Purpose of review: Anemia remains an early and common complication of chronic kidney disease that causes troubling symptoms and reduced quality of life. Recent literature has raised concern about the safety of erythropoiesis-stimulating agent (ESA) treatment to higher hemoglobin targets, making this an ideal time to review this subject. In addition, new drugs are being developed in both the ESA and intravenous (i.v.) iron classes.
Recent findings: ESA treatment to higher hemoglobin targets is now more clearly associated with increased risk for death and cardiovascular events. The mechanisms are unclear, but treatment has become somewhat more conservative as a result. New ESA drugs in development include methoxy polyethylene glycol-epoetin beta (continuous erythropoietin receptor activator) and hematide, an erythropoietin mimetic. The Dialysis patients' Response to I.V. iron with Elevated ferritin (DRIVE) series of studies have provided important new information about i.v. iron treatment when serum ferritin is more than 500 ng/ml. Ferumoxytol, a new i.v. iron drug, has interesting properties that may improve the convenience of i.v. iron treatment.
Summary: A more cautious era of anemia therapy in chronic kidney disease has emerged. As the mechanisms of safety problems are being worked out, new ESA and iron drugs continue to be developed in an attempt to improve treatment options.