Erythropoietin and Iron Therapy in Patients with Renal Failure

Abstract

SUMMARY Anemia, which is a common complication of chronic kidney disease (CKD), may significantly impair quality of life, increase cardiovascular risk and reduce long-term survival if left untreated. Today, erythropoiesis-stimulating agents (ESAs) are the main tool for anemia correction; they can be differentiated on the basis of mean serum half life on short- and long-acting molecules, the latter requiring longer administration intervals. According to international guidelines, the target hemoglobin to be obtained by treatment is between 11 and 12 g/dL. In general, the intravenous route is more convenient for hemodialysis patients, whereas the subcutaneous one is preferable in all other CKD patients. ESA dose requirements are rarely predictable in the individual patient and thus need to be titrated according to hemoglobin increases. In order to achieve ESA effectiveness, patients often need iron supplementation, either orally or intravenously. The intravenous route is the most widely used, especially in hemodialysis patients.