Expert offers recommendations: treating anemia in patients with kidney disease

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Expert offers recommendations for treating anemia in patients with kidney disease

12/27/2009


Recent findings that an anemia-fighting drug doubles the risk of stroke in patients with diabetes and chronic kidney disease without substantially improving their quality of life should lead doctors to be more cautious about prescribing these medications. However, the agents may be warranted for certain CKD patients who have severe anemia and need frequent blood transfusions or who are candidates for a kidney transplant, according to an editorial appearing in an upcoming issue of the Journal of the American Society Nephrology.

Ajay Singh, MD, (Brigham and Women’s Hospital and Harvard Medical School), in this new JASN editorial, offers advice for nephrologists to help manage anemia in CKD patients. In patients with mild to moderate anemia, especially those who feel well or have only mild symptoms and low-level fatigue, Singh recommends iron therapy.

“Avoiding use of ESAs in managing anemia in nondialysis patients with CKD is now the soundest approach given the remarkable observations from the TREAT study,” wrote Singh. He noted that a blood transfusion or treatment with a short course of an ESA may be necessary if anemia worsens and the patient develops symptoms.

Singh stressed that most CKD patients who have cancer should be treated with blood transfusions, not ESAs. He indicated, however, that long-term treatment with ESAs should be considered for CKD patients who are candidates for a kidney transplant (who cannot receive blood transfusions) and for those who have more severe anemia.

Singh added that more clinical trials are needed to answer a number of questions, such as whether there is a toxic dosage range of ESAs, if the frequency of administration of ESAs makes a difference, and whether the risks seen in TREAT also occur in dialysis patients with CKD.

Singh is a senior nephrologist at the same institution as the primary investigator of the TREAT study, was principal investigator of the CHOIR study and a member of the executive committee for the TREAT study. He has received consulting income and grant support from Amgen, Johnson and Johnson, and Watson. He has also received consulting income from Fibrogen.

Dr. Berns has served on advisory or executive committees for and received consulting income from Amgen, Affymax, GSK, and Wyeth.

The editorial, entitled “Does TREAT Give the Boot to ESAs in the Treatment of CKD Anemia?” appears online at http://jasn.asnjournals.org/ on Dec. 24, 2009.

http://www.nephronline.com/news.asp?N_ID=3444