RenalWEB Home Page
Last Updated 02/21/10

Web Resources

 

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
Systematic Review and Meta-analysis of Exercise Tolerance and Physical Functioning in Dialysis Patients Treated With Erythropoiesis-Stimulating Agents - Article in Press abstract from the American Journal of Kidney Diseases. - March 2010
(Editor: Note authors, note journal)
FDA Ruling Is a Relief for Amgen's Anemia Drugs, but the Storm's Not Over Yet - Article from BNET. - February 18, 2010
FDA Finally Unveils Risk Management Plan for ESAs - Article from GoozNews. - February 17, 2010
"The failure to simultaneously force the companies to reeducate the renal physician community was disappointing. There's mounting evidence that high doses of ESAs in renal disease patients is associated with increased risk of heart attacks, strokes and earlier mortality. Many of these patients are poor and unaware of the quality of care they receive at dialysis centers. They, just as much as cancer patients, need to be informed about the risks posed by overuse of ESAs."
Early Intervention with Erythropoietin Does Not Affect the Outcome of Acute Kidney Injury (the EARLYARF Trial) - Advance online abstract from Kidney International. - February 17, 2010
FDA Approves Plan To Manage ESA Risks; Amgen and J&J Must Educate Oncologists and All Patients - Articles from Reuters, HealthDay, Medscape, and AP. - February 16, 2010
Press release, safety information, and Drug Safety Communication from the FDA.
The guidelines call for all patients treated with Amgen and J&J's anemia drugs to receive a booklet outlining their risks and benefits.
Upstart Affymax Targets Amgen Anemia Drug Aided by U.S. (Bundle) Rules - Article from Bloomberg. - February 16, 2010

CMS Forming Technical Expert Panels for 6 New ESRD Quality Measures - February 4, 2010

  • Anemia Management (Target value for Serum Ferritin, Target value for Transferrin Saturation)
  • Mineral Metabolism (Target value for Calcium, Target value for Phosphorus)
  • Vascular Access Infection Rate (Catheter Infection Rate)
  • Pediatric Adequacy (Hemodialysis [HD], Peritoneal Dialysis [PD])
  • Pediatric Anemia (Anemia Management)
  • Fluid Weight Management

Editor's Note: Where are the quality-of-life measures?
Potential New Target for Drugs To Treat Iron Deficiency and Overload Discovered - Press release from the Medical College of Georgia. - January 28, 2010
Iron, Inflammation, Dialysis Adequacy, Nutritional Status, and Hyperparathyroidism Modify Erythropoietic Response - abstract from CJASN. - January 28, 2010
Anti-erythropoietin Antibodies Followed by Endogenous Erythropoietin Production in a Dialysis Patient - Online First, brief report sneak preview from Pediatric Nephrology. - January 21, 2010
Hema Metrics Awaits 510 (k) Approval for New Anemia Management Software - Press release. - January 18, 2010
Comparison of Parenteral Iron Sucrose and Ferric Chloride during Erythropoietin Therapy of Hemodialysis Patients - Free, full-text article from Nephrology. - January 2010
Booklet on Iron Deficiency from the AAKP. - January 2010
The Question of Anemia Correction in Patients With Diabetes and CKD - Article by Lynda Szczech, MD from Medscape Nephrology (registration required, but free). - January 8, 2010
Top of Page

  ESSENTIALS AND CLASSICS
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
IV Iron Therapy and Anemia Management In Patients on Hemodialysis: Benefits Of a Revised CQI Strategy - (pdf) article from the Nephrology Nursing Journal - July/August 2008
FDA Video on Patient Safety Topics: Erythropoietic Agents and Antibody-Mediated Anemias - from the U. S. Food and Drug Administration (FDA) - May 2006
Information on Erythropoiesis-Stimulating Agents (ESAs) and Q&A page - from the U. S. Food and Drug Administration (FDA)
Iron Management: A Clinical Perspective on Iron Parameters ceu from The National Kidney Foundation (NKF)
Iron Supplementation in Hemodialysis - Practical Clinical Guidelines (pdf format requires Adobe Acrobat reader) from Nephrology Dialysis Transplantation (NDT) - October 1998
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 (pdf) pamphlet from The National Kidney Foundation (NKF)
Top of Page

  WEB RESOURCES
Latest Scientific Journal Articles on Anemia - list compiled by RenalWEB's Journal Watch
Anemia LifeLine™ - The Anemia LifeLine™ educational initiative was created to help improve the lives of millions of Americans who suffer from anemia associated with many common, serious diseases.
Anemia and Chronic Kidney Disease - (pdf) from the National Kidney Foundation (NKF) web site
Anemia, EPO, kidney failure—and you from the Home Dialysis Central web site
Anemia in children with chronic kidney disease - full-text educational feature from Pediatric Nephrology - February 2008
Anemia: Mobilizing Resources for Positive Outcomes - (pdf) from the Kidney Learning System web site
Anaemia Nurse Specialist Association - UK web site
Iron Deficiency booklet from the AAKP web site
Just the Facts: Anemia and Información esencial: Anemia (pdf format requires Adobe Acrobat Reader) from the Life Options web site
National Anemia Action Council (NAAC) 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   
Revisions to the EPO/ Aranesp Monitoring Policy (pdf) from the Centers for Medicare and Medicaid Services (CMS)
Teaming Up for Peak Performance: Early Identification and Optimal Management of CKD-Related Anemia (pdf) free on-line CE program from the National Kidney Foundation (NKF) web site
Understanding Anemia in Kidney Disease from the AAKP web site
CMS's ESRD Clinical Performance Measures (CPM) Project
Top of Page

  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
Top of Page

  K/DOQI™ -  Kidney Disease Outcomes Quality Initiative

Anemia Management - Clinical Practice Guidelines for the Treatment of Anemia of Chronic Renal Failure (Table of Contents)

  1. Anemia Work-up
  2. Target Hematocrit/Hemoglobin
  3. Iron Support
  4. Administration of Epoetin
  5. Inadequate Epoetin Response
  6. Role of Red Blood Cell Transfusions
  7. Possible Adverse Effects Related to Epoetin Therapy
K/DOQI Home Page from the National Kidney Foundation web site
Top of Page

  DISCUSSION FORUM
General Dialysis Nursing Issues and Questions (No dedicated RenalWEB forum yet for this topic)
Top of Page

  PRODUCTS
Full prescribing information from Otho Biotech's web site for Procrit® (epoetin alpha) (pdf format requires Adobe Acrobat Reader)
Top of Page

  INPUT / SUGGESTIONS
E-mail to RenalWEB on the Adequate Hematocrit Topic
Top of Page

Except where noted, no information within the RenalWEB web site can be copied, duplicated, or reproduced in any form without the express written consent of RenalWEB.