Clinical Practice Guidelines for supplemental therapies and issues

Klarenbach, Scott; Moist, Louise; Foley, Rob; Barrett, Brendan; Madore, François; White, Colin; Culleton, Bruce F.; Manns, Braden

doi:10.1038/ki.2008.271

Cited by 4 publications

(4 citation statements)

References 35 publications

(23 reference statements)

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“…The issue of hyporesponsiveness is important in patients with CKD as their risk of cardiovascular events and mortality is extremely high, even when patient comorbidity is accounted for by adjustment. 42 Since ϳ15% of patients with CKD-D have ESA resistance, 58 there is an immediate need for studies to discern optimal anemia management in this population. There has been uncertainty in the definition of ESA hyporesponsiveness, though the definition provided by KDIGO seems reasonable.…”

Section: Commentarymentioning

confidence: 99%

Canadian Society of Nephrology Commentary on the 2012 KDIGO Clinical Practice Guideline for Anemia in CKD

Moist

Troyanov

White

et al. 2013

American Journal of Kidney Diseases

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Section: Commentarymentioning

confidence: 99%

Canadian Society of Nephrology Commentary on the 2012 KDIGO Clinical Practice Guideline for Anemia in CKD

Moist

Troyanov

White

et al. 2013

American Journal of Kidney Diseases

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“…Although no clinical trials have investigated different ESA dosing protocols in patients with ESA resistance, this concern seems appropriate given that these patients are at exceedingly high risk of cardiovascular events and mortality-even after adjustment for patient comorbidity (17). Given that ;15% of ESRD patients have ESA resistance (18), trials are urgently required to determine the optimal strategy for anemia management in this population.…”

Section: Managing Patients With Esa Resistancementioning

confidence: 99%

The New FDA Labeling for ESA—Implications for Patients and Providers

Manns

2012

Clinical Journal of the American Society of Nephrology

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SummaryRecent clinical trials comparing the use of erythropoiesis-stimulating agents targeting low (generally a hemoglobin of 90-115 g/L) and near-normal hemoglobin targets (generally a hemoglobin >130 g/L) in patients with chronic kidney disease have shown no improvements in clinical outcomes (aside from a small reduction in transfusion) and potential harm for erythropoiesis-stimulating agents use targeting near-normal hemoglobin targets. Based on these results, the US Food and Drug Administration recently released modified recommendations for more conservative dosing of erythropoiesis-stimulating agents in patients with CKD. These recommendations now stress individualizing therapy for each patient and using the lowest possible erythropoiesis-stimulating agents dose required to reduce the need for transfusions. The evolution in the management of anemia associated with chronic kidney disease over time and the recent evidence that has stimulated these labeling changes is discussed. Also, the US Food and Drug Administration labeling changes are discussed, and areas of controversy are highlighted. Although the US Food and Drug Administration labeling changes are based on the results of recent large randomized trials testing ESAs targeting near-normal hemoglobin levels, more specific guidance to clinicians would have been helpful.

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“…Guidance regarding patients with ND-CKD include the Kidney Disease Improving Global Outcomes (KDIGO) (1) and the Kidney Disease Outcomes Quality Initiative (2) guidelines and position papers from the Canadian Society of Nephrology (3)(4)(5)(6), the National Institute for Health and Care Excellence (NICE) (7), and European Renal Best Practice (8) (Table 1). Although there are some exceptions, these guidelines and position papers are generally consistent regarding the definition of hemoglobin (Hb) thresholds of anemia.…”

Section: Current Treatment Guidelinesmentioning

confidence: 99%

“…Guidelines for treating anemia in patients with CKD, particularly patients with nondialysis (ND) -CKD, vary, especially across different areas of the world (1)(2)(3)(4)(5)(6)(7)(8). In addition, the growing number of patients with CKD and anemia and the increasingly insufficient number of nephrologists have led primary care physicians, particularly those in the United States, to take on the burden of care for many of these patients (9).…”

Section: Introductionmentioning

confidence: 99%

Iron Therapy Challenges for the Treatment of Nondialysis CKD Patients

Locatelli

Mazzaferro

Yee

2016

CJASN

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The clinical consequences of untreated, severe anemia in patients with nondialysis CKD can be significant, but disparities exist in the anemia treatment guidelines and position papers issued from working groups and associations across the world. These differ in hemoglobin target and iron levels and their emphasis on various iron markers and other clinical outcomes. Not surprisingly, disparities are observed in anemia treatment strategies among patients with nondialysis CKD across different areas of the world. Over the past decade, the prescription and dosage of both iron therapies and erythropoiesis-stimulating agents have shifted, with notable regional differences observed. Moreover, there is ongoing debate regarding oral versus intravenous administration of iron. Compared with oral iron therapy, which often leads to gastrointestinal adverse events, low patient adherence, and low efficacy, intravenous iron administration has been associated with potential serious adverse events, such as anaphylaxis. New iron-based compounds and drugs currently under development are reviewed to describe their potential benefits in the treatment of anemia in patients with CKD. New oral compounds, including iron-based phosphate binders, heme iron polypeptide, and liposomal iron, show different rates of absorption with possibly different efficacy and improved tolerability. These new potential therapies offer health care providers additional anemia treatment options for their patients with CKD; however, the management of anemia in the CKD population continues to present challenges that require prospective studies to identify the optimal iron therapy for patients.

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Clinical Practice Guidelines for supplemental therapies and issues

Cited by 4 publications

References 35 publications

Canadian Society of Nephrology Commentary on the 2012 KDIGO Clinical Practice Guideline for Anemia in CKD

Canadian Society of Nephrology Commentary on the 2012 KDIGO Clinical Practice Guideline for Anemia in CKD

The New FDA Labeling for ESA—Implications for Patients and Providers

Iron Therapy Challenges for the Treatment of Nondialysis CKD Patients

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