Paper

What Is Needed to Achieve a Hemoglobin of 11.0-13.0 g/dl in End-Stage Renal Disease
Steven Fishbane

Winthrop-University Hospital, Mineola, N.Y., USA

Address of Corresponding Author

Blood Purif 2007;25:53-57 (DOI: 10.1159/000096398)

  Key Words

• End-stage renal disease
• Hemoglobin
• Anemia

  Abstract

Effective treatment of anemia in end-stage renal disease (ESRD) results in reduced fatigue and improved quality of life. The National Kidney Foundation's 2006 anemia treatment guidelines recommend maintaining hemoglobin (Hb) at >11 g/dl, while noting that there is insufficient evidence to routinely maintain Hb levels 13.0 g/dl. Success in achieving Hb levels within these targets requires careful monitoring and adjustments to treatment. In addition, causes for diminished response and refractory anemia must be adequately evaluated. In this article, factors important for achieving Hb 11-13 g/dl in patients with ESRD are reviewed.

Copyright © 2007 S. Karger AG, Basel

  References

1.

KDOQI; National Kidney Foundation: II. Clinical practice guidelines and clinical practice recommendations for anemia in chronic kidney disease in adults. Am J Kidney Dis 2006;47(suppl 3):S16-S85.

2.

Besarab A, Bolton WK, Browne JK, Egrie JC, Nissenson AR, Okamoto DM, Schwab SJ, Goodkin DA: 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.

3.

Parfrey PS, Foley RN, Wittreich BH, Sullivan DJ, Zagari MJ, Frei D: Double-blind comparison of full and partial anemia correction in incident hemodialysis patients without symptomatic heart disease. J Am Soc Nephrol 2005;16:2180-2189.

4.

Foley RN, Parfrey PS, Morgan J, Barre PE, Campbell P, Cartier P, Coyle D, Fine A, Handa P, Kingma I, Lau CY, Levin A, Mendelssohn D, Muirhead N, Murphy B, Plante RK, Posen G, Wells GA: Effect of hemoglobin levels in hemodialysis patients with asymptomatic cardiomyopathy. Kidney Int 2000;58:1325-1335.

5.

Effect of recombinant human erythropoietin therapy on blood pressure in hemodialysis patients. Canadian Erythropoietin Study Group. Am J Nephrol 1991;11:23-26.

6.

Furuland H, Linde T, Ahlmen J, Christensson A, Strombom U, Danielson BG: A randomized controlled trial of haemoglobin normalization with epoetin alfa in pre-dialysis and dialysis patients. Nephrol Dial Transplant 2003;18:353-361.

7.

McMahon LP, Mason K, Skinner SL, Burge CM, Grigg LE, Becker GJ: Effects of haemoglobin normalization on quality of life and cardiovascular parameters in end-stage renal failure. Nephrol Dial Transplant 2000;15:1425-1430.

8.

McMahon LP, McKenna MJ, Sangkabutra T, Mason K, Sostaric S, Skinner SL, Burge C, Murphy B, Crankshaw D: Physical performance and associated electrolyte changes after haemoglobin normalization: a comparative study in haemodialysis patients. Nephrol Dial Transplant 1999;14:1182-1187.

9.

Morris KP, Sharp J, Watson S, Coulthard MG: Non-cardiac benefits of human recombinant erythropoietin in end stage renal failure and anaemia. Arch Dis Child 1993;69:580-586.

10.

Fishbane S: Recombinant human erythropoietin: has treatment reached its full potential? Semin Dial 2006;19:1-4.

11.

Berns JS, Elzein H, Lynn RI, Fishbane S, Meisels IS, Deoreo PB: Hemoglobin variability in epoetin-treated hemodialysis patients. Kidney Int 2003;64:1514-1521.

12.

Lacson E Jr, Ofsthun N, Lazarus JM: Effect of variability in anemia management on hemoglobin outcomes in ESRD. Am J Kidney Dis 2003;41:111-124.

