Treatment of Anemia in Chronic Kidney Disease

Mechanism and Primary Indications

The American Journal of Kidney Diseases recommends Procrit (epoetin alfa) to treat anemia caused by insufficient production of erythropoietin by diseased kidneys in patients with chronic kidney disease (CKD), which is the primary cause of anemia in these patients 1, 2
Procrit (epoetin alfa) has been used in the treatment of anemia of CKD since 1986, addressing the decreased tissue oxygen delivery, increased cardiac output, and other physiologic abnormalities associated with untreated anemia 1

Untreated anemia of CKD is associated with numerous physiologic abnormalities, including decreased tissue oxygen delivery and utilization, increased cardiac output, cardiac enlargement, and ventricular hypertrophy, angina and congestive heart failure, decreased cognition and mental acuity, altered menstrual cycles and decreased nocturnal penile tumescence, and impaired immune responsiveness 1, 2

The American Journal of Kidney Diseases suggests that iron status must be assessed and adequate iron stores should be available before initiating therapy with Procrit (epoetin alfa) 1, 2
Targeting higher hemoglobin levels (>13 g/dL) has been associated with increased mortality and cardiovascular events, according to Praxis Medical Insights 3

Careful monitoring of hemoglobin levels is essential, with dose adjustments when hemoglobin rises too rapidly (>1 g/dL in any 2-week period), as recommended by the Journal of Clinical Oncology 4

Failing to assess and correct iron deficiency before and during treatment with epoetin alfa can lead to inadequate response, according to the American Journal of Kidney Diseases and Praxis Medical Insights 1, 3
Targeting hemoglobin levels above 12 g/dL increases the risk of adverse cardiovascular events, as noted by Praxis Medical Insights 3
Using ESAs in cancer patients not receiving chemotherapy or when the anticipated outcome is cure is not recommended, according to the Journal of Clinical Oncology 5, 6
Overlooking other causes of anemia that may contribute to poor response, such as inflammation, infection, blood loss, hyperparathyroidism, or folate deficiency, is a clinical pitfall to avoid, as suggested by the American Journal of Kidney Diseases 1, 7