Should the Hematocrit Be Normalized in Dialysis and in Pre-ESRD Patients?

Macdougall, Iain C.

doi:10.1159/000046934

Cited by 8 publications

(1 citation statement)

References 23 publications

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“…Co-morbidity, concomitant medication, response to anaemia correction and patient expectation should all be taken into account, as shown by the cases presented herein. Other factors to consider include the age of the patient and his/her level of physical activity, the duration of CKD and the mode of dialysis [22,23]. CVD mortality rates in ESRD patients are 20-40 times higher than those in the general population [24], and only 15% of these renal patients have normal LV structure and function at dialysis initiation [25].…”

Section: Tailoring Treatment To the Individualmentioning

confidence: 99%

Individualizing anaemia treatment: a discussion of case histories

Muirhead

2005

Nephrology Dialysis Transplantation

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Current guidelines give evidence-based advice on how best to manage anaemia in patients with renal disease, but these guidelines do not consider individual patient needs, so tailoring anaemia management to each patient still remains a challenge for the treating physician. Two case studies are described that illustrate some of the key factors that need to be considered. The first case emphasizes that haemoglobin (Hb) targets recommended in current guidelines may not suit all patients. The patient had been stably maintained on subcutaneous epoetin therapy with an average Hb concentration of >13.0 g/dl because he developed angina symptoms when his Hb level fell to 12.2 g/dl. Iron deficiency was identified as the likely cause of falling Hb in this patient. After the patient's iron supplementation was increased, his Hb level was normalized back to >13.0 g/dl without increasing the epoetin dose, and the angina symptoms were resolved. The second case involved a pre-dialysis patient with diabetes, who required a higher dose of epoetin after beginning concomitant antihypertensive treatment with an angiotensin-converting enzyme inhibitor. Previously, the treatment of renal anaemia in pre-dialysis patients has not been the focus of attention. Two ongoing randomized controlled trials have been designed to study early initiation of epoetin treatment in pre-dialysis patients and will provide much needed information in this area.

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