| Theme | Diagnostic and Therapeutic Guidelines in End-stage Renal Failure | |
|---|---|---|
| Title | Guidelines for renal anemia | |
| Publish Date | 2004/01 | |
| Author | Teiryo Maeda | Department of Internal Medicine, Maeda Institute of Renal Research |
| [ Summary ] | With decreases in renal functioning, the production of erythropoietin by the kidney decreases. As a result, blood hemoglobin (Hb) levels lower. This state is defined as renal anemia. When we treat renal anemia, we should differentiate it from anemia due to other diseases. The administration of recombinant human erythropoietin (rHuEPO) is the first choice for renal anemia therapy. According to the definition of anemia, we should use, as a rule, Hb levels as the main indicator of renal anemia. Ht is unsuitable, for it enlarges with the course of times. Concerning blood Hb levels, the best survival rate for dialysis patients can be achieved at between 10 to 11g/dl, so, this level is recommended as the target Hb level for rHuEPO therapy. In relation to iron status, the transferrin saturation rate (TSAT) should be above 20% (desirably above 23%) and the serum ferritin level between 40 to 200ng/ml. The European and American guideline shows that serum ferritin levels are recommended to be above 200 or 300ng/ml, but this level is in a dangerous range, because high serum ferritin levels are one cause of oxidative stress. Other indices of iron status are blood reticurocyte count, content of reticurocyte Hb (CHr) and serum soluble transferrin receptors. It is adequate for high TSAT and low serum ferritin levels to be used as simple guidelines of iron status. |
|