Should anaemia in subtypes of CRF patients be managed differently?

In patients with cardiovascular disease, partial correction of anaemia with epoetin improves quality of life and exercise capacity, and reduces left v entricular hypertrophy. The currently recommended haemoglobin in these pati ents is 11-12 g/dl. The optimal haemoglobin in patients with diabetes melli tus does not differ from that in non-diabetic patients; however, haemoglobi n should be increased slowly. There is no difference in the recommended hae moglobin between children and adults. However, epoetin sensitivity is lower in children who, therefore, typically need the same absolute dose of epoet in as adults. Epoetin treatment may delay the progression of chronic renal failure (CRF) in paediatric patients. Elderly patients obtain similar benef its from epoetin as younger adults; moreover, there are no differences in t he doses of epoetin required or the optimal haemoglobin. There are very few data available on the effects of epoetin in patients with CRF and chronic obstructive pulmonary disease. At present, a haemoglobin of 11 g/dl seems a ppropriate. In sickle-cell anaemia patients with CRF, a high haemoglobin co uld precipitate painful crises; consequently, the recommended haemoglobin i s