Anemia of CKD/ESRD

Question 1

Why don’t you measure EPO?

Answer 1

Not usable as an indicator of a renal source of the anemia, because, in kidney disease, there is ‘relative erythropoietin deficiency,’ that is, an inappropriate rise in erythropoietin levels for the severity of anemia.

Question 2

Why EPO has fallen out of favor among hematologists

Answer 2

• increased risk of mortality and recurrent HF

Question 3

Other main mechanism of anemia in CKD

Answer 3

• secondary hyperparathyroidism (results in resistance to EPO. also shortens RBC survival because high levels of PTH acts as a uremic substance)
• parathyroidectomy has been shown to reduce requirements for postoperative ESAs