Current concepts of anemia management in chronic renal failure: impact of NKF-DOQI.
Since the introduction of recombinant human erythropoietin (rHuEPO) into clinical nephrology practice 10 years ago, there has been a slow increase in hemoglobin (Hgb) levels, but most patients with the anemia of chronic renal failure are still moderately anemic and have not achieved the target Hgb (11 to 12 g/dL) recommended by the NKF-DOQI anemia guidelines. Functional iron deficiency, insufficient rHuEPO doses and comorbid factors such as inflammation/infection have been the major reasons for not achieving this target. By optimizing iron stores with regular infusions of intravenous iron in the hemodialysis patient (who has significant blood [iron] losses related to the hemodialysis procedure), and giving adequate amounts of rHuEPO, preferably subcutaneously instead of intravenously, the NKF-DOQI recommended target Hb can be achieved in the majority of patients so treated.
Minor and James Medical Center, University of Washington, Seattle 98104, USA.
J W
JW
Eschbach
D018798:Anemia, Iron-Deficiency / Q000188:drug therapy* / Q000209:etiology* / Q000517:prevention & control; D002986:Clinical Trials as Topic; D004921:Erythropoietin / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D007279:Injections, Subcutaneous; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D008297:Male; D017410:Practice Guidelines as Topic; D011379:Prognosis; D011994:Recombinant Proteins; D006435:Renal Dialysis; D016896:Treatment Outcome; D014481:United States
D011994:Recombinant Proteins; D004921:Erythropoietin