Renal Anaemia

What are the challenges of renal anaemia?

The treatment of renal anaemia poses both economic and epidemiological challenges. Chronic kidney disease (CKD) affects up to 11% of the adult population in the US¹ and erythropoiesis-stimulating agents (ESAs) accounts for the largest spending compared with intravenous iron, intravenous vitamin D or other injectables². In the US, Medicare costs associated with end-stage renal disease are estimated to reach $28 billion per year by 2010, up from $22 billion in 2001³.

Screening for renal anaemia is challenging due to variability in haemoglobin levels. This is most likely caused by intermittent bursts of red cell production when patients are treated with ESAs, which require regular dose adjustments to keep Hb levels within the target range (above 11 g/dL). One study found that haemoglobin fluctuation occurred on average three times per year in renal anaemia patients and may last for weeks at a time. In >90% of patients, at least one episode per year resulted in potentially harmful levels⁴.

CKD and renal anaemia are typically detected late on in the course of disease. Due to the public health burden caused by renal anaemia it is important to raise awareness of this condition and encourage early diagnosis and treatment ^5-9.

References:
1. Coresh J, Astor BC, Greene T, et al. Prevalence of chronic kidney disease and decreased kidney function in the adult US population: Third National Health and Nutrition Examination Survey. Am J Kidney Dis. 2003;41:1-12.
2. U.S. Renal Data System. USRDS 2004 annual report: atlas of end-stage renal disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2004.
3. Valderrabáno F, Golper T, Muirhead N, et al. Chronic kidney disease: why is current management uncoordinated and suboptimal Nephol Dial Transplant. 2001;16:61-4.
4. Fishbane S, Berns JS. Haemoglobin cycling in hemodialysis patients treated with recombinant human erythropoietin. Kidney Int. 2005;68:1337-43.
5. Gouva C, Nikolopoulos P, Ioannidis JP, Siamopoulos KC. Treating anaemia early in renal failure patients slows the decline of renal function: a randomized controlled trial. Kidney Intl. 2004;66:753-60.
6. Lu WX, Jones-Burton C, Zhan M, et al.Survival benefit of recombinant human erythropoietin administration prior to onset of end-stage renal disease : variations across surrogates for quality of care and time. Nephron Clin Pract. 2005;101:c79-c86.
7. Collins AJ, Li S, St. Peter W. Death, hospitalization, and economic associations among incident hemodialysis patients with hematocrit values of 36 to 39%. J Am Soc Nephrol. 2001;12:2465-73.
8. Portoles J. The beneficial effects of intervention in early renal disease. Nephrol Dial Transplant. 2001;16:12-15.
9. Parfrey P. Anaemia in chronic renal disease: lessons learned since Seville 1994. Nephrol Dial Transplant. 2001;16:41-5.