New insights into anemia management in people with chronic kidney disease.
Abstract of the interview of Dr Ajay Singh, Nephrologist by Dr George Bakris, MD

• Trial to Reduce Cardiovascular Events with Aranesp Therapy (TREAT) study was a large randomized controlled study in patients having diabetes with chronic kidney disease and anemia.
• Patients were randomized to either an active treatment arm with darbepoetin or to a placebo rescue arm, in which patients were on placebo but were rescued if their hemoglobin fell below 9 g/dL
• It was found that there was a null effect for a reduction in cardiovascular or renal risk in these patients, but there was a heightened risk for stroke in patients treated with darbepoetin.
• There was also no dramatic improvement in quality of life.
• Non responders as those who don’t respond to 2 fixed doses of erythropoiesis-stimulating agents (ESA) given initially, did poorly.
• They have a higher risk for stroke and higher risk for cardiovascular mortality.
• The responder group did very well on low doses of ESA.
• The patients responding to low doses of ESA because they’re healthier and they survive longer.
• Factor for non responsive, patients for not responding is likely to be iron and iron deficiency.
• To get adequate hematopoiesis, both ESA and iron are needed
• Inflammation is a very important story in cardiovascular medicine and in defining risk.
• Patient who has a failed or failing allograft will have a very powerful inflammatory focus, which might account for ESA resistance.
• Hyperparathyroidism might account for significant ESA resistance.
• Iron-deficiency anemia is probably the most common cause of erythropoietin not working.

Read More: http://www.medscape.com/viewarticle/733117?src=mp&spon=34