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Therapeutic targets for the anemia of predialysis chronic kidney disease: a meta-analysis of randomized, controlled trials
  1. Hongyong Liu1,
  2. Yuqiu Ye2,
  3. Yanbing Chen3,
  4. Yunqiang Zhang1,
  5. Shaomin Li2,
  6. Wentao Hu2,
  7. Rongqian Yang4,
  8. Zhesi Zhang4,
  9. Hongquan Peng5,
  10. Linsheng Lv6,
  11. Xun Liu2
  1. 1 Division of Nephrology, The Third Affiliated Hospital of Sun Yat-sen University, Yuedong Hospital, Meizhou, China
  2. 2 Department of Nephrology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
  3. 3 Medical Genetic Center, Guangdong Women and Children Hospital, Guangzhou, China
  4. 4 Department of Biomedical Engineering, South China University of Technology, Guangdong, China
  5. 5 Renal Division, Kiang Wu Hospital, Macau SAR, China
  6. 6 Operation Room, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
  1. Correspondence to Ms. Linsheng Lv, Departmentof Nephrology and Operation Room, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; lv.linsheng{at} and Dr Xun Liu, Division of Nephrology, The Third Affiliated Hospital of Sun Yat-sen University, Yuedong Hospital, Meizhou 514700, China; naturestyle{at}


Anemia is one of the major complications in predialysis patients with chronic kidney disease (CKD). A clearer cognition of the prognostic impact of hemoglobin (Hb) or hematocrit (Hct) target on the outcomes of predialysis patients with CKD is significant. This article aims to establish the suitable hemoglobin target to provide clinical guidance. MEDLINE, EmBase, the Cochrane Library and other databases were searched with both MeSH terms and keywords to gather researches that assessed all-cause mortality, stroke, treatment of renal replacement, and transfusion. The meta-analysis was accomplished via Revman 5.3 version. Totally, 13 eligible studies involving 7606 patients were included. There was a significantly lower risk of transfusion (risk ratio (RR) 0.59, 95% CI 0.52 to 0.67; p<0.00001) in the higher hemoglobin group than in the lower one. However, no significant difference was found in all-cause mortality (RR 1.10, 95% CI 0.98 to 1.23; p=0.11), stroke (RR 1.32, 95% CI 0.82 to 2.10; p=0.25) and treatment of renal replacement including hemodialysis, peritoneal dialysis and renal transplant (RR 1.08, 95% CI 0.95 to 1.22; p= 0.23) between the higher hemoglobin group and the lower one. The results favor the higher hemoglobin target. To target the higher hemoglobin when treating predialysis patients with CKD may decrease the risk of transfusion without increasing the risk of death, stoke, and treatment of renal replacement.

  • anemia
  • prognosis
  • kidney diseases

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  • HL, YY and YC contributed equally.

  • Contributors Conceived and designed the experiments: XL, HL, YY. Performed the experiments: YZ, SL, HP. Analyzed the data: WH, RY, YC. Contributed reagents/materials/analysis tools: ZZ, LL, YC. Wrote the paper: YY, SL, XL.

  • Funding This study was supported by the National Natural Science Foundation of China (Grant No. 81873631, Grant No.81370866), the Third Affiliated Hospital of Sun Yat-Sen University, Clinical Research Program (Grant No.YHJH201806).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Correction notice This article has been corrected since it was published Online First. The affiliations for Rongqian Yang, Zhesi Zhang, Hongquan Peng and Yanbing Chen have been corrected.

  • Patient consent for publication Not required.

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