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Last Updated 4/21/19

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Anemia is a common complication of end-stage renal disease (ESRD). Anemia occurs when there is a shortage of red blood cells or when the red blood cells are not correctly formed. In dialysis units, anemia is usually measured by the hematocrit blood test, which reports the percentage of the blood that is comprised of red blood cells. Normally, a hematocrit is from 37% to 47% for women and from 42% to 52% for men. Without interventions, a dialysis patient's hematocrit usually stabilizes between 20-25%. At this level, most patients tire easily and feel drained of energy. Several statistical analyses have shown that dialysis patients have signficantly more complications, hospitalizations, and a higher mortality rate when their hematocrit is below 30% (approximately).

Dialysis patients experience anemia (low hematocrit) primarily because their kidneys no longer produce adequate amounts of erythropoietin (EPO). EPO is the principal factor that stimulates red blood cell production in the bone marrow.

Before 1990, most dialysis patients experienced moderate to severe anemia on a long-term basis. At that time, dialysis patients were given frequent blood transfusions which also exposed them to possible infection by bloodborne pathogens such as hepatitis viruses and HIV. Today, thanks to the availability of bioengineered EPO, the need for most transfusions has been eliminated.

With most patients now routinely receiving EPO during their dialysis treatments, hematocrits are routinely in the range of 30-36%. The NKF-DOQI recommended target hematocrit range for dialysis patients currently is 33% to 36%. Most insurance companies and Medicare will not reimburse the dialysis facilities for EPO injections when the patient's hematocrit is above a certain number (36% approximately).

The production of healthy blood cells is also dependent on the body having enough iron, vitamin B12, folic acid and other substances. If a patient does not respond to EPO therapy, the most likely cause is a deficiency of iron. For this reason, most dialysis centers routinely monitor iron levels in the blood.

 

Warning:  Changes should never be made in a patient's treatment or care based solely on the information found here.  Every patient has unique healthcare concerns and considerations and all these factors must all be taken into account before any changes can be safely made.  All medical and therapeutic decisions must come from a qualified health care provider.  Read RenalWEB's Legal Disclaimer before proceeding.


  NEWS & LATEST ARTICLES
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High-Dose IV Iron For Anemia Correction in Chronic Kidney Disease - Article extract from Kidney International. - April 2019

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Safety of Dynamic Intravenous Iron Administration Strategies in Hemodialysis Patients - Published Ahead of Print CJASN article. - April 15, 2019

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Online First Abstracts from Blood Purification - April 3, 2019

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Will the Results of the Proactive IV Iron Therapy in Hemodialysis Patients Trial Impact the Anemia Guidelines? - Free, full-text, Advance Article from NDT. - April 1, 2019

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A Retrospective Study on Erythropoiesis Stimulating Agent Dose Reducing Potential of an Anti-Platelet Activation Membrane Dialyzer in Hemodialysis Patients - Free, Open Access article from Therapeutic Apheresis and Dialysis. - April 1, 2019

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Safety of Intravenous Iron – Cosmofer and Monofer Therapy in Peritoneal Dialysis and Non-Dialysis-Dependent Chronic Kidney Disease Patients - Free, Open Access article from Peritoneal Dialysis Internation. - March-April 2019

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Economic and Quality of Life Burden of Anemia on Patients with CKD on Dialysis: A Systematic Review - Open Access article from Journal of Medical Economics. - March 27, 2019

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Effect of Additional Oral Semaglutide vs Sitagliptin on Glycated Hemoglobin in Adults With Type 2 Diabetes Uncontrolled With Metformin Alone or With Sulfonylurea — The PIONEER 3 Randomized Clinical Trial - Abstract and editorial extract from the Journal of the American Medical Association. - March 23, 2019

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Erythropoietin, a Multifaceted Protein with Innate and Adaptive Immune Modulatory Activity - Accepted Articles Abstract from American Journal of Transplantation. - March 23, 201

