Treatment of anemia in peritoneal dialysis patients
- Wajeh Y Qunibi, MD
Wajeh Y Qunibi, MD
- Professor of Medicine
- University of Texas Health Sciences Center
- William L Henrich, MD, MACP
William L Henrich, MD, MACP
- Professor of Medicine
- President of the Health Science Center
- University of Texas Health Science Center School of Medicine
Anemia is common among peritoneal dialysis patients and underlies many of the symptoms associated with reduced kidney function. Among such patients, untreated anemia is associated with increased mortality and an increased risk of hospitalization and hospital length of stay [1-4].
Screening for and treating anemia is a routine part of the care of peritoneal dialysis patients. This topic review provides an approach to screening and treating anemia. The treatment of iron deficiency among peritoneal dialysis patients is discussed elsewhere. (See "Treatment of iron deficiency in peritoneal dialysis patients".)
The screening and treatment of iron deficiency and anemia among nondialysis chronic kidney disease (CKD) patients and among hemodialysis patients are discussed elsewhere. (See "Treatment of anemia in nondialysis chronic kidney disease" and "Treatment of iron deficiency in nondialysis chronic kidney disease (CKD) patients" and "Treatment of iron deficiency in hemodialysis patients" and "Treatment of anemia in hemodialysis patients".)
Anemia is defined by the World Health Organization (WHO) criteria as a hemoglobin (Hb) concentration <13 g/dL for adult males and postmenopausal women and an Hb <12 g/dL for premenopausal women . (See "Approach to the adult patient with anemia", section on 'Normal ranges for hemoglobin/HCT'.)
However, the WHO definition of anemia does not define goals of treatment among peritoneal dialysis patients. This is because the goals of treatment of anemia with erythropoiesis-stimulating agents (ESAs) are to prevent the development of severe anemia and reduce the need for blood transfusions but not to normalize Hb levels. This approach is based on findings from several randomized, controlled trials among patients with chronic kidney disease and who are on hemodialysis showing that targeting a normal Hb with ESAs results in adverse outcomes. Studies have not been conducted in peritoneal dialysis patients. Regardless, the same principles likely apply to such patients. Thus, even when treated to accepted goals, peritoneal dialysis patients will have anemia as defined above.
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- EPIDEMIOLOGY AND CAUSES
- Initial screening
- Continued monitoring
- INDICATIONS FOR TREATMENT
- Hemoglobin <10 g/dL
- Hemoglobin 10 to 12 g/dL
- Hemoglobin >12 g/dL
- Erythropoiesis-stimulating agents
- - Indications and contraindications
- - Route of administration
- - Dosing
- - Target levels
- - Adverse effects of ESAs
- SUMMARY AND RECOMMENDATIONS