KDOQI (Kidney Disease Outcomes Quality Initiative)
NKF KDOQI GUIDELINES

KDOQI Clinical Practice Guideline and Clinical Practice Recommendations for Anemia in Chronic Kidney Disease: 2007 Update of Hemoglobin Target


BIOGRAPHICAL AND DISCLOSURE INFORMATION

Work Group

John W. Adamson, MD, has served as Executive Vice President for Research and Director of the Blood Research Institute of the Blood Center of Southeastern Wisconsin in Milwaukee since 1998. He holds the position of Professor of Medicine (Hematology) at the Medical College of Wisconsin. Before moving to Milwaukee, he was Director of the Lindsley F. Kimball Research Institute of the New York Blood Center since 1989 and President of the Center from 1989 to 1997. Dr Adamson received his MD from the University of California, Los Angeles, after which he trained at the University ofWashington in Seattle and the National Institutes of Health (NIH) in Bethesda, MD, in the fields of internal medicine and hematology. Before assuming his position in New York, Dr Adamson was professor of medicine and head of the Division of Hematology at the University of Washington. Dr Adamson is a past President of the American Society of Hematology and past Chairman of its committees on scientific affairs and transfusion medicine. Dr Adamson served as a member of the Advisory Council of the National Institute of Diabetes, Digestive and Kidney Diseases of the NIH. In 1988, he was designated clinical research professor by the American Cancer Society and elected a Fellow of the American Association for the Advancement of Science. Dr Adamson is past editor-in-chief of Blood, past editor of the Journal of Cellular Physiology, and founding editor of Current Opinion in Hematology. Altogether, he has authored or co-authored more than 400 scientific publications.

Consultant: Affymax; Fibrogen;Watson
Speaker:Watson
Grant/Research Support (no personal income): N/A
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Part-Time Employee: N/A
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Jeffrey S. Berns, MD, earned his MD at Case Western Reserve University, then completed his internship and residency in Internal Medicine at University Hospitals of Cleveland. He completed a fellowship in Nephrology and was anAssociate Research Scientist in the Department of Physiology at Yale University. Dr Berns was recently promoted to Professor of Medicine at the University of Pennsylvania School of Medicine, where he is Director of Clinical Nephrology and Director of the Renal Fellowship Program for the Renal, Electrolyte and Hypertension Division. He has published and lectured on topics related to CKD, anemia management in patients with CKD, and other areas in clinical nephrology. He is co-editor of Drug Prescribing in Renal Failure-Dosing Guidelines for Adults. He also serves on the editorial board of Seminars in Dialysis, American Journal of Kidney Diseases, and Clinical Journal of the American Society of Nephrology. He is an active investigator in clinical trials related to anemia treatment in patients with CKD.

Consultant: Amgen; Neose
Speaker: N/A
Grant/Research Support (no personal income):
Advanced Magnetics; Hoffman LaRoche
Grant/Research Support (includes personal income): N/A
Part-Time Employee: N/A
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Kai-Uwe Eckardt, MD (Work Group Co- Chair), is Professor of Medicine and Chief of Nephrology and Hypertension at the University of Erlangen–Nuremberg, Germany. He received his MD from theWestfälischeWilhelms-Universität Münster, Germany. In 1993, following postgraduate training in internal medicine, pathology, and physiology, he was appointed Assistant Professor of Physiology at the University of Regensburg, Germany. Subsequently, he continued his training in internal medicine and nephrology at the Charité, Humboldt University in Berlin, where he was appointed Associate Professor of Nephrology in 2000. His major scientific interests are in the molecular mechanisms and physiological/pathophysiological relevance of oxygen sensing and the management of anemia. Professor Eckardt is Subject Editor of Nephrology, Dialysis and Transplantation and serves on the editorial board of several other journals. He contributed to the development of the European Best Practice Guidelines for Anemia. Management and is a member of the executive committee of Kidney Disease: Improving Global Outcomes (KDIGO). Dr Eckardt is associated with the CREATE and TREAT studies.

