Clinical considerations and practical recommendations for the primary care practitioner in the management of anemia of chronic kidney disease.
Anemia is prevalent in patients with chronic kidney disease (CKD) and is a risk factor for poor disease outcome. Anemia acts as a risk multiplier, significantly increasing the risk of death in anemic versus nonanemic CKD patients with similar comorbidities. Erythropoiesis-stimulating agents (ESA) are a mainstay for the treatment of anemia in renal patients on dialysis, but recent data suggests that earlier treatment of anemia in CKD may delay the onset of end-stage renal disease (ESRD) and decrease mortality. Nonetheless, anemia of CKD is under-recognized and undertreated during the period before initiation of dialysis, when anemia correction may have the greatest impact on disease outcome. This report describes anemia in CKD and its association with diabetes, cardiovascular disease, and poor disease outcome, and offers suggestions for the recognition and treatment of anemia of CKD in the primary care setting.
Basile
Jan N
JN
Ralph H. Johnson VA Medical Center and the Medical University of South Carolina, Charleston, South Carolina 29401, USA. Jan.Basile@med.va.gov
D000465:Algorithms; D000740:Anemia / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D015897:Comorbidity; D003928:Diabetic Nephropathies / Q000150:complications; D018450:Disease Progression; D004920:Erythropoiesis; D004921:Erythropoietin / Q000627:therapeutic use; D005293:Ferritins / Q000097:blood; D006801:Humans; D006973:Hypertension / Q000150:complications; D007674:Kidney Diseases / Q000150:complications* / Q000503:physiopathology; D018384:Oxidative Stress / Q000502:physiology; D011320:Primary Health Care / Q000379:methods*; D011788:Quality of Life; D011994:Recombinant Proteins; D012307:Risk Factors
D011994:Recombinant Proteins; D004921:Erythropoietin; D005293:Ferritins