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Nephrol Dial Transplant (2002) 17: 35-38
© 2002 European Renal Association-European Dialysis and Transplant Association


Non-erythropoietin-based anaemia management in chronic kidney disease

Walter H. Hörl

Division of Nephrology and Dialysis, Department of Medicine III, University of Vienna, Vienna, Austria

Abstract

Renal anaemia starts earlier in the progression of chronic kidney disease (CKD) than was previously thought and is often inadequately monitored and treated. Current treatment guidelines recommend giving recombinant erythropoietin (rHuEPO) as soon as haemoglobin (Hb) concentration falls below 11 g/dl and alternative causes of anaemia have been ruled out. Recent studies show that, in practice, few patients receive rHuEPO in the pre-dialysis period and Hb concentrations are often <9 g/dl at the start of haemodialysis. This is at odds with best practice since renal anaemia is a major risk factor for left ventricular hypertrophy. Many factors other than provision of rHuEPO therapy can affect the occurrence and severity of renal anaemia. Iron deficiency is the most common cause of resistance to rHuEPO and appropriate use of iron supplementation in patients with CKD is still being debated. The acute-phase immune response has a more significant role in renal anaemia and rHuEPO resistance than previously believed, as demonstrated by the need for higher rHuEPO doses in patients with raised levels of C-reactive protein. Women often need higher doses of rHuEPO than men, which may be related to differences in androgen levels between the sexes. Low erythropoietin concentrations are a major factor in diabetic nephropathy. Correction of anaemia with rHuEPO may slow progression of CKD by reducing oxidative stress. These and other factors need to be considered for the optimal treatment of patients with anaemia of CKD.

Keywords: ACE inhibitors; anaemia; chronic kidney disease; darbepoetin alfa; erythropoietin; iron

Notes

Correspondence and offprint requests to: Prof. Dr Dr Walter H. Hörl, Professor of Medicine, Chief, Division of Nephrology and Dialysis, Department of Medicine III, Währinger Gürtel 18-20, A-1090 Vienna, Austria. Email: walter.hoerl{at}nephro.imed3.akh\|[hyphen]\|wien.ac.at


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