Evaluation and Treatment of Anemia in Chronic Kidney Disease [Kronik Bobrek Hastaliklarinda Aneminin Degerlendirilmesi ve Tedavisi

Abstract

Abstract Anemia is common in patients with chronic kidney disease. Anemia is a major risk factor for cardiovascular disease and affects life quality. The reduction of renal erythropoietin synthesis is the essentially cause of anemia. Among other reasons can considered iron deficiency, inflammation, uremic toxins, hyperparathyroidism, hemolysis, reduction of erythrocyte survival and malnutrition. The reasons that lead to anemia should be investigated primarily in the treatment of anemia and treatment should be for the cause. Erythropoiesis-stimulating agents is the basis of the treatment of anemia in chronic kidney disease. ESA therapy should be initiated to patient after the ruled out other causes of anemia. The target hemoglobin value should be 11-12 g/dL. Iron deficiency must be evaluated before starting treatment with erythropoiesis stimulating agents and should be treated if any iron deficiency. Transferrin saturation (TSAT) and ferritin level is the most commonly used parameters in the evaluation of iron deficiency in chronic kidney disease in practice. Iron therapy should be given if serum ferritin concentrations <100 ng/ml and TSAT <20%. Iron therapy is recommended in recent guidelines, in order to reduce the dose of ESA as well as delaying the uptake, in chronic kidney disease patients with TSAT <30% and ferritin <300 ng/mL. Iron may be administered orally or parenterally in patients with iron deficiency. Parenteral administration should be preferred in hemodialysis patients. Correction of iron deficiency anemia reduces requirement for ESA. The treatment of anemia raises life quality of patients with chronic kidney diseases and is associated with a better prognosis. Keywords: Chronic kidney disease, anemia, iron deficiency anemia, erythropoietin