Anemia of chronic kidney disease: when normalcy becomes undesirable.
In patients with chronic kidney disease and renal failure, hemoglobin levels have been rising in parallel with more intensive use of erythropoiesis-stimulating agents (ESAs). However, several recent studies indicate that raising hemoglobin to normal levels with ESAs can be too much of a good thing. Compared with partial correction, normalization of hemoglobin did not improve outcome, and it may have led to more frequent adverse events. The US Food and Drug Administration (FDA) now recommends a hemoglobin goal in the range of 10 to 12 g/dL.
Section of Extracorporeal Therapy, Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Ohio 44195, USA. demirjs@ccf.org
Sevag G
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Demirjian
Saul
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Nurko
D000740:Anemia / Q000188:drug therapy* / Q000209:etiology; D000970:Antineoplastic Agents / Q000009:adverse effects; D004920:Erythropoiesis / Q000187:drug effects*; D004921:Erythropoietin / Q000009:adverse effects* / Q000096:biosynthesis / Q000627:therapeutic use; D006454:Hemoglobins / Q000032:analysis*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000188:drug therapy*; D009369:Neoplasms / Q000188:drug therapy; D017467:Receptors, Erythropoietin / Q000187:drug effects*; D012016:Reference Values; D006435:Renal Dialysis; D012307:Risk Factors; D014481:United States; D014486:United States Food and Drug Administration
D000970:Antineoplastic Agents; D006454:Hemoglobins; D017467:Receptors, Erythropoietin; D004921:Erythropoietin