Consultant: Affymax; Amgen; Hoffman LaRoche; Ortho Biotech/Johnson & Johnson
Speaker: Amgen; Hoffman LaRoche; Ortho Biotech/Johnson & Johnson
Grant/Research Support (no personal income): Hoffman LaRoche; Ortho Biotech/Johnson & Johnson
Grant/Research Support (includes personal income):N/A
Part-Time Employee: N/A
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Steven Fishbane, MD, currently is Chief of Nephrology and Associate Chair of the Department of Medicine atWinthrop-University Hospital (WUH) in Mineola, NY, as well as Professor of Medicine at SUNY Stony Brook School of Medicine. He is the Medical Director of WUH Dialysis Network, which includes 4 outpatient dialysis units and 3 hospital units. Dr Fishbane serves as the Chairman of the Long Island Health Network Quality Council; Chairman of the Department of Medicine Quality Improvement Program, WUH; Chairman of Clinical Guidelines Committee, WUH; Co-Chairman of WUH Patient Care Committee; and Associate Chairman of the Department of Medicine, WUH. Dr Fishbane is a member of the Network 2 Medical Review Board.

Consultant: Abbott; Affymax; Amgen; Genzyme; Hoffman LaRoche; Renal Management Strategies;Watson
Speaker: Abbott; Genzyme; Ortho Biotech;Watson
Grant/Research Support (no personal income):
Abbott; Amgen; Genentech; Genzyme; Hoffman LaRoche; Ortho Biotech; Shire; Speedel;Watson
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Robert N. Foley, MD, was born in Ireland and received his undergraduateMDfrom University College Cork. He completed Internal Medicine training in Cork, later moving to Saint John’s, Newfoundland, Canada, where he completed a residency in nephrology, as well as a Masters in Clinical Epidemiology. From 1999 to 2002, Dr Foley worked at Hope Hospital, Salford, UK, and has been Director of the Chronic Disease Research Group since September of 2002. Dr Foley was also a Co-Editor of the American Journal of Kidney Diseases. His major interest is in outcomes research, especially the interplay of cardiovascular and renal disease. Dr Foley is active in anemia correction trials, as well as in the US Renal Data System Cardiovascular Special Study Center.

Consultant: Amgen; Genzyme; Hoffman LaRoche; Ortho Biotech
Speaker: Amgen; Hoffman LaRoche; Ortho Biotech
Grant/Research Support (no personal income): Amgen; Hoffman LaRoche; Ortho Biotech
Grant/Research Support (includes personal income): N/A
Part-Time Employee: N/A
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Sana Ghaddar, PhD, RD, is an Assistant professor at the American University of Beirut, Lebanon. She has more than 10 years of experience in the renal and clinical dietetics field. She was a renal dietitian and researcher at Peninsula Nephrology Inc in San Mateo, currently a division of Satellite Healthcare. She has served as a principal investigator for anemia management studies that examined the response of heme-iron polypeptide to ESAs in patients with CKD, in addition to other studies that examined patient perceptions, beliefs, and compliance with hemodialysis and nutritional therapy. She has presented her studies at national conferences, including the NKF, American Dietetic Association, and Gerontological Society of America.

Dr. Ghaddar reported no relevant financial relationships.

John S. Gill, MD, MS, obtained his MD from the University of British Columbia (UBC) in 1995. He completed his internal medicine training at the University of Western Ontario in 1998 and his nephrology training in 2000 at UBC. He then completed his transplantation training at Tufts–New England Medical Center in Boston, MA, and obtained a Masters in Clinical Care Research from Tufts in 2002. Dr Gill currently is assistant professor of medicine in the Division of Nephrology at UBC and has a cross appointment at Tufts–New England Medical Center. Dr Gill’s research interests focus on clinical outcomes in kidney transplant recipients. He is the principal investigator and co-investigator on current Canadian Institutes of Health Research, Kidney Foundation, and Michael Smith funded studies. Dr Gill is Chair of the Canadian Society of Transplantation Work Group for Pan-Canadian database development, member of the Canadian Organ Replacement Register Advisory Board, and member of a number of NKF Committees.