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Akebia Therapeutics Announces Positive Top-Line Results from Two Pivotal Phase 3 Studies of Vadadustat in Japanese Patients with Anemia Due to Chronic Kidney Disease - Press release. - March 12, 2019

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Long-Term Efficacy and Safety of Molidustat for Anemia in Chronic Kidney Disease: DIALOGUE Extension Studies - Free, full-text, Online First article from American Journal of Nephrology. - March 8 2019

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  ESSENTIALS AND CLASSICS
blue ball Anemia Management quality improvement from The Renal Network (ESRD Network 9/10) web page
Anemia Fact Sheet (pdf format requires Adobe Acrobat reader.) from the American Nephrology Nurses’ Association
Information on Erythropoiesis-Stimulating Agents (ESAs) - from the U. S. Food and Drug Administration (FDA)
Iron Supplementation in Hemodialysis - Practical Clinical Guidelines (pdf format requires Adobe Acrobat reader) from Nephrology Dialysis Transplantation (NDT) - October 1998

Kidney Disease: Improving Global Outcomes — Guidelines on Anemia Management in Chronic Kidney Disease: a European Renal Best Practice Position Statement - Free, full-text article from NDT. - June 2013

Revised European Best Practice Guidelines for the Management of Anaemia in Patients with Chronic Renal Failure - guidelines endorsed by the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA)
What You Need to Know About Anemia and Chronic Kidney Disease from The National Kidney Foundation (NKF)
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  WEB RESOURCES
Latest Scientific Journal Articles on Anemia Continually Updated!
blue ball Anemia - this is a growing library of key high-impact articles in nephrology, chosen by UKidney's contributors as suggested reading for nephrology trainees and practitioners.
Anemia in children with chronic kidney disease - full-text educational feature from Pediatric Nephrology - February 2008
Anaemia Nurse Specialist Association - UK web site
Dialysis Facility Compare - Medicare's comparison of the quality of care that is provided at dialysis facilities throughout the United States and its territories includes information on anemia management
Drug and Supplements Info: Epoetin and Iron from National Library of Medicine MedLine Plus
Just the Facts: Anemia and Información esencial: Anemia (pdf format requires Adobe Acrobat Reader) from the Life Options web site
blue ball Treatment of Anemia in Patients With Heart Disease: A Clinical Practice Guideline From the American College of Physicians article from the Annals of Internal Medicine - December 2013
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Update on Anemia in ESRD and Earlier Stages of CKD: Core Curriculum 2018 - Free, Full-Text, Articles in Press from American Journal Of Kidney Diseases. - January 2018

Understanding Anemia in Kidney Disease from the AAKP web site
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  PUBMED SEARCHES (National Library of Medicine's MEDLINE Database)
anemia AND dialysis   Continually Updated!
EPO AND dialysis   Continually Updated!
MEDLINE / Pubmed Information from the National Library of Medicine
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  K/DOQI™ -  Kidney Disease Outcomes Quality Initiative

KDOQI Clinical Practice Guidelines and Clinical Practice Recommendations for Anemia in Chronic Kidney Disease (2012)

KDOQI Clinical Practice Guideline and Clinical Practice Recommendations for Anemia in Chronic Kidney Disease: 2007 Update of Hemoglobin Target

K/DOQI Home Page from the National Kidney Foundation web site
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  KDIGO™ -  Kidney Disease: Improving Global Outcomes

Anemia in CKD - Clinical Practice Guidelines for the Treatment of Anemia of Chronic Renal Failure

  1. Download complete Anemia Guideline in English (PDF 1.3MB)
  2. Download Supplementary Materials: Online Appendices 1-2 (PDF 1.3MB)
  3. Download Supplementary Tables (PDF 502KB)
KDIGO Home Page


  DISCUSSION FORUM
General Dialysis Nursing Issues and Questions (No dedicated RenalWEB forum yet for this topic)
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  PRODUCTS
 
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  INPUT / SUGGESTIONS
E-mail to RenalWEB on the Adequate Hematocrit Topic
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