This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citing articles on ISI (1)  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in this journal  Topic Collections  • Anemias  • Alert me on articles by topic

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

While Goodnough et al¹ provide a recent review of selected anemia management and mortality studies, their conclusions regarding the end-stage renal disease population must distinguish between association and causal effect. As noted by Goodnough et al,¹ cause-and-effect relationships are difficult to prove using observational retrospective analyses. Although the observational studies cited in their Commentary may suggest that anemia is "an independent factor impacting mortality," bias due to confounding may be present.² In other words, there are a multitude of other reasons that may cause both the anemia and increased mortality (eg, chronic inflammatory condition).³ In this case, anemia is an innocent bystander, and ameliorating the anemia will not necessarily impact mortality.

Causality is a complex issue that is best addressed by the use of a carefully designed randomized clinical trial to draw the correct inferences from study results.⁴ Unfortunately, Goodnough et al¹ do not cite the 2 studies that are . . . [Full Text of this Article]

Dennis Cotter, MSE
Bethesda, Md

RELATED ARTICLE

Anemia: Not Just an Innocent Bystander?
Allen R. Nissenson, Lawrence T. Goodnough, and Robert W. Dubois
Arch Intern Med. 2003;163(12):1400-1404.
EXTRACT | FULL TEXT