| Theme | Importance of Preservative Management in Chronic Renal Failure -- for a Better Dialysis | |
|---|---|---|
| Title | Renal anemia | |
| Publish Date | 2004/06 | |
| Author | Masamitsu Fujii | Department of Internal Medicine, Osaka Kousei-Nenkin Hospital |
| [ Summary ] | As renal function declines, the incidence of anemia increases. Anemia associated with chronic renal failure is mainly caused by reduced renal erythropoietin (EPO) production. Successful treatment of anemia with recombinant human EPO (rHuEPO) before the initiation of dialysis improves anemia-induced symptoms, exercise capacity, cardiovascular morbidity, central nerve system dysfunction, quality of life, and patient survival. rHuEPO treatment in predialysis patients may slow the rate of progression of renal failure as long as blood pressure is well controlled. Target hemoglobin concentration (hematocrit) is>10 to 11 g/dl (30 to 33%). The most common cause of an incomplete response to rHuEPO is iron deficiency. In iron deficient patients, oral iron should be tried as the first mode of treatment. Iron must be administered intravenously as needed. The upper limits of optimal hemoglobin concentration (hematocrit), indications for intravenous iron administration and the ideal markers for iron deficiency are unclear and more studies will be required. |
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