US Pharm. 2011;36(1):6. 

Ann Arbor, MI--According to a multinational study of nearly 30,000 dialysis patients, naturally occurring high hemoglobin (Hb) levels are safe for kidney disease patients on dialysis, and it may not be necessary to lower these levels to protect patients' health. In the study, which appears in the Journal of the American Society of Nephrology, 1.8% of subjects maintained Hb concentrations above 12 g/dL without medication to stimulate red blood cell production. After adjustment for age, sex, and concomitant diagnoses, these subjects did not have a higher risk of mortality than subjects with lower Hb levels. There also were no differences in mortality between these subjects and those who were taking drugs to achieve Hb levels above 12 g/dL. While current guidelines caution against prescribing drugs to achieve Hb concentrations above 12 g/dL, there appears to be no need to phlebotomize patients whose Hb reaches this level without medication. 

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