TY - JOUR
T1 - Erythropoiesis-stimulating agents in chronic kidney disease
T2 - What have we learned in 25 years?
AU - Hung, Szu Chun
AU - Lin, Yao Ping
AU - Tarng, Der Cherng
PY - 2014/1
Y1 - 2014/1
N2 - Since the pioneering studies by Eschbach etal in 1987, erythropoiesis-stimulating agents (ESAs) have become the mainstay of anemia therapy in chronic kidney disease (CKD) patients. The introduction of ESAs 25 years ago markedly improved the lives of many patients with CKD, who until then had severe, often transfusion-dependent anemia. However, randomized controlled trials demonstrate an increased risk for cardiovascular events such as stroke, thrombosis, and death at nearly normal hemoglobin concentrations and higher ESA doses in CKD. By contrast, kidney transplant recipients may represent a unique population of CKD patients who may benefit from ESA therapy. This review discusses potential mechanisms involving the erythropoietic and nonerythropoietic effects of ESA treatment and ESA resistance. Further research aimed at elucidating the causal pathways is strongly recommended. Given current knowledge, however, clinical practice should avoid disproportionately high dosages of ESAs to achieve recommended hemoglobin targets, particularly in those with significant cardiovascular morbidity or ESA resistance. The key to CKD anemia management will be individualization of the potential benefits of reducing blood transfusions and anemia-related symptoms against the risks of harm.
AB - Since the pioneering studies by Eschbach etal in 1987, erythropoiesis-stimulating agents (ESAs) have become the mainstay of anemia therapy in chronic kidney disease (CKD) patients. The introduction of ESAs 25 years ago markedly improved the lives of many patients with CKD, who until then had severe, often transfusion-dependent anemia. However, randomized controlled trials demonstrate an increased risk for cardiovascular events such as stroke, thrombosis, and death at nearly normal hemoglobin concentrations and higher ESA doses in CKD. By contrast, kidney transplant recipients may represent a unique population of CKD patients who may benefit from ESA therapy. This review discusses potential mechanisms involving the erythropoietic and nonerythropoietic effects of ESA treatment and ESA resistance. Further research aimed at elucidating the causal pathways is strongly recommended. Given current knowledge, however, clinical practice should avoid disproportionately high dosages of ESAs to achieve recommended hemoglobin targets, particularly in those with significant cardiovascular morbidity or ESA resistance. The key to CKD anemia management will be individualization of the potential benefits of reducing blood transfusions and anemia-related symptoms against the risks of harm.
KW - Anemia
KW - Chronic kidney disease
KW - Erythropoiesis-stimulating agents
KW - Erythropoietin
KW - Hemodialysis
UR - http://www.scopus.com/inward/record.url?scp=84892554663&partnerID=8YFLogxK
U2 - 10.1016/j.jfma.2013.09.004
DO - 10.1016/j.jfma.2013.09.004
M3 - Review article
C2 - 24090633
AN - SCOPUS:84892554663
SN - 0929-6646
VL - 113
SP - 3
EP - 10
JO - Journal of the Formosan Medical Association
JF - Journal of the Formosan Medical Association
IS - 1
ER -