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Part 3: Education Programs in PD |
Tung Wah Hospital, The University of Hong Kong, Hong Kong SAR, PR China
Correspondence to: Wai Kei Lo, Tung Wah Hospital, The University of Hong Kong,
12 Po Yan Street, Hong Kong SAR, PR
China.
wkloc{at}hkucc.hku.hk
The target of renal anemia correction with erythropoietin stimulating
agents (ESAs) has been traditionally set at a hemoglobin (Hb) level of 11 - 12
g/dL. However, a trend has arisen of progressively increasing the Hb level to
beyond 12 g/dL. Recent randomized control trials (RCTs) on correction of renal
anemia in chronic kidney disease patients found that normalization of anemia
to above 13 g/dL was associated with negative outcome parameters, echoing a
previous RCT that showed increased death and myocardial infarction risk after
normalization of hemoglobin level in hemodialysis patients. The latest
consensus is to limit Hb to a level not exceeding 13 g/dL during renal anemia
correction with ESAs.
Currently, there are three ESAs available commercially. The choice of ESA
should consider safety of subcutaneous administration, cost-effectiveness, and
dosing frequency, all of which may affect compliance with ESA administration.
Early identification of, and an early search for the causes of
hyporesponsiveness to, ESAs is needed to avoid unnecessary escalation in the
dose of ESAs. These approaches will help to improve the cost-effectiveness of
ESA therapy and permit early detection of hidden problems. The current
definitions of hyporesponsiveness are far too stringent and should be
reviewed.
KEY WORDS: Renal anemia; erythropoietic agents.
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