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Is it safe to use erythropoiesis‐stimulating agents to treat anemia in chronic kidney disease patients with active malignancies?

studies suggest that the administration of oral pentoxifylline may help improve hemoglobin and response to erythropoietin by reducing expression of TNF-a and IFN-c. Results from a multicenter randomized doubleblind controlled study designed to measure the effects of pentoxifylline in ESA resistant anemia for advanced CKDpatients will be of interest (14). In summary, evidence suggests short term efficacy of ascorbic acid and pentoxifylline in improving ESA resistant anemia in the ESRD population. Literature on ascorbic acid shows that higher hemoglobin levels can be achieved with lower doses of erythropoietin; the observed increase in transferrin saturation suggests particular utility in iron overload. However, current studies vary widely on the duration of treatment, dose and route of administration and lack adequate power. Also, long-term safety may be an issue of concern. Pentoxifylline appears promising, however there is a paucity of studies for this cohort. The longterm effects of these therapies in ESRD patients with respect to cardiovascular morbidity and mortality are unknown.