Consultant: Hoffman LaRoche
Speaker: N/A
Grant/Research Support (no personal income): N/A
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Kathy Jabs, MD, is a Pediatric Nephrologist who was trained at Babies Hospital, NY, and Children’s Hospital, Boston, MA. She was a faculty member at Children’s Hospital in Boston (1988 to 1996) and served as Director of Dialysis and Renal Transplantation at Children’s Hospital of Philadelphia (1996 to 2000). She currently is the Director of Pediatric Nephrology at Vanderbilt Children’s Hospital and an Associate Professor of Pediatrics at Vanderbilt University School of Medicine, Nashville, TN. Dr Jabs has had a long-standing interest in the care of children with chronic kidney disease. Dr Jabs is associated with the CKid and FSGS studies sponsored by the NIH.

Dr Jabs reported no relevant financial relationships.

Francesco Locatelli, MD, FRCP, is Head of the Department of Nephrology and Dialysis at A. Manzoni Hospital, Lecco, Italy, and postgraduate Professor of Nephrology at the Universities of Brescia and Milan. He is Past President of the European Renal Association–European Dialysis and Transplant Association, the International Society of Blood Purification, and the Italian Society of Nephrology. He is an Honorary Member of the Czech, Hungarian, Polish, Romanian, and Turkish Societies of Nephrology and an International Distinguished Medalist and recipient of the Garabed Eknoyan Award of the NKF, United States (2006). He is also an honorary fellow of the Royal College of Physicians of London, UK (FRCP). He has been Chairman of the Lombardy Regional Dialysis and Transplantation Registry since 1982. He also serves as Chairman of the board of European Best Practice Guidelines and is on the board of the NKF-Dialysis Outcomes Quality Initiative and the executive board of directors of KDIGO. Dr Locatelli is President- Elect of the World Congress of Nephrology (2009), Subject Editor of Nephrology Dialysis Transplantation, Associate Editor of the Journal of Nephrology, member of the Editorial Board of Journal of the American Society of Nephrology, past Associate Editor of the American Journal of Kidney Diseases (2001 to 2004), and serves as reviewer for a number of journals (including the New England Journal of Medicine and The Lancet). He has authored more than 600 papers in the fields of hypertension, nutrition, and CKD progression; adequacy in dialysis; sodium and other electrolyte balance, immunoglobulin A nephropathy, and anemia.

Consultant: Amgen; Dompé Biotec; Hoffman LaRoche; Shire
Speaker: Abbott; Amgen; Bayer; Bellco; Bristol-Myers Squibb; Dompé Biotec; Fresenius; Gambro-Hospal; Hoffman LaRoche; Merck Sharp & Dohme; Novartis; Pfizer; Sanofi-Aventis;Shire
Grant/Research Support (no personal income):N/A
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Iain C. Macdougall, MD, is a combined medical and science graduate of Glasgow University, Scotland, from which he was awarded a First Class Honours BSc in Pharmacology in 1980. For the last 11 years, he has been Consultant Nephrologist and Honorary Senior Lecturer at King’s College Hospital in London, UK. He developed both a clinical and a basic science research interest in factors affecting responsiveness to ESAs. He has served on the Working Parties responsible for both the 1999 and the 2004 versions of the European Best Practice Guidelines on Renal Anaemia Management, as well as the KDOQI Anemia Guidelines Work Group. He is a current Council member of the European Renal Association and a past member of the KDIGO Board of Directors. He has coauthored the section on renal anemia for the last 2 editions of the Oxford Textbook of Clinical Nephrology and the current edition of Comprehensive Clinical Nephrology and is a Subject Editor of Nephrology Dialysis Transplantation.

