Chronic kidney disease

Anaemia in CKD stages 4–5
ESA with high vs low haemoglobin 
target
Need for blood 
transfusions
Decreased need for transfusions
CVD and mortality, 
quality of life
No benefi t for mortality;
probable harm for CVD
ESA vs placebo
Need for blood 
transfusions
Decreased need for transfusions
CVD and mortality; 
quality of life
Benefi cial eff ect on quality of life;
no benefi t for mortality;
probable harm for CVD
Mineral and bone disorders in CKD stages 4–5
Vitamin D or analogues vs other 
agents
Parathyroid hormone
Lower concentrations of 
parathyroid hormone 
Fractures
Not tested
Cinacalcet vs other agents
Parathyroid hormone
Lower concentrations of 
parathyroid hormone 
Fractures
Not tested
Sevelamer vs calcium-containing 
phosphorus binders
Vascular calcifi cation
Reduced increase in vascular 
calcifi cation
CVD and mortality
No benefi cial eff ect
Dialysis delivery in CKD stage 5D†
Early vs usual initiation of dialysis
Uraemic symptoms
Few symptoms
Mortality
No benefi t
High vs low dialysis dose
Hospital admissions
No diff erence
CVD and mortality
No benefi t
High vs low dialysis membrane fl ux Hospital admissions
No diff erence
CVD and mortality
No benefi t
Short daily (6 days per week) vs 
usual (3 days per week) 
haemodialysis
Left ventricular mass
Improved left ventricular mass
Quality of life
Benefi cial eff ect on self-assessed 
physical function
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Seminar
174 
www.thelancet.com Vol 379 January 14, 2012
in these disorders, and intensive dialysis is some-
times associated with amelioration. No specifi c thera-
pies have yet been developed for these neurological 
manifestations.