Managing Anemia of Chronic Kidney Disease

Abstract

Anemia begins early in the course of declining kidney function and is a frequent complication of chronic kidney disease. Both anemia and chronic kidney disease are underdiagnosed and undertreated. Anemia is associated with significantly increased risk of morbidity and mortality, including increased risks of left ventricular hypertrophy and heart failure. Although the detrimental effects of anemia are more common in patients with advanced chronic kidney disease, it has been suggested that correcting anemia in early stage kidney disease may improve health-related quality of life and also delay the progression to end-stage kidney disease. The identification of anemia in early stage chronic kidney disease and its aggressive management may also improve cardiovascular complications. Anemia of chronic kidney disease is predominantly a result of abnormal erythropoietin production and iron deficiency. Anemia may be the result of kidney failure itself, blood losses, nutritional deficiencies, and endocrine disorders. Guidelines and protocols for treating anemia can assist practitioners in identifying patients with anemia, treating anemia, evaluating response to treatment, and modifying treatment based on response. Erythropoeisis-stimulating agents have been shown to be effective in treating anemia in predialysis and dialysis patients. Iron supplementation is usually required in patients receiving erythropoeisis-stimulating agent therapy or with iron deficiency. Successfully managing anemia of chronic kidney disease with treatment strategies that accommodate patient lifestyle and improve compliance is paramount. Primary care physicians play an important role in the care of patients with kidney disease, as does collaboration with other medical professionals involved in their care.