Abstract / Summary
Abstract Anemia is common in patients with nondialysis-dependent (NDD) and dialysis-dependent (DD) chronic kidney disease (CKD). Insufficient erythropoietin (EPO) production is regarded as the main cause of renal anemia and, under sufficient iron supplementation, erythropoietin-stimulating agent (ESA) administration has been recommended for renal anemia treatment. Anemia is also common in patients with heart failure. Structural renal disease, which can reduce EPO production, is infrequent but is characterized by a low serum EPO level in these populations. Although intravenous iron repletion has a beneficial effect on quality of life for patients with heart failure independent of the presence of anemia, ESA use for anemia treatment in patients with heart failure is not recommended because there is no benefit and more thromboembolic adverse events occur. CKD and heart failure coexist frequently, and anemia, which is associated with these disorders, is termed cardiorenal anemia syndrome (CRAS). However, evaluation and management of anemia in CKD and patients with heart failure is not the same, especially with regards to the use of ESA, creating a dilemma for clinicians treating CRAS. For the treatment of anemia in patients with CKD, the influence of heart failure with volume overload should also be considered. The initiation and dosing of ESA therapy in patients with CKD should be determined by balancing the contributions of CKD and heart failure, rather than by targeting a specific hemoglobin level.