Anemia is a condition commonly associated with Chronic Kidney Disease (CKD). It frequently develops as renal function decreases to less than 50% of normal, and is caused primarily by a deficiency in endogenous erythropoietin, a glycoprotein hormone produced in the kidney. Another factor responsible for this anemia of CKD is increased red blood cell (RBC) destruction. Since non-CKD causes of anemia, e.g. occult blood loss with resultant iron deficiency, can also occur, screening for such conditions is also important in patients with CKD and anemia.
Anemia can cause deterioration in cardiac function, result in the need for RBC transfusions and hospitalizations, and contribute significantly to a reduction in quality of life. Therefore it is very important to monitor CKD patients for anemia, recognize it early, evaluate the causes and provide appropriate treatment.
***The FDA issued a public health advisory on March 9, 2007 citing the potential dangers of overusing ESAs (erythropoiesis stimulating agents, i.e. medications such as Procrit, Aranesp and Epogen). We are concerned that the FDA advisory as currently drafted may be misleading and only partly applicable to CKD and ESRD patients, and as a result could cause considerable confusion among kidney patients and the kidney community. Anemia-management drugs have been accepted for use in this population since approval of ESAs in 1989. Before the advent of ESAs, blood transfusions were the only effective treatment for boosting dangerously low blood counts. We believe that some of the FDA advisory recommendations do not apply to CKD patients. Therefore, we, along with our colleagues at the RPA (Renal Physicians Association) recommend that the risk and benefits for ESA use must be considered on an individual patient basis by the patient’s kidney doctor. The clinical standard of care has been to maintain hemoglobin concentration > = 10 g/dL, and more recently to avoid excessive rises in Hgb in patients treated with ESAs e.g. to > 12. As available and updated, evidence-based guidelines should continue to guide therapy. Patient health and safety is of paramount importance. Please contact us with your questions.