hematology and oncology
Anemia of Renal Disease
Treatment of Anemia of Renal Disease
Treatment of underlying renal disease Sometimes, recombinanterythropoietinandironsupplements Treatment of anemia of renal disease is directed at Improving renal function Increasing RBC production If renal function returns to normal, anemia is slowly corrected. ) along with iron supplements is the treatment of choice. However, because there is both reduced production of EPO and marrow resistance to EPO, the recombinant EPO dose may need to be higher. The goal is a hemoglobin of 10 to 11.5 g/dL (100 to 115 g/L). Careful monitoring of hemoglobin response is needed because adverse effects (eg, Deep Venous Thrombosis (DVT) , In addition, adequate repletion of iron stores is required to ensure an adequate response to recombinant EPO, and Treatment is often needed. The addition of IV iron is considered in patients with hemoglobin < 10 g/dL (< 100 g/L), ferritin ≤ 500 ng/mL (< 500 micrograms/L), and transferrin saturation (TSAT) ≤ 30%. In almost all cases, maximum increases in RBCs are reached by 8 to 12 weeks. ) are an oral option in patients on dialysis. HIF-PH inhibitors increase endogenous erythropoietin levels by preventing HIF degradation. HIF-PH inhibitors appear to produce similar increases in hemoglobin and have similar rates of adverse cardiovascular outcomes to erythropoiesis-stimulating agents ( Treatment reference ); however, long-term safety data are lacking. 1.Singh AK, Carroll K, Perkovic V, et al:Daprodustatfor the Treatment of Anemia in Patients Undergoing Dialysis.N Engl J Med2021;385(25):2325-2335. doi:10.1056/NEJMoa2113379 