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    "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">To the Editor&#44;</span></p><p class="elsevierStylePara">Different scientific societies have frequently revised the recommendations for the treatment of anaemia in patients with pre-dialysis &#40;no-D&#41; chronic kidney disease &#40;CKD&#41;&#44; which include target values of haemoglobin &#40;Hb&#41;&#44; ferritin and transferrin saturation rate &#40;TSAT&#41;&#46; In 2005&#44; the Agence Fran&#231;aise de S&#233;curit&#233; Sanitaire des Produits de Sant&#233; recommended target Hb values between 110-130g&#47;l&#46;<span class="elsevierStyleSup">1</span> The KDOQI2006 guidelines &#40;Kidney Disease Outcomes Quality Initiative&#41; recommend not intentionally maintaining Hb&#62;130g&#47;l and in 2007&#44; recommended a range of 110-120g&#47;l&#46;<span class="elsevierStyleSup">2</span> In 2007&#44; the European Medicine Agency recommended an Hb range of 100-120g&#47;l and in 2009&#44; the ERBP guidelines &#40;European Renal Best Practice&#41; recommended 110-120g&#47;l&#44; not exceeding the value of 130g&#47;l&#46;<span class="elsevierStyleSup">3&#44;4</span> The latest update to the KDOQI2012 guidelines recommends maintaining an Hb level between 100-115&#160;g&#47;l&#46;<span class="elsevierStyleSup">5</span></p><p class="elsevierStylePara">With the aim of evaluating the degree of compliance of the established target values according to the different guidelines&#44; we carried out a retrospective observational study of all the patients with no-D CKD and non-transplant patients treated with an erythopoiesis-stimulating agent &#40;ESA&#41; on 1&#160;September&#160;2012&#44; with no changes made to the dosage for a minimum of 6&#160;months&#46; We obtained our data from the outpatient pharmacy programme and the hospital clinical workstation&#46; The following variables were recorded&#58; age&#44; sex&#44; levels of Hb&#44; ferritin and TSAT&#44; CKD stage&#44; type of ESA and monthly dose&#44; treatment concurrent with angiotensin-converting-enzyme inhibitors &#40;ACE inhibitors&#41;&#44; angiotensin II receptor antagonists &#40;ARBs&#41;&#44; iron supplements and treatment for secondary hyperparathyroidism &#40;SHPT&#41;&#59; and diabetes mellitus &#40;DM&#41; as underlying comorbidity&#46;</p><p class="elsevierStylePara">The study included a total of 305 patients &#40;141 male&#41; with stage 3 CKD &#40;65 patients&#41;&#44; stage 4 CKD &#40;140 patients&#41; or no-D stage 5 CKD &#40;100 patients&#41;&#46; The mean age was 68 years &#40;range&#58; 22-95&#160;years&#41;&#46; The administered average monthly dose of ESA &#40;expressed in micrograms of darbepoetin&#41; was 90&#181;g&#46; 17&#37; of the patients were being treated with ARBs and 14&#160;&#37; with ACE inhibitors&#46; 40&#160;&#37; took iron supplements and 60&#160;&#37; received treatment for SHPT&#46; 25&#37; of patients presented DM&#46;</p><p class="elsevierStylePara">Mean Hb was 112g&#47;l&#44; mean ferritin 195&#181;g&#47;l and mean TSAT 20&#37; &#40;Table&#160;1&#41;&#46; Statistically significant differences were not observed between the parameters studied &#40;mean Hb&#44; mean ferritin&#44; mean TSAT&#44; Hb&#60;100g&#47;l&#44; Hb&#62;130g&#47;l&#44; ferritin &#60;100&#181;g&#47;l and TSAT&#60;20&#37;&#41; according to the CKD stage&#44; the type and dose of ESA&#44; the iron supplement&#44; the concomitant medication for anaemia &#40;ACE inhibitors&#44; ARBs&#41;&#44; SHPT controlled with drugs or DM&#46; There are a higher percentage of patients with Hb&#60;100g&#47;l in more advanced stages of CKD&#46;</p><p class="elsevierStylePara">The degree of compliance of the established objectives according to different guidelines is shown in Figure 1&#46; Mainly&#44; the percentage within the suitable range is less than 60&#37;&#46; Only 40&#46;7&#37; of the patients presented an Hb level within the range recommended by the KDOQI2012 guidelines&#44; and 54&#46;7&#160;&#37; according to the objectives of the ERBP&#46; The results of this study coincide with those from a study by OCEANE&#44; in which only 50&#37; of the patients met the objective values of Hb &#40;100-120g&#47;l&#41;&#46;<span class="elsevierStyleSup">6 </span>In another previous study&#44; the percentage of patients compliant with the objective Hb values &#40;100-120g&#47;l&#41; was 38&#46;4&#37;&#46; According to Valderrabano et al&#46;&#44; 96&#37; of the patients had levels of Hb&#62;100g&#47;l&#46;<span class="elsevierStyleSup">8</span> In our results this percentage was 78&#46;3&#37;&#46; These results reflect the difficulty in maintaining Hb within the recommended margins&#44; due to a narrow objective range&#44; the variability of Hb values and the complexity of patients &#40;age and cardiovascular comorbidities&#41;&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflicts of interest</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">Dr A&#46; Martinez-Castelao has collaborated with Novartis&#44; Bo&#235;hringer&#44; Abbvie&#44; Shire&#44; Amgen and Roche laboratories and has participated in the advisory boards of the laboratories Abbvie and Amgen&#46;</p><p class="elsevierStylePara"><a href="grande&#47;12312&#95;16025&#95;56746&#95;en&#95;t1&#46;12312&#46;jpg" class="elsevierStyleCrossRefs"><img src="12312_16025_56746_en_t1.12312.jpg" alt="Values of haemoglobin&#44; ferritin and the rate of transferrin saturation according to the stage of renal function and the type of erythropoiesis-stimulating agent&#46;"></img></a></p><p class="elsevierStylePara">Table 1&#46; Values of haemoglobin&#44; ferritin and the rate of transferrin saturation according to the stage of renal function and the type of erythropoiesis-stimulating agent&#46;</p><p class="elsevierStylePara"><a href="grande&#47;12312&#95;16025&#95;56747&#95;en&#95;f1&#95;12312&#46;jpg" class="elsevierStyleCrossRefs"><img src="12312_16025_56747_en_f1_12312.jpg" alt="Degree of compliance of the established objectives according to the different clinical guidelines&#46;"></img></a></p><p class="elsevierStylePara">Figure 1&#46; Degree of compliance of the established objectives according to the different clinical guidelines&#46;</p>"
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