13.

Fishbane S, Berns JS: Hemoglobin cycling in hemodialysis patients treated with recombinant human erythropoietin. Kidney Int 2005;68:1337-1343.

14.

Van Wyck DB: Iron deficiency in patients with dialysis-associated anemia during erythropoietin replacement therapy: strategies for assessment and management. Semin Nephrol 1989;9(1 suppl 2):21-24.

15.

Markowitz GS, Kahn GA, Feingold RE, Coco M, Lynn RI: An evaluation of the effectiveness of oral iron therapy in hemodialysis patients receiving recombinant human erythropoietin. Clin Nephrol 1997;48:34-40.

16.

Fudin R, Jaichenko J, Shostak A, Bennett M, Gotloib L: Correction of uremic iron deficiency anemia in hemodialyzed patients: A prospective study. Nephron 1998;79:299-305.

17.

Macdougall IC, Tucker B, Thompson J, Tomson CR, Baker LR, Raine AE: A randomized controlled study of iron supplementation in patients treated with erythropoietin. Kidney Int 1996;50:1694-1699.

18.

Fishbane S, Lynn RI: The efficacy of iron dextran for the treatment of iron deficiency in hemodialysis patients. Clin Nephrol 1995;44:238-240.

19.

Besarab A, Amin N, Ahsan M, Vogel SE, Zazuwa G, Frinak S, Zazra JJ, Anandan JV, Gupta A: Optimization of epoetin therapy with intravenous iron therapy in hemodialysis patients. J Am Soc Nephrol 2000;11:530-538.

20.

Fishbane S, Frei GL, Maesaka J: Reduction in recombinant human erythropoietin doses by the use of chronic intravenous iron supplementation. Am J Kidney Dis 1995;26:41-46.

21.

Theodoridis M, Passadakis P, Kriki P, Panagoutsos S, Yannatos E, Kantartzi K, Sivridis D, Vargemezis V: Efficient monthly subcutaneous administration of darbepoetin in stable CAPD patients. Perit Dial Int 2005;25:564-569.

22.

Bush B: IV iron administration in a peritoneal dialysis clinic. Nephrol Nurs J 2004;31:447-448.

23.

Yaqub MS, Leiser J, Molitoris BA: Erythropoietin requirements increase following hospitalization in end-stage renal disease patients. Am J Nephrol 2001;21:390-396.

24.

Ayus JC, Sheikh-Hamad D: Silent infection in clotted hemodialysis access grafts. J Am Soc Nephrol 1998;9:1314-1317.

25.

Nassar GM, Fishbane S, Ayus JC: Occult infection of old nonfunctioning arteriovenous grafts: A novel cause of erythropoietin resistance and chronic inflammation in hemodialysis patients. Kidney Int Suppl 2002;80:49-54.

26.

Kalantar-Zadeh K, McAllister CJ, Lehn RS, Lee GH, Nissenson AR, Kopple JD: Effect of malnutrition-inflammation complex syndrome on EPO hyporesponsiveness in maintenance hemodialysis patients. Am J Kidney Dis 2003;42:761-773.

  Author Contacts

Steven Fishbane, MD
Winthrop-University Hospital
200 Old Country Road Suite 135
Mineola, NY 11501 (USA)
Tel. +1 516 663 2169, Fax +1 516 663 2179, E-Mail sfishbane@winthrop.org

  Article Information

Published online: December 14, 2006
Number of Print Pages : 5
Number of Figures : 0, Number of Tables : 0, Number of References : 26

  Publication Details

Blood Purification

Vol. 25, No. 1, Year 2007 (Cover Date: December 2006)

Journal Editor: Leunissen, K.M.L. (Maastricht)
ISSN: 0253-5068 (print), 1421-9735 (Online)

For additional information: http://www.karger.com/BPU

  Drug Dosage / Copyright

Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.