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Darbepoetin alfa for the management of anemia in chronic kidney disease

Authors
Allen R Nissenson, MD
Shaan Anand, MD
Section Editor
Jeffrey S Berns, MD
Deputy Editor
Alice M Sheridan, MD

INTRODUCTION

Anemia, an extremely common complication of chronic kidney disease (CKD), can develop well before the onset of uremic symptoms due to end-stage renal disease (ESRD). Although anemia due to renal dysfunction generally develops when the glomerular filtration rate (GFR) declines to <30 mL/min, it can also be observed in those with markedly higher GFRs (such as 60 mL/min) [1].

If left untreated, the anemia of CKD is associated with several physiologic abnormalities, including deterioration in cardiac function and decreased cognition and mental acuity [2]. It can also be accompanied by debilitating symptoms, such as fatigue, weakness, lethargy, anorexia, and sleep disturbances. In addition, anemic patients commonly lack the stamina needed to perform normal daily activities or to work [3].

Anemia may also, in part, underlie the high cardiovascular mortality observed in the CKD population as a low hematocrit (Hct) is an independent risk factor for death in this population. In one study, for example, a 3 percent decrease in Hct was associated with a 7 percent increased risk of death [4]. This is most likely due to an increased propensity for the development of left ventricular hypertrophy (LVH) (see "Myocardial dysfunction in end-stage renal disease"). The overall result of untreated anemia in this setting is maladaptive cardiac remodeling [5], with every 1 g/dL decrease in hemoglobin (Hb) concentration being associated with a 6 percent increase in risk of LVH [6]. (See "Effects of anemia in chronic kidney disease".)

National Kidney Foundation (NKF) Kidney Disease Outcome Quality Initiative (K/DOQI) guidelines recommend that patients with CKD undergo an assessment for the cause of anemia when the Hb is <13.5 g/dL in adult males and <12.0 g/dL in adult females [2]. Among patients with kidney disease, anemia arises principally because of insufficient production of erythropoietin (EPO) by the kidneys [7]. However, other causes and/or additional contributing factors may be involved, particularly iron or folate deficiency, which also require evaluation prior to treatment of the anemia [2,8]. (See "Diagnosis of iron deficiency in chronic kidney disease" and "Treatment of iron deficiency in nondialysis chronic kidney disease (CKD) patients" and "Treatment of iron deficiency in hemodialysis patients".)

The EPO deficiency evident in patients with CKD can be corrected by the exogenous administration of erythropoiesis-stimulating agents (ESAs). Two such agents are currently available in the United States (see "Treatment of anemia in nondialysis chronic kidney disease" and "Resistance to erythropoiesis-stimulating agents (ESAs) in chronic kidney disease"):

             

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Literature review current through: Nov 2016. | This topic last updated: Thu Aug 06 00:00:00 GMT+00:00 2015.
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References
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