BRIEF COMMENT

Is there a deleterious effect of erythropoietin in end-stage renal disease?

Ajay K. Singh, MBBS, FRCP
Brigham and Women's Hospital
Harvard Medical School

I wanted to draw your attention to a recent commentary/editorial that was published in KI (KI link) (1). Admittedly, I am shamelessly plugging the article; I do want to make a few points.

1. The FDA has emphasized the importance of individualizing anemia management and of using the lowest possible dose of erythropoiesis stimulating agent (ESA). Look out for whether a dialysis provider near you is embracing this. Of course, if they are continuing to push the use of an anemia protocol, they are clearly not doing so. Ask why?

2. It is important to recognize that correction of anemia with ESA is not disease modifying. Rather, treatment is symptom modifying. Ask the question: what symptoms am I trying to treat? And, once you’ve started treatment: have I been successful?

3. Try to determine what the transfusion trigger is – I like the term “hemoglobin trigger” – defined as the hemoglobin (Hb) concentration at which intervention with either ESA or blood transfusion or iron is necessary. The Hb trigger will differ for each patient, but is likely to be in the Hb 8 to 10 g/dL range.

1. Singh AK, Commentary Kidney International 80, 569-571 (September (2) 2011) | doi:10.1038/ki.2011.190