Anemia in chronic kidney disease: new advances.
Anemia resulting from iron and erythropoietin deficiencies is a common complication of advanced chronic kidney disease (CKD). This article covers major advances in our understanding of anemia in patients with CKD, including newly discovered regulatory molecules, such as hepcidin, to innovative intravenous iron therapies. The use of erythropoiesis-stimulating agents (ESA) in the treatment of anemia has undergone seismic shift in the past 3 years as a result of adverse outcomes associated with targeting higher hemoglobin levels with these agents. Potential mechanisms for adverse outcomes, such as higher mortality, are discussed. Despite the disappointing experience with ESAs, there is a tremendous interest in other novel agents to treat anemia in CKD. Lastly, while awaiting updated guidelines, the authors outline their recommendations on how to best manage patients who are anemic and have CKD.
Patel
Tejas V
TV
Renal Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
Singh
Ajay K
AK
D018798:Anemia, Iron-Deficiency / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D023181:Antimicrobial Cationic Peptides / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000517:prevention & control; D004921:Erythropoietin / Q000627:therapeutic use; D052203:Ferrosoferric Oxide / Q000627:therapeutic use; D006333:Heart Failure / Q000517:prevention & control; D006397:Hematinics / Q000627:therapeutic use*; D064451:Hepcidins; D006801:Humans; D007202:Indicators and Reagents / Q000627:therapeutic use; D019266:Iron, Dietary / Q000378:metabolism / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000503:physiopathology
D000900:Anti-Bacterial Agents; D023181:Antimicrobial Cationic Peptides; C578702:HAMP protein, human; D006397:Hematinics; D064451:Hepcidins; D007202:Indicators and Reagents; D019266:Iron, Dietary; D004921:Erythropoietin; D052203:Ferrosoferric Oxide