The evolving science of anemia management in chronic kidney disease

  • Ziad A. Massy
    Affiliations
    Inserm Unit 1018, Team 5, Centre de recherche en Epidémiologie et Santé des Populations, Paul Brousse University Hospital, Paris-Sud University and Versailles Saint-Quentin-en-Yvelines University (Paris-Ile-de-France-Ouest University), Villejuif, France

    Department of Nephrology, Ambroise Paré University Hospital, Assistance Publique - Hôpitaux de Paris, Boulogne-Billancourt/Paris, France
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  • Tilman B. Drueke
    Affiliations
    Inserm Unit 1018, Team 5, Centre de recherche en Epidémiologie et Santé des Populations, Paul Brousse University Hospital, Paris-Sud University and Versailles Saint-Quentin-en-Yvelines University (Paris-Ile-de-France-Ouest University), Villejuif, France
    Search for articles by this author
      The articles in this edition of Kidney International Supplements timely focus on the rapidly evolving field of anemia management in patients with chronic kidney disease (CKD). The revolutionary introduction of recombinant human erythropoietin into the therapeutic arena in the 1980s profoundly changed the quality of life of most patients with end-stage kidney disease. However, it subsequently became clear that normalization of hemoglobin by erythropoiesis-stimulating agents (ESAs) was generally more harmful than beneficial, as demonstrated by several randomized controlled trials performed at the turn of the century.
      • Besarab A.
      • Bolton W.K.
      • Browne J.K.
      • et al.
      The effects of normal as compared with low hematocrit values in patients with cardiac disease who are receiving hemodialysis and epoetin.
      • Drueke T.B.
      • Locatelli F.
      • Clyne N.
      • et al.
      Normalization of hemoglobin level in patients with chronic kidney disease and anemia.
      • Singh A.K.
      • Szczech L.
      • Tang K.L.
      • et al.
      Correction of anemia with epoetin alfa in chronic kidney disease.
      • Pfeffer M.A.
      • Burdmann E.A.
      • Chen C.Y.
      • et al.
      A trial of darbepoetin alfa in type 2 diabetes and chronic kidney disease.
      Therefore, partial anemia correction has become the preferred treatment option in patients with CKD.

      Keywords

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      References

        • Besarab A.
        • Bolton W.K.
        • Browne J.K.
        • et al.
        The effects of normal as compared with low hematocrit values in patients with cardiac disease who are receiving hemodialysis and epoetin.
        N Engl J Med. 1998; 339: 584-590
        • Drueke T.B.
        • Locatelli F.
        • Clyne N.
        • et al.
        Normalization of hemoglobin level in patients with chronic kidney disease and anemia.
        N Engl J Med. 2006; 355: 2071-2084
        • Singh A.K.
        • Szczech L.
        • Tang K.L.
        • et al.
        Correction of anemia with epoetin alfa in chronic kidney disease.
        N Engl J Med. 2006; 355: 2085-2098
        • Pfeffer M.A.
        • Burdmann E.A.
        • Chen C.Y.
        • et al.
        A trial of darbepoetin alfa in type 2 diabetes and chronic kidney disease.
        N Engl J Med. 2009; 361: 2019-2032
        • Macdougall I.C.
        • White C.
        • Anker S.D.
        • et al.
        Intravenous iron in patients undergoing maintenance hemodialysis.
        N Engl J Med. 2019; 380: 447-458
        • Macdougall I.C.
        • Bhandari S.
        • White C.
        • et al.
        Intravenous iron dosing and infection risk in patients on hemodialysis: a prespecified secondary analysis of the PIVOTAL trial.
        J Am Soc Nephrol. 2020; 31: 1118-1127
        • Chen N.
        • Hao C.
        • Peng X.
        • et al.
        Roxadustat for anemia in patients with kidney disease not receiving dialysis.
        N Engl J Med. 2019; 381: 1001-1010
        • Chen N.
        • Hao C.
        • Liu B.C.
        • et al.
        Roxadustat treatment for anemia in patients undergoing long-term dialysis.
        N Engl J Med. 2019; 381: 1011-1022
        • Sanghani N.S.
        • Haase V.H.
        Hypoxia-inducible factor activators in renal anemia: current clinical experience.
        Adv Chronic Kidney Dis. 2019; 26: 253-266
        • Schmid H.
        • Jelkmann W.
        Investigational therapies for renal disease-induced anemia.
        Expert Opin Investig Drugs. 2016; 25: 901-916