Nephrol Dial Transplant (2002) 17: 56-59
© 2002 European Renal Association-European Dialysis and Transplant Association
Adjunctive therapy in anaemia management
Division of Nephrology and Dialysis, Department of Medicine III, University of Vienna, Vienna, Austria
Abstract
Iron supplementation is essential for adequate response to recombinant human erythropoietin (rHuEPO) or darbepoetin alfa. Oral iron therapy is often ineffective as the quantity of iron absorbed after oral intake may be insufficient to keep pace with the demands of rHuEPO-stimulated erythropoiesis in patients with end-stage renal disease (ESRD). Currently available i.v. iron preparations include dextran, iron gluconate, and iron sucrose. As rare, but serious, adverse reactions to i.v. iron dextran have been reported, alternative preparations may be preferred. Careful monitoring of iron parameters is required to avoid the effects of over-treatment. Renal anaemia and iron therapy are associated with oxidative stress, leading to a shortening of the lifespan of red blood cells (RBC) and resistance to rHuEPO. rHuEPO therapy may also enhance oxidative stress on RBC. Oxidative stress can be attenuated or prevented by supplementation with vitamin E or melatonin. Vitamin E therapy has also been shown to have a rHuEPO-sparing effect. Disturbances of carnitine metabolism may contribute to the development of renal anaemia in ESRD patients. Oral or i.v. L-carnitine therapy results in an increase in haematocrit and a significant decrease in rHuEPO requirement in HD patients. As yet, there is no general recommendation for L-carnitine supplementation for ESRD patients with renal anaemia.
Keywords: anaemia; carnitine; chronic kidney disease; erythropoietin; iron; oxidative stress; vitamin E
Notes
Correspondence and offprint requests to: Professor Dr Walter H. Hörl, Chief, Division of Nephrology and Dialysis, Department of Medicine III, University of Vienna, Währinger Gürtel 18–20, A-1090 Vienna, Austria. Email: walter.hoerl{at}nephro.imed3.akh\|[hyphen]\|wien.ac.at
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