New approaches to the management of anemia of chronic kidney disease: Beyond Epogen and Infed

Abstract

Anemia is a common and debilitating condition seen worldwide but it is specially common and severe in patients with chronic kidney disease (CKD) (peritubular cells being the source of erythropoietin) and cancer (secondary to myelosuppressive treatment). Before the introduction of the first erythropoiesis-stimulating agent (ESA), recombinant human erythropoietin (rHuEPO), in the late 1980s, blood transfusion and anabolic steroids were the mainstay of treatment. Even though rHuEPO changed the way anemia was managed in patients with renal disease, it does have its limitations including efficacy, duration of activity, route of administration and concomitant iron deficiency, and inflammation. There are several innovative agents including hypoxia-inducible factor stabilizers and erythropoietin-mimetic peptides that are being developed to overcome some of these limitations of rHuEPO and are currently in various stages of clinical testing. Iron deficiency is also very common in patients with CKD because of impaired absorption and mobilization of iron and increased demands for iron when ESAs are administered. There are several novel agents including ferumoxytol, dialysate iron, and iron oligosaccharide that are being evaluated to manage iron deficiency in this patient population. © 2006 International Society of Nephrology.