placebo/no treatment to prevent or delay CKD progression was found (evidence from SR). Progression rates do not appear to be affected by Hgb targets (evidence from SR). Methodological quality of included RCT was suboptimal. In diabetic patients not receiving renin-angiotensin-system inhibitors, early EPO treatment (when Hgb ≥9 g/dL) with target Hgb ≥13 g/dL as compared to delayed treatment initiation (Hgb < 9 g/dL) is associated with reduced risk of disease progression, end-stage renal disease and death (evidence from RCT).
Conclusion: In CKD patients not undergoing dialysis current evidence does not support the hypothesis that EPO treatment or optimal Hgb targets reduce the progression rate of the disease. Further studies are necessary to test this hypothesis in selected patient populations.