Expired CME Article

Clinical Considerations and Practical Recommendations for the Primary Care Practitioner in the Management of Anemia of Chronic Kidney Disease

Authors: Jan N. Basile, MD

Abstract

Anemia is prevalent in patients with chronic kidney disease (CKD) and is a risk factor for poor disease outcome. Anemia acts as a risk multiplier, significantly increasing the risk of death in anemic versus nonanemic CKD patients with similar comorbidities. Erythropoiesis-stimulating agents (ESA) are a mainstay for the treatment of anemia in renal patients on dialysis, but recent data suggests that earlier treatment of anemia in CKD may delay the onset of end-stage renal disease (ESRD) and decrease mortality. Nonetheless, anemia of CKD is under-recognized and undertreated during the period before initiation of dialysis, when anemia correction may have the greatest impact on disease outcome. This report describes anemia in CKD and its association with diabetes, cardiovascular disease, and poor disease outcome, and offers suggestions for the recognition and treatment of anemia of CKD in the primary care setting.


Key Points


* The prevalence of CKD is increasing at a rapid rate worldwide, subsequent to the dramatic increase in diabetes and hypertension, the 2 leading causes of CKD.


* As a result of a decrease in the production of erythropoietin, anemia is commonly associated with CKD and worsens as kidney function declines.


* Anemia significantly increases the risk of adverse outcomes and death in CKD patients with diabetes and/or hypertension.


* Although evidence suggests that treatment of anemia in CKD significantly improves patient quality of life and may have a beneficial effect on the rate of progression of kidney disease and mortality, anemia is often only treated in the late stages of CKD or after the initiation of renal replacement therapy.


* To proactively manage high-risk patients with CKD and its associated comorbidities, anemia should be diagnosed earlier and treated appropriately in the primary care setting.


* Current US guidelines specify a target Hb in patients with CKD of ≥11 g/dL with caution when intentionally maintaining Hb levels >13 g/dL.

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