Anemia Management in Chronic Kidney Disease: Bursting the Hemoglobin Bubble

摘要

Until the approval of recombinant erythropoietin ther-napy in 1989, many patients receiving dialysis werenseverely anemic and needed transfusions to maintain a he-nmoglobin level greater than 70 g/L (1–3). Recombinantnerythropoietin was greeted as a panacea for anemia innchronic kidney disease (CKD) and was approved for usenwith considerable fanfare, relatively little clinical trial data,nand few reservations. Early reports (4–6) described sus-ntained increases in hemoglobin levels accompanied by im-nprovements in exercise tolerance, quality of life, and cog-nnitive functioning, with relatively few adverse events.nThese benefits were seen with only modest increases inntarget hemoglobin level, often to 90 to 100 g/L.