Consultant: Affymax; Amgen; Hoffman La-Roche; Ortho Biotech; Shire
Speaker: Amgen; Hoffman LaRoche; Ortho Biotech; Shire Grant/Research Support (no personal income):
Affymax; Amgen; Hoffman LaRoche; Ortho Biotech;Shire
Grant/Research Support (includes personal income):N/A
Part-Time Employee: N/A
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Patricia Bargo McCarley, RN, MSN, NP, is a nephrology nurse practitioner at Diablo Nephrology Medical Group in Walnut Creek, CA. Ms McCarley received her BSN and MSN from Vanderbilt University. She is active in the American Nephrology Nurses Association (ANNA), having served on local, regional, and national committees. She is currently a member of the Nephrology Nursing Journal Board. Ms McCarley has authored many publications, including most recently chapters in the 2005 ANNA Nephrology Nursing Standards of Practice and Guidelines for Care and the Contemporary Nephrology Nursing: Principles and Practice (2nd edition).

Consultant: N/A
Speaker: Amgen
Grant/Research Support (no personal income): N/A
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Allen R. Nissenson, MD, FACP, is Professor of Medicine and Director of the Dialysis Program at the David Geffen School of Medicine at University of California at Los Angeles (UCLA), where he has developed a comprehensive dialysis program. He is President of the National Anemia Action Council and recently chaired a Chancellor’s committee at UCLA on Financial Conflicts of Interest in Clinical Research. He is currently serving on a University of California Task Force on Institutional Conflicts of Interest in Research. Dr Nissenson is Chair of the Faculty Executive Council for the David Geffen School of Medicine at UCLA. He has served as Chair of the Southern California End-Stage Renal Disease (ESRD) Network during its organizational years in the early 1980s and is its recent President- Elect. He is Chair of the Medical Review Board. Dr Nissenson served as a Robert Wood Johnson Health Policy Fellow of the Institute of Medicine from 1994 to 1995. He is Immediate Past President of the Renal Physicians Association and has served as a member of the Advisory Group overseeing the entire NKF-Dialysis Outcomes Quality Initiative. Dr Nissenson’s major research interests focus on the quality of care for patients with CKD. His research has included extensive clinical trials of new devices and drugs related to renal disease. Dr Nissenson is co-principal investigator on a recently obtained NIH Center Grant looking at issues of disparities in health care delivery for patients with CKD. He is the author of 2 dialysis textbooks, both in their fourth editions, and was the founding Editor-in-Chief of Advances in Renal Replacement Therapy (currently, Advances in Chronic Kidney Disease), an official journal of the NKF. He currently is Editorin- Chief of Hemodialysis International, the official journal of the International Society for Hemodialysis. He has more than 340 publications in the field of nephrology, dialysis, anemia management, and health care delivery and policy.Among his numerous honors is the President’s Award of the NKF.

Consultant: Advanced Magnetics; Affymax;Amgen; DaVita; Fibrogen; Hoffman LaRoche;Medgenics; Ortho Biotech; Prometic
Speaker:Watson
Grant/Research Support (no personal income):Amgen; Hoffman LaRoche; Ortho Biotech
Grant/Research Support (includes personal income):N/A
Part-Time Employee: N/A
Shares: Advanced Magnetics

Gregorio T. Obrador, MD, MPH, is Professor of Medicine and Dean at the Universidad Panamericana School of Medicine in Mexico City. He also serves as Adjunct Staff at the Division of Nephrology of the Tufts–New England Medical Center and Assistant Professor of Medicine at the Tufts University School of Medicine in Boston, MA. While doing a clinical research fellowship at the Tufts–New England Medical Center and a Master of Public Health at Harvard University, he began a line of investigation in the area of CKD. Through several publications, he and others showed that the pre-ESRD management of patients with CKD is suboptimal, and that this is an important factor for the high morbidity and mortality observed in these patients. A particular area of interest has been anemia management before the initiation of dialysis therapy. By using population registry data, he and his colleagues have reported trends in anemia and iron management. Dr Obrador has served as reviewer for several journals, including Kidney International, the Journal of the American Society of Nephrology, and the American Journal of Kidney Diseases. He also has been a member of the Advisory Board of the NKFKDOQI.

Dr Obrador reported no relevant financial relationships.

