Abstract
Anemia is an underrecognized but characteristic feature of chronic kidney disease (CKD), associated with significant cardiovascular morbidity, hospitalization, and mortality. Since their inception nearly two decades ago, erythropoiesis-stimulating agents (ESAs) have revolutionized the care of patients with renal anemia, and their use has been associated with improved quality of life and reduced hospitalizations, inpatient costs, and mortality. Hemoglobin targets ≥13 g/dL have been linked with adverse events in recent randomized trials, raising concerns over the proper hemoglobin range for ESA treatment. This review appraises observational and randomized studies of the outcomes of erythropoietic treatment and offers recommendations for managing renal anemia in the primary care setting.
Highlights
Anemia, a common manifestation of chronic kidney disease (CKD), results primarily from inadequate renal secretion of erythropoietin [1,2]
Anemia showed a graded, independent relationship to mortality in Congestive heart failure (CHF) patients, the risk of death rising from 16% for 12.0–12.9 g/dL to 248% for
The recent randomized controlled trials Correction of Hemoglobin and Outcomes in Renal Insufficiency (CHOIR) [60] and Cardiovascular Risk Reduction by Early Anemia Treatment with Epoetin (CREATE) [61] showed unforeseen increases in cardiovascular events [60] and dialysis initiation [61] among patients assigned to the highest Hb targets, prompting reexamination of the optimal targets and appropriate recipients of erythropoietic therapies
Summary
A common manifestation of chronic kidney disease (CKD), results primarily from inadequate renal secretion of erythropoietin [1,2]. The recent randomized controlled trials Correction of Hemoglobin and Outcomes in Renal Insufficiency (CHOIR) [60] and Cardiovascular Risk Reduction by Early Anemia Treatment with Epoetin (CREATE) [61] showed unforeseen increases in cardiovascular events [60] and dialysis initiation [61] among patients assigned to the highest Hb targets, prompting reexamination of the optimal targets and appropriate recipients of erythropoietic therapies. C-cs = case-control study; CHF = congestive heart failure;CrCl = creatinine clearance; db = double-blind; EPO = epoetin; (e)GFR = (estimated) glomerular filtration rate; Hct = hematocrit; mc = multicenter; IV = intravenous; mo = months; NIDDM = noninsulin-dependent diabetes mellitus; nr = nonrandomized; PLA = placebo; PRN = as required; pts = patients; r = randomized; SrCr = serum creatinine; wks = weeks. Physiologic levels of folate, vitamin B12, and pyridoxine can be maintained with oral supplementation
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