This uncertainty has arisen because trials up until now have primarily focused on haemoglobin targets without considering the roles of ESA dosage per se or other patient-related factors, such as concurrent illness, inflammation and iron therapy. Until such high level clinical PD0325901 ic50 evidence becomes available, it would seem prudent to avoid both high haemoglobin levels (i.e. >120–125 g/L) and high ESA dosages (i.e. erythopoietin dosage ≥200 IU/kg per week or darbepoetin dosage ≥1 µg/kg per week). Future RCTs need to consider

the clinical impacts of therapies purported to reduce ESA resistance, such as oxpenifylline,35 and of different ESA dosages on clinical outcomes within the currently recommended haemoglobin target range of 95–125 g/L. One study, the Clinical Evaluation of the DOSe of Erythropoietins (C.E. DOSE) trial, is currently underway in Italy to evaluate the impacts of two fixed ESA doses (4000 IU/week iv. vs 18 000 IU/week) on a composite primary end-point of all-cause mortality and fatal and non-fatal cardiovascular events in haemodialysis patients.36 We further propose that a trial with a 2 × 2 factorial design will

help better answer the question of whether ESA dose, haemoglobin level or both affect outcomes (See Fig. 1). In this trial proposal, eligible patients would be randomized to high or low dose of ESA and a higher or lower haemoglobin level within the currently recommended selleck screening library target range. Considering the sample size required for such a trial, an international collaboration of nephrologists and clinical trialists would be required and

the trial should be developed as a priority. “
“The prevalence of chronic kidney disease (CKD) in children has been on the rise in China and more and more paediatric patients are now relying on chronic renal replacement therapies to sustain their lives. However, there is still a lack of literature in China about Immune system their outcomes, thus making it difficult, if not impossible for the paediatric nephrology community to develop strategies to guide future developments and to better serve this group of sick children. Our institution has recently conducted a nation-wide survey to obtain data of children with end-stage renal disease (ESRD) between the years 2007 to 2012. Questionnaires were distributed to 39 member hospitals of the Chinese Paediatric Nephrology Association. Only 28 of our member hospitals were actively providing dialysis services to children and their responses were included in this study. There were a total of 1033 children with ESRD and within this cohort, 474 patients (45.9%) received chronic dialysis and 380 patients (80.2%) preferred haemodialysis. Haemodialysis is far more commonly used than peritoneal dialysis in China and the outcomes were similar to the experiences in North America.