Expert guidance for treating anemia in chronic kidney disease: what is the appropriate drug treatment strategy?

Figures & data

Table 1. Key messages for correcting CKD patient’s anemia.

- Iron supplementation is of paramount importance for correcting anemia in CKD patients
- ESA treatment should be started only after having obtained the correction of iron deficiency
- Targeting near-to-normal Hb levels is dangerous, mainly when using high ESAs doses in hypo-responsive patients
- The Hb target should be individualized by considering patient characteristics and associated risk factors
- ESAs should not be used to intentionally increase the Hb concentration above 13 g/dL
- Avoid too fast anemia correction

Table 2. Potential advantages and disadvantages of HIF-HPIs.

Advantages
- Oral administration in ND, peritoneal dialysis, and home hemodialysis (?)
- Improved iron utilization (?) (of importance particularly in ND, peritoneal dialysis, home hemodialysis or dialysis center with limited medical presence)
- Efficacy in inflamed patients (?)
Disadvantages and possible risks
- Less clinical experience compared to ESAs
- Polypharmacy
- Drug-to-drug interaction
- Adherence to oral administration
- Risk of worsening retinopathy
- Risk of cyst growth in autosomal dominant polycystic kidney disease
- Risk of worsening pulmonary hypertension
- Risk of enhancing tumor growth (in common with ESAs)
- Risk of venous or arterial thrombosis (in common with ESAs)