Anemia is a prevalent and premature comorbidity in chronic kidney disease (CKD) and associated with
multiple adverse clinical consequences including increased mortality. Today Erythropoiesis-stimulating agents (ESAs),
together with iron supplementation, are the cornerstones of therapy for correcting anemia in CKD patients. As no
generally accepted dosing algorithms for these agents exist, current recommendations prefer a partial but not complete
anemia correction thereby favoring a more conservative and individualized ESA and iron dosing. Here we discuss in
detail current evidence derived from large randomized trials about the proposed hemoglobin targets to aim at in CKD and
End-Stage renal disease patients and report recent data from the thriving European market of biosimilar erythropoietins.
We summarize promising investigational strategies including peginesatide and prolyl hydroxylase inhibitors for
stabilization of the hypoxia inducible factor and provide a clinical review of novel high dose iron formulations like
ferumoxytol or iron (III)-carboxymaltose. Taking these findings together, treatment strategies for anemia of CKD have
got considerably more complicated so that a careful balance between maximization of patient`s quality of life while
minimizing all risks associated with anemia treatment has become a major task of current nephrology.
Keywords: Anemia, biosimilars, chronic kidney disease, darbepoetin alfa, end-stage renal disease, erythropoiesis stimulating
agents, ferritin, ferumoxytol, hepcidin, Hypoxia-inducible factor 1, iron, iron (III) – carboxymaltose, peginesatide, Prolyl
Rights & PermissionsPrintExport