Management of Anemia in Renal

Management of Anemia in Renal

Introduction

Anemia is common among patients with chronic kidney disease. In such patients, treatment with erythropoietin has been shown to enhance the quality of life. However, evidence suggesting that the correction of anemia improves cardiovascular outcomes has largely been derived from observational studies and small interventional trials associating a high level of hemoglobin with a lower rate of complications and death from cardiovascular causes. Other evidence has also indicated that cardiovascular complications, such as left ventricular hypertrophy, might be improved through the use of a high hemoglobin level as a target (Singh, et al., 2006). Observational data indicate that correction of anemia is associated with improved outcomes. However, the normalization of hemoglobin in prospective trials involving patients receiving hemodialysis did not improve left ventricular indexes or decrease the risk of death (Drüeke, et al., 2006).

Anemia Management

Anemia is managed with an appropriate combination of iron supplements and erythropoietin stimulating agents (ESAs—often referred to as EPO). ESAs are introduced to treat anemia in patients with renal disease has dramatically improved patient quality of life. In addition, patients no longer have to be transfused on a regular basis. Before ESAs were available, patients commonly received red blood cell transfusions, which carried the risks of infection, iron overload, and potentially reducing the chances of receiving a kidney transplant. Given the fact that there is a major loss of blood inherent with dialysis, ESA treatment sustains the hemoglobin level and allows patients to have higher levels of energy. As a result, patients are able to engage more in normal daily activities, including preparing a meal, working or volunteering, attending school, managing a household, raising children, etc. Furthermore, the patients’ clinical conditions, such as rapid heartbeat, shortness of breath, and lack of clear thinking, often improve significantly. With the proper care and anemia management, a patient can have a better quality of life. This type of health care management was introduced to be one of the advances in the care of the patients with kidney problems and this development is an important part of the dialysis procedure. However, there are no specific recommendations for monitoring non-hematological laboratory tests or monitoring non-hemoglobin elements of complete blood count (CBC). The anemia management done by the medical professionals is expected to show effects on the renal function that can be both harmful and beneficial for the patients (NKF, 2007).

Importance of Management in Anemia

Anemia is strongly predictive of complications and death from cardiovascular causes in patients with chronic kidney disease (Drüeke, et al., 2006). As part of the kidney disease initiatives for positive outcomes recommended to implement a target level of hemoglobin for the patients. The potential improvement in the patient’s quality of life can be measured through the appropriate management (Singh, et al., 2006).  Among patients with chronic kidney disease, the effect of correction or management of anemia may differ between those who require dialysis and those who do not. The latter group generally has less advanced cardiovascular disease and no risk of dialysis-related increases in hemoglobin or vascular access thrombosis. Several observational and small interventional studies of patients with chronic kidney disease who were not receiving dialysis reported an inverse relation between hemoglobin levels and cardiovascular outcomes (Drüeke, et al., 2006)

In the aim of Cardiovascular Risk Reduction by Early Anemia Treatment with Epoetin Beta (CREATE) trial, the complete correction of anemia in patients with stage 3 or 4 chronic kidney disease improves cardiovascular outcomes as compared with partial correction of anemia (Drüeke, et al., 2006). Part of the Clinical Practice Guideline (CPG) and Clinical Practice Recommendations (CPRs) are designed to provide information and assist decision-making. These policies are not intentionally made to define a standard of care, and should not be construed as one. Neither should they be interpreted as prescribing an exclusive course of management (NKF, 2007).

Conclusion

With the appropriate administration the benefits or improvement in the therapy can be shown through the changes among the patient. Because anemia is characterized in human blood, the renal functions and dialysis can be dangerous for the patient who is considered anemic. The management of anemia are created because of the pursuance of the medical professionals to support their aim towards the quality life and wellness. And learning the method for managing the anemia can deliberately increase the life expectancy of  the patient and reduce the risks that may involved.

 

References:

Drüeke, T.B., Locateli, F., Clyne, N., Eckardt, K-U., Macdougall, I.C., Tsakins, D., Burger, H-U., & Scherhag, A., (2006) Normalization of Hemoglobin Level in Patients with Chronic Kidney Disease and Anemia, New England Journal of Medicine [Online] Available at: http://www.nejm.org/doi/full/10.1056/NEJMoa062276#articleBackground [Accessed 14 September 2010].

NKF (2007) KDOQI Clinical Practice Guideline and Clinical Practice Recommendations for Anemia in Chronic Kidney Disease: Update of Hemoglobin Target, National Kidney Foundation [Online] Available at: http://www.therenalnetwork.org/qi/resources/KDOQIAnemiaCKD2007Update.pdf [Accessed 14 September 2010].

Singh, A.K., Szczech, L., Tang, K., Banhart, H., Sapp, S., Wolfson, M., & Reddan, D., (2006) Correction of Anemia with Epoetin Alfa in Chronic Kidney Disease, New England Journal of Medicine [Online] Available at: http://www.nejm.org/doi/full/10.1056/NEJMoa065485#articleBackground [Accessed 14 September 2010].

 

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