Erythropoietin for treatment of the anemia of chronic kidney disease in hemodialysis patients
- Jeffrey S Berns, MD
Jeffrey S Berns, MD
- Editor-in-Chief — Nephrology
- Section Editor — Dialysis
- Professor of Medicine
- Perelman School of Medicine at the University of Pennsylvania
The anemia of chronic kidney disease (CKD) is, in most patients, normocytic and normochromic. It is principally due to reduced renal erythropoietin (EPO) production (a presumed reflection of the reduction in the number of EPO-producing cells in the kidneys) and, to a lesser degree, to shortened red cell survival.
Anemia 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 be observed in those with higher GFRs.
If left untreated, the anemia of CKD is associated with several abnormalities. These include deterioration in cardiac function, decreased cognition and mental acuity, fatigue, and other signs and symptoms. There are also associations with an increased risk of morbidity and mortality, principally due to cardiac disease and stroke.
The primary therapeutic options for the anemia of CKD include red blood cell transfusions, erythropoietin-stimulating agents (ESAs), and, to a much lesser degree, androgens. Iron must also be available to support erythropoiesis, so iron supplementation is also an important component of anemia management in patient with anemia of CKD.
The use of recombinant human EPO in the treatment of anemia of CKD in hemodialysis patients is discussed in this topic review. The use of EPO in predialysis patients with CKD and peritoneal dialysis patients, overviews of the use of iron or darbepoetin in patients with kidney disease, and target hemoglobin levels in patients with CKD are discussed separately. (See "Darbepoetin alfa for the management of anemia in chronic kidney disease" and "Anemia of chronic kidney disease: Target hemoglobin/hematocrit for patients treated with erythropoietic agents".)
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- KIDNEY AND ERYTHROPOIETIN PHYSIOLOGY
- OVERVIEW OF TREATMENT OPTIONS
- Red blood cell transfusions
- Erythropoietin-stimulating agents (ESAs)
- USE FOR ANEMIA IN PATIENTS ON CHRONIC HEMODIALYSIS
- Efficacy and benefits
- Iron issues
- Hemoglobin versus hematocrit
- Hemoglobin level
- Route of administration
- Side effects
- - Adverse cardiovascular effects with high hemoglobin levels
- - Pure red cell aplasia
- Hyporesponsiveness to ESAs
- Lowering EPO requirements
- Adequacy of dialysis and different dialysis modalities
- SUMMARY AND RECOMMENDATIONS