title: Use of Erythropoietin-Stimulating Agents (ESA) in Patients With End-Stage Renal Failure Decided to Forego Dialysis: Palliative Perspective.
abstract: Normochromic normocytic anemia is a common complication in chronic kidney disease (CKD) and is associated with many adverse clinical consequences. Erythropoiesis-stimulating agents (ESAs) act to replace endogenous erythropoietin for patients with end-stage renal disease having anemia. Today, ESAs remain the main tool for treating anemia associated with CKD. In current practice, the use of ESA is not limited to the patients on renal replacement therapy but has extended to nondialysis patients under palliative care (PC). Current evidence on ESA usage in patients with CKD decided to forego dialysis often have to take reference from studies conducted in other groups of patients with CKD, including pre-dialysis patients and those on renal replacement therapy. There is paucity of studies targeting use of ESAs in renal PC patients. Small-scale retrospective study in renal PC patients had suggested clinical advantage of ESAs in terms of hemoglobin improvement, reduction in fatigue, and hospitalization rate. With the expected growth in elderly patients with CKD decided to forego dialysis and manage conservatively, there remains an urgent need to call for large-scale prospective trial in exploring efficacy of ESAs in this population, targeting on quality of life and symptoms improvement outcome. This article also reviews the mechanism of action, pharmacology, adverse effects, and clinical trial evidence for ESA in patients with CKD under renal PC.
authors.affiliation: 1 Department of Medicine & Geriatrics, Medical Palliative Medicine (MPM) Unit, Tuen Mun Hospital, New Territories, Hong Kong.
authors.forename: Hon Wai Benjamin
authors.initials: HW
authors.lastname: Cheng
authors.affiliation: 2 Palliative Medical Unit, Grantham Hospital, Aberdeen, Hong Kong.
authors.forename: Kwok Ying
authors.initials: KY
authors.lastname: Chan
authors.affiliation: 1 Department of Medicine & Geriatrics, Medical Palliative Medicine (MPM) Unit, Tuen Mun Hospital, New Territories, Hong Kong.
authors.forename: Hoi To
authors.initials: HT
authors.lastname: Lau
authors.affiliation: 1 Department of Medicine & Geriatrics, Medical Palliative Medicine (MPM) Unit, Tuen Mun Hospital, New Territories, Hong Kong.
authors.forename: Ching Wah
authors.initials: CW
authors.lastname: Man
authors.affiliation: 1 Department of Medicine & Geriatrics, Medical Palliative Medicine (MPM) Unit, Tuen Mun Hospital, New Territories, Hong Kong.
authors.forename: Suk Ching
authors.initials: SC
authors.lastname: Cheng
authors.affiliation: 1 Department of Medicine & Geriatrics, Medical Palliative Medicine (MPM) Unit, Tuen Mun Hospital, New Territories, Hong Kong.
authors.forename: Carman
authors.initials: C
authors.lastname: Lam
mesh_terms: D000740:Anemia / Q000209:etiology*; D016903:Drug Monitoring; D004921:Erythropoietin / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D006397:Hematinics / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D006454:Hemoglobins; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D010166:Palliative Care / Q000379:methods*; D011788:Quality of Life; D006435:Renal Dialysis / Q000523:psychology; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D006397:Hematinics; D006454:Hemoglobins; D004921:Erythropoietin
keywords: ESA; Hong Kong; anemia; chronic renal failure; erythropoiesis-stimulating agents; nondialysis; palliative