Anemia management in patients on peritoneal dialysis.

Anemia is a common complication of patients receiving peritoneal dialysis (PD) but has been little studied compared to other chronic kidney disease (CKD) populations. A number of factors can affect its severity or response to erythropoiesis-stimulating agents (ESA). Some, such as iron deficiency, occult blood loss, infection, inflammation, oxidative stress, inadequate dialysis dose, and hyperparathyroidism are common to all dialysis patients but they may be more or less important depending on dialysis modality. The net balance of their contribution explains the fact that on average PD patients require less ESA doses compared to hemodialysis patients to correct anemia and maintain stable Hb levels. As in other CKD patients, low hemoglobin levels have been associated with increased mortality in PD patients. Unfortunately, no clinical trials have been carried out specifically in this population whether aiming at different Hb targets with ESAs may modify patient outcome. Given the lack of a vascular access, it is advisable to give PD patients ESA therapy subcutaneously. Long-acting molecules may be of advantage, especially when the drug is administered at the dialysis center.