KDIGO Clinical Practice Guideline for Anemia in …

1 OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF NEPHROLOGY. KDIGO Clinical Practice Guideline for Anemia in chronic Kidney Disease VOLUME 2 | ISSUE 4 | AUGUST 2 2012. 1 7/11/12 12:00 PM. KDIGO Clinical Practice Guideline for Anemia in chronic Kidney Disease KDIGO gratefully acknowledges the following consortium of sponsors that make our initiatives possible: Abbott, Amgen, Bayer Schering Pharma, Belo Foundation, Bristol-Myers Squibb, Chugai Pharmaceutical, Coca-Cola Company, Dole Food Company, Fresenius Medical Care, Genzyme, Hoffmann-LaRoche, JC Penney, Kyowa Hakko Kirin, NATCO The Organization for Transplant Professionals, NKF-Board of Directors, Novartis, Pharmacosmos, PUMC Pharmaceutical, Robert and Jane Cizik Foundation, Shire, Takeda Pharmaceutical, Transwestern Commercial Services, Vifor Pharma, and Wyeth.

2 Sponsorship Statement: KDIGO is supported by a consortium of sponsors and no funding is accepted for the development of specific guidelines. contents & 2012 KDIGO . VOL 2 | ISSUE 4 | AUGUST (2) 2012. KDIGO Clinical Practice Guideline for Anemia in chronic Kidney Disease v Tables and Figures vi KDIGO Board Members vii Reference Keys viii Abbreviations and Acronyms 279 Notice 280 Foreword 281 Work Group Membership 282 Abstract 283 Summary of Recommendation Statements 288 Chapter 1: Diagnosis and evaluation of Anemia in CKD. 292 Chapter 2: Use of iron to treat Anemia in CKD.

3 299 Chapter 3: Use of ESAs and other agents to treat Anemia in CKD. 311 Chapter 4: Red cell transfusion to treat Anemia in CKD. 317 Methods for Guideline Development 324 Biographic and Disclosure Information 330 Acknowledgments 331 References contents & 2012 KDIGO . TABLES. 289 Table 1. Hb levels in children between 1 19 years for initiation of Anemia workup 289 Table 2. Hb levels in children between birth and 24 months for initiation of Anemia workup 307 Table 3. Potentially correctable versus non correctable factors involved in the Anemia of CKD, in addition to ESA.

4 Deficiency 308 Table 4. Practical approach in presence of ESA hyporesponsiveness 312 Table 5. Estimated risk associated with blood transfusions per unit transfused 312 Table 6. Estimated risk of transfusion-related infections per unit transfused 314 Table 7. Indications for blood transfusions 318 Table 8. Systematic review topics and screening criteria 318 Table 9. Hierarchy of importance of outcomes 319 Table 10. Literature search yield of primary articles for systematic review topics 319 Table 11. Classification of study quality 320 Table 12. GRADE system for grading quality of evidence 320 Table 13.

5 Final grade for overall quality of evidence 321 Table 14. Balance of benefits and harm 321 Table 15. KDIGO nomenclature and description for grading recommendations 321 Table 16. Determinants of strength of recommendation 322 Table 17. The Conference on Guideline Standardization (COGS) checklist for reporting Clinical Practice guidelines FIGURES. 293 Figure 1. Receiver operating characteristic (ROC) curves, examining the utility of iron status tests to distinguish iron deficient from nondeficient study patients 294 Figure 2. Sensitivity and specificity of TSAT and serum ferritin and their combination (TSAT + ferritin) and bone marrow iron (BM iron) to identify correctly a positive erythropoietic response (Z1-g/dl [Z10-g/l] increase in Hb [DHb]) to intravenous iron in 100 nondialysis patients with CKD (areas under the ROCs).

6 313 Figure 3. Lymphocytotoxic antibody reactivity against random donor test panel in relation to the number of blood transfusions 315 Figure 4. Algorithms for red cell transfusion use in CKD patients Additional information in the form of supplementary materials can be found online at Kidney International Supplements (2012) 2, v v & 2012 KDIGO . KDIGO Board Members Garabed Eknoyan, MD. Norbert Lameire, MD, PhD. Founding KDIGO Co-Chairs Kai-Uwe Eckardt, MD. Immediate Past Co-Chair Bertram L Kasiske, MD David C Wheeler, MD, FRCP. KDIGO Co-Chair KDIGO Co-Chair Omar I Abboud, MD, FRCP Michel Jadoul, MD.

7 Sharon Adler, MD, FASN Simon Jenkins, MBE, FRCGP. Rajiv Agarwal, MD Suhnggwon Kim, MD, PhD. Sharon P Andreoli, MD Martin K Kuhlmann, MD. Gavin J Becker, MD, FRACP Nathan W Levin, MD, FACP. Fred Brown, MBA, FACHE Philip K-T Li, MD, FRCP, FACP. Daniel C Cattran, MD, FRCPC Zhi-Hong Liu, MD. Allan J Collins, MD, FACP Pablo Massari, MD. Rosanna Coppo, MD Peter A McCullough, MD, MPH, FACC, FACP. Josef Coresh, MD, PhD Rafique Moosa, MD. Ricardo Correa-Rotter, MD Miguel C Riella, MD. Adrian Covic, MD, PhD Adibul Hasan Rizvi, MBBS, FRCP. Jonathan C Craig, MBChB, MM (Clin Epi), DCH, FRACP, PhD Bernardo Rodriquez-Iturbe, MD.

8 Angel de Francisco, MD Robert Schrier, MD. Paul de Jong, MD, PhD Justin Silver, MD, PhD. Ana Figueiredo, RN, MSc, PhD Marcello Tonelli, MD, SM, FRCPC. Mohammed Benghanem Gharbi, MD Yusuke Tsukamoto, MD. Gordon Guyatt, MD, MSc, BSc, FRCPC Theodor Vogels, MSW. David Harris, MD Angela Yee-Moon Wang, MD, PhD, FRCP. Lai Seong Hooi, MD Christoph Wanner, MD. Enyu Imai, MD, PhD Elena Zakharova, MD, PhD. Lesley A Inker, MD, MS, FRCP. NKF- KDIGO Guideline DEVELOPMENT STAFF. Kerry Willis, PhD, Senior Vice-President for Scientific Activities Michael Cheung, MA, Guideline Development Director Sean Slifer, BA, Guideline Development Manager Kidney International Supplements (2012) 2, vi vi & 2012 KDIGO .

9 Reference Keys NOMENCLATURE AND DESCRIPTION FOR RATING Guideline RECOMMENDATIONS. Within each recommendation, the strength of recommendation is indicated as Level 1, Level 2, or Not Graded, and the quality of the supporting evidence is shown as A, B, C, or D. Implications Grade* Patients Clinicians Policy Level 1 Most people in your situation would Most patients should receive the recommended The recommendation can be evaluated We recommend' want the recommended course of action course of action. as a candidate for developing a policy or and only a small proportion would not.

10 A performance measure. Level 2 The majority of people in your situation Different choices will be appropriate for different The recommendation is likely to require We suggest' would want the recommended course of patients. Each patient needs help to arrive at a substantial debate and involvement of action, management decision consistent with her or his stakeholders before policy can be but many would not. values and preferences. determined. *The additional category Not Graded' was used, typically, to provide guidance based on common sense or where the topic does not allow adequate application of evidence.