John C. Stivelman, MD, is Chief Medical Officer of the Northwest Kidney Centers and Associate Professor of Medicine in the Division of Nephrology, Department of Medicine, at the University ofWashington School of Medicine in Seattle. Dr Stivelman obtained his MD from the University of Pennsylvania, completed his residency in Internal Medicine at Harbor-UCLA Medical Center, and nephrology training at Brigham and Women’s Hospital. Dr Stivelman has been involved in investigative efforts to optimize hematopoietic therapy for dialysis patients since the phase III recombinant erythropoietin trials in 1986. His major interests and literature contributions center on iron utilization, mechanisms of resistance of erythropoietin therapy, improved dialytic survival in disadvantaged populations, and the interaction of regulatory issues with optimization of care. Dr Stivelman has served as the Chair of the Network 6 Medical Review Board and a member of the Forum of ESRD Networks Board of Directors. He currently serves as medical director of one of Northwest Kidney Centers’ free-standing facilities and as a member of the Boards of Directors of the Renal Physicians’ Association and the Northwest Renal Network (Network 16).

Consultant:Watson
Speaker:Watson
Grant/Research Support (no personal income):Amgen; Auxilium;Watson
Grant/Research Support (includes personal income):N/A
Part-Time Employee: N/A
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David B. Van Wyck, MD (Work Group Co- Chair), is Professor of Medicine and Surgery at the University of Arizona College of Medicine in Tucson. After completing his undergraduate studies at Washington University, St Louis, Dr Van Wyck earned his MD at the University of Arizona College of Medicine. There, he undertook a research fellowship in Surgical Biology and completed his residency in Internal Medicine and fellowship in Nephrology. Dr Van Wyck has written or contributed to books, book chapters, articles, and abstracts on basic iron metabolism and reticuloendothelial function and on clinical aspects of iron and anemia in patients with CKD. On the subject of anemia and kidney disease, he pursues research, provides consultation to industry including American Regent, Amgen, and DaVita, Inc, and reviews manuscripts for the major nephrology journals. Dr Van Wyck served on the original KDOQI AnemiaWork Group and assumed Co-Chair responsibilities in 2002. Frequently invited to speak, Dr Van Wyck has lectured on the molecular and cellular control of erythropoiesis and iron homeostasis, diagnostic and treatment issues in anemia and iron management, protocol development in the treatment of dialysis-associated anemia, and new approaches to iron and erythropoietin replacement therapy.

Consultant: Affymax; American Regent; Amgen;DaVita; Ortho Biotech/Johnson & Johnson;Vifor
Speaker: American Regent; Amgen; DaVita;Ortho Biotech/Johnson & Johnson; Vifor
Grant/Research Support (no personal income):N/A
Grant/Research Support (includes personal income):American Regent
Part-Time Employee: DaVita
Shares:N/A

Colin T. White, MD, is a pediatric nephrologist at British Columbia (BC) Children’s Hospital in Vancouver and clinical assistant professor at the University of BC in Canada. He completed medical school in Ottawa and Pediatrics in London, Ontario. There, he finished 3 years of pediatric nephrology training before moving to Vancouver to complete 3 more years. He has been on staff as a Pediatric Nephrologist since 2003 and is currently the Director of Dialysis at BC Children’s Hospital. He has a number of research interests, including medical education, optimizing dialysis care in children, estimation of glomerular filtration rate, and CKD and its complications. Dr White’s interest in anemia management is geared towards children. He is presently completing a Masters degree in Medical Education. Dr White is associated with the CKid study and various NAPRTC protocols.

