Anaemia treatment: therapies and targets
The standard indicator of anaemia management is Hb level.1
The appropriate Hb target for therapy is an ongoing debate, and CKD guidelines may not be appropriate for the CHF population or pre-dialysis CKD population.1 Currently, there is no guidance for the treatment of anaemia in CHF.
According to CKD anaemia guidelines, erythropoiesis stimulating agents (ESAs) are critical components in managing the anaemia of CKD2
- ESA dose should be determined according to the patient’s initial and target Hb level, the observed rate of increase in Hb, and the clinical circumstances.
- Use of ESAs should be accompanied by iron supplementation regardless of dialysis status.3
Since iron deficiency is common in patients with CHF4,5 and CKD,6 it may represent a valid therapeutic target itself.
- In patients with CKD, intravenous iron therapy, with or without ESA, is standard practice for the management of anaemia.7
- In CHF patients with reduced LVEF, with or without anaemia, the correction of iron status has been shown to improve symptoms and peak oxygen consumption.8–11
1. Kazory A and Ross EA. J Am Coll Cardiol 2009;53:639–47
2. KDOQI; National Kidney Foundation Am J Kidney Dis 2006;47(suppl 3):S58–70
3. Locatelli F et al. Nephrol Dial Transplant 2004;19(suppl 2):ii1-47
4. Ezekowitz JA et al. Circulation 2003;107:223–225
5. Nanas JN et al. J Am Coll Cardiol 2006;48:2485–2489
6. Fishbane S et al. Clin J Am Soc Nephrol 2009;4:57–61
7. KDOQI; National Kidney Foundation Am J Kidney Dis 2006;47(suppl 3):S58–70
8. Bolger AP et al. J Am Coll Cardiol 2006;48:1225–1227
9. Okonko DO et al. J Am Coll Cardiol 2008;51:103–112
10. Toblli JE et al. J Am Coll Cardiol 2007;50:1657–1665
11. Anker SD et al. N Engl J Med 2009;361:2436–2448