Anaemia management in non-dialysis chronic kidney disease: flexibility of target to target stability?

International clinical practice guidelines have recently recognized for the first time the concrete difficulty of keeping chronic kidney disease (CKD) patients within the narrow haemoglobin (Hb) target recommended of 11-12 g/dl (110-120 g/l) because of the variability of individual patient Hb levels. This emerging clinical problem has been the topic of several editorials that, however, exclusively focused on haemodialysis patients. Recently, 3 retrospective studies have been published on Hb variability in non-dialysis CKD. The studies which overall included more than 6,000 patients showed that Hb variability in non-dialysis CKD is greatly prevalent and is associated with a worse cardiorenal outcome. This minireview summarizes the results and limits of these studies and discusses the potential implications for clinical practice.