Update on clinical practice recommendations and new therapeutic modalities for treating anemia in patients with chronic kidney disease.

PURPOSE: The National Kidney Foundation (NKF) clinical practice recommendations for treating anemia in chronic kidney disease (CKD) and the dosing, route and frequency of administration, efficacy, and safety of currently available and investigational drug therapies for anemia in patients with CKD, including the erythropoietin-stimulating agents (ESAs) iron replacement, and adjuvants, are described.
SUMMARY: The NKF recommendations for ESA use are general and include dosing based on the measured and target hemoglobin concentrations, the rate of increase in hemoglobin, and clinical circumstances, with the route and frequency of administration determined by the CKD stage, treatment setting, efficacy, and ESA class. A serum ferritin concentration of 100-500 ng/mL is the target during oral and intravenous (i.v.) iron therapy for predialysis and peritoneal dialysis patients, but use of the i.v. route of administration and a target serum ferritin concentration of 200-500 ng/mL is recommended for hemodialysis patients by NKF. Iron deficiency and inflammation are possible causes of inadequate response to ESAs. The safety profile of epoetin alfa and darbepoetin alfa are similar, but the longer half-life of darbepoetin alfa permits administration on a once-monthly basis in patients with CKD and anemia. Extended dosing of CERA also appears safe and effective in dialysis patients with CKD. Several investigational anemia therapies with a variety of mechanisms of action are in development.
CONCLUSION: Efforts by the NKF to update their clinical practice recommendations provide clinicians with insight into the optimal therapeutic approach to treating anemia in patients with CKD. Clinical research has resulted in the development of new therapeutic modalities to improve outcomes in patients with CKD and anemia.