Consultant: Hoffman LaRoche
Speaker: N/A
Grant/Research Support (no personal income):Genzyme Canada
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KDOQI Chair, Vice-Chair and ERT

Adeera Levin, MD, FACP, is Professor of Medicine and the Co-Chair of the Clinical Investigator Program at the University of British Columbia (UBC). She received her medical degree from McMaster University and nephrology training at the University of Toronto. Dr Levin currently serves as the Director of the Kidney Function Clinic at St Paul’s Hospital in Vancouver, Executive Director of the British Columbia Provincial Renal Agency, Curriculum Chair of the Kidney Research Scientist Core Education and National Training program, and KDOQI Chair at the NKF. In addition, she is a member of the KDIGO Executive Committee, International Society of Nephrology Council, and ROFAR Board of Trustees. Her research interests include early kidney disease, anemia, mineral metabolism disorders, cardiovascular diseases, and CKD progression and health outcomes. Dr. Levin is also the recipient of the UBC Martin Hoffman Award for research excellence and the Dean Whitlaw Award for Outstanding Grand Rounds. She is presently on the editorial board of the American Journal of Kidney Diseases and Nephrology Dialysis and Transplantation.

Consultant: Hoffman LaRoche
Speaker: Abbott; Amgen; Hoffman LaRoche;Merck Frosst; Ortho Biotech
Grant/Research Support (no personal income): Abbott; Genzyme; Merck Frosst; Ortho Biotech;Shire
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Part-Time Employee: N/A
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Michael V. Rocco, MD, MSCE, is Professor of Medicine at Wake Forest University in Winston- Salem, NC. He received his MD degree from Vanderbilt University in Nashville, TN, and also served his Internal Medicine residency at Vanderbilt. He completed a nephrology fellowship at the University of Pennsylvania in Philadelphia, PA, and received a master’s degree in epidemiology at Wake Forest University. He has been on the faculty of the Wake Forest University School of Medicine since 1991 and currently holds the Vardaman M. Buckalew Jr Chair in Nephrology. He has more than 100 manuscripts and book chapters in the areas of hemodialysis, peritoneal dialysis, nutrition, chronic renal failure, and epidemiology. He has served as the clinical center Principal Investigator at Wake Forest for several NIH trials, including the HEMO Study, the Acute Renal Failure Trial Network, the Dialysis Access Consortium, and the Frequent Hemodialysis Network. Dr. Rocco has served as the Vice-Chair for KDOQI since 2003 and was the Vice-Chair for the NKF-KDOQI Hypertension Work Group. He was also a workgroup member of the Centers for Medicare & Medicaid Services (CMS) ESRD Clinical Performance Measures Quality Improvement Committee and served as the Chair of the peritoneal dialysis subcommittee.

Consultant: Amgen; DaVita; Hoffman La-Roche; Renaissance Health Care
Speaker: N/A
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Joseph Lau, MD, is a Professor of Medicine at Tufts University and Program Director, Evidence- based Medicine, NKF Center for CPG Development and Implementation at Tufts New England Medical Center in Boston, MA. Dr Lau completed a fellowship in Clinical Decision Making and Medical Computer Science and he holds a joint appointment as Physician and Clinical Investigator at Tufts. He is also a recipient of the Tufts School of Medicine Distinguished Faculty Award (2003) and an Agency for Healthcare Research and Quality Evidence-Based Practice Center contract. His primary research focus is evidence-based medicine and meta-analyses.

Dr Lau reported no relevant financial relationships.

Katrin Uhlig, MD, MS, is an Assistant Professor of Medicine at Tufts University and Program Director, Nephrology, NKF Center for CPG Development and Implementation at Tufts-New England Medical Center in Boston, MA. She completed a rheumatology fellowship at Policlinic, Munich University in Germany and a nephrology fellowship at Tufts, where she is currently a Staff Physician, Division of Nephrology. She is Co-Editor of the American Journal of Kidney Diseases. She is a recipient of the German National Merit Foundation scholarship. Her research interests include developing evidence-based CPGs, conducting systematic reviews, performing critical literature appraisal, and teaching evidence-based medicine.

Dr Uhlig reported no relevant financial relationships.

Amy Earley, BS, is a Research Assistant at the NKF Center for CPG Development and Implementation at Tufts–New England Medical Center in Boston, MA. She assists in the development of evidence-based clinical guidelines and conducts systematic reviews and critical literature appraisals.

Ms Earley reported no relevant financial relationships.