Higher hemoglobin levels and quality of life in patients with advanced chronic kidney disease: no longer a moving target?

International clinical practice guidelines for the management of anemia in chronic kidney disease suggest target hemoglobin levels ≤ 11.5 g/dl (115 g/l), with individualized consideration of slightly higher hemoglobin targets to improve quality of life. An updated meta-analysis of randomized trials demonstrates no significant improvement in quality of life with erythropoietin-stimulating agent therapy targeting higher hemoglobin levels. Limitations of the available data suggest that individualized targets should nonetheless remain an option in future clinical practice guidelines.