One-size-fits-all protocol-based approaches to anemia management with erythropoiesis-stimulating agents (ESAs) may result in undesired patterns of hemoglobin variability in people with Chronic Kidney Disease (CKD), states a very recent study in the Journal of American Society of America. Individualized ESA dosing decreases total hemoglobin (Hb) variability and associated risks including increased transfusions and cardiovascular incidents.
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The hormone erythropoietin is produced by the kidneys naturally and travels to the bone marrow to turn on the mechanisms that help red blood cells "mature." When a CKD patient's kidneys begin to decline the production of red cells progressively reduce and the cells responsible for manufacturing erythropoietin die, causing anemia. Anemia is a well-known and common disorder in patients with CKD that cause a "marked" increased risk for cardiovascular morbidity and mortality including heart failure, coronary artery disease, and sudden cardiac death.
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The primary findings of the double blind study were, after following dialysis patients for 12 months, 72.5% of those who received individualized anemia treatment maintained their hemoglobin, at a desired level (between 10 to 12 g/dL). This was compared with 61.9% in patients who received treatment based on current standardized protocol. Also, those who were given individualized treatment experienced fewer dips of Hb below 10 g/dL (11.8%), compared to the standard treatment (24.7%).
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When asked, Daniel Coyne, MD believes that individualized anemia treatment is practical and possible for CKD patients to receive, "but in most patients it is unnecessary, as newer protocols are appropriate for a large majority of patients." However, KidneyBuzz.com suggests that your Nephrologist is best equipped to determine if your personal health situation is best corrected by altering routine practice. In the past, whether Nephrologists or the Dialysis Provider controls the anemia treatment may differ among dialysis chains and facilities. Recently, providers have become sensitive to Nephrologists deciding that anemia management in certain patients needs to be individualized.
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