Critical Missing Data on Erythropoiesis-Stimulating Agents in CKD: First Beat Placebo

摘要

The clinical application of erythropoiesis-stimulating agents (ESA) to patients with anemia^and chronic kidney disease (CKD) has missed a vital evidence-gathering step and hence current use appears to have greatly outpaced the data. Benefits achieved in dialysis patients with severe anemia (hemoglobin < 9 g/dL [90 g/L]) have been extrapolated without sufficient data to nondialysis patients with less profound anemia. Some in the nephrology community have focused on the secondary issue of target hemoglobin for ESA, which circumvents the more critical overarching question of whether the risk-benefit ratio of these costly agents warrants use in nondialysis populations. This critical gap can only be addressed by randomized controlled trials (RCTs) comparing ESA to placebo: first beat placebo#