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Management of Anemia in Peritoneal Dialysis Patients

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Nolph and Gokal's Textbook of Peritoneal Dialysis

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Abstract

Anemia is a common complication among patients undergoing peritoneal dialysis (PD), impacting quality of life and associated with increased mortality. Erythropoietin deficiency, absolute and functional iron deficiency, and shortened red blood cell (RBC) life span contribute to the anemia. Evaluation includes assessment of iron stores and, if deficient, iron supplementation is the initial therapy. The formulation and route of administration of iron is based on tolerability and previous response to treatment. Less frequent dosing of intravenous iron may be desirable for patients on PD due to lack of readily available intravenous access. Erythropoietin stimulating agents (ESAs) remain the cornerstone of anemia therapy. ESAs with a longer dosing interval are generally preferred for PD patients. Randomized controlled trials have demonstrated increased major cardiovascular events with higher hemoglobin targets and ESA doses; the mechanism is incompletely understood. It is recommended that the hemoglobin target for most patients receiving ESAs should not exceed 11.5 g/dL. The discovery of hepcidin and the oxygen sensing pathway in the kidney has increased our understanding of the mechanism for the development of anemia in patients with kidney disease. Increased levels of hepcidin due to inflammation decrease iron absorption and internal mobilization, leading to functional iron deficiency. Hypoxia-induced factor prolyl hydroxylase inhibitors (HIF-PHIs) stimulate endogenous erythropoietin production and improve iron delivery to the bone marrow, thereby increasing RBC production. Some long-term studies of these agents to date have revealed safety signals compared to ESAs, but HIF-PHIs have not been extensively studied in the PD population. Due to their oral route of administration, HIF-PHIs may have an advantage in PD patients over ESAs.

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Authors and Affiliations

  1. Indiana University School of Medicine, Indianapolis, IN, USA

    Nupur Gupta

  2. Division of Nephrology, Indiana University School of Medicine, IU Health University Hospital, Indianapolis, IN, USA

    Jay B. Wish

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  1. Nupur Gupta
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  2. Jay B. Wish
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Correspondence to Jay B. Wish .

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  1. Nephrology, School of Medicine Department of Medicine Division of, Columbia, MO, USA

    Ramesh Khanna

  2. Dept. Medicine Div. Nephrology, University of Amsterdam Academic Medical Center, Amsterdam, The Netherlands

    Raymond T. Krediet

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Gupta, N., Wish, J.B. (2022). Management of Anemia in Peritoneal Dialysis Patients. In: Khanna, R., Krediet, R.T. (eds) Nolph and Gokal's Textbook of Peritoneal Dialysis. Springer, Cham. https://doi.org/10.1007/978-3-319-90760-4_45-1

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  • DOI: https://doi.org/10.1007/978-3-319-90760-4_45-1

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