06/01/2004What is all the fuss about the treatment of anemia?

Robert Provenzano, MD, FACP

The association of progressive anemia with decreasing renal function has been known for over a century.  It was only until 1988 with the advent of erythropoietin that treatment became feasible.  Prior to that, blood transfusions were necessary with all the inherit risks including hepatitis and transfusion reactions.

Initially, Epogen was restricted for use in the dialysis center and had a major impact in improving the anemia of end stage renal disease.  In the last several years, though, focus had been placed on chronic kidney disease estimated to affect over 8 million Americans.  The old thought of “Asymptomatic Anemia” is no longer valid.  Several studies have shown that even mild anemias with hemoglobins of approximately 10-11 grams result in left ventricular hypertrophy and this is directly related to increased morbidity and mortality in this group of patients.  Additionally, studies performed at St. John Hospital and Medical Center by our Nephrology Department has shown that the quality of life, mental functioning, and sense of well being are all significantly improved in patients with Chronic Kidney Disease who have had their anemia treated.

Unfortunately, the message is still not out.  Only 28% of patients eligible for treatment of anemia are indeed treated.  It is therefore extremely important that anemia and chronic kidney disease be identified and treated so that the patients are receiving the level of healthcare they deserve in the 21st century.

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