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W. H. Hörl, Y. Vanrenterghem, P. Aljama, P. Brunet, R. Brunkhorst, L. Gesualdo, I. Macdougall, C. Wanner, B. Wikström, OPTA: Optimal treatment of anaemia in patients with chronic kidney disease (CKD), Nephrology Dialysis Transplantation, Volume 22, Issue suppl_3, June 2007, Pages iii20–iii26, https://doi.org/10.1093/ndt/gfm017
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Introduction
Anaemia is an early complication of chronic kidney disease (CKD). The optimal treatment of anaemia in patients with CKD is of increasing importance, since early and adequate treatment of anaemia may have a positive impact or morbidity and mortality in this patient population. A timely start of anaemia treatment is only partly realized due to different reasons:
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Patients are categorized according to their underlying disease, comorbidity and the stage of CKD.
Epidemiology and definitions
In the general population, the mean Hb concentration of healthy individuals is a function of age, gender and iron status. In men, free testosterone levels decrease with advanced age and this may lead to a decrease in Hb. In women, Hb concentrations are lower as compared with men, probably due to lower testosterone levels but not iron deficiency, since transferrin saturation increases with advanced age in both men and women [ 2 ].
Anaemia is an early complication of CKD [ 3 ]. In the NHANES III study, a statistically significant decrease in Hb was already apparent among men starting at creatinine clearance (CrCl) below 70 ml/min and among women starting at CrCl below 50 ml/min [ 4 ]. Anaemia should be investigated and treated as recommended by the European Best Practice Guidelines (EBPG) (5). The Hb levels at which therapy with erythropoiesis-stimulating agents (ESAs) should be initiated, as well as its target Hb level, remain controversial [ 6 ]. The EBPG recommend Hb values >11 g/dl, while the K/DOQI clinical practice guidelines and clinical practice recommendations suggest Hb levels between 11 and 13 g/dl [ 7 ]. Recent trials recommend a target Hb level between 11 and 12 g/dl in CKD patients [ 8 , 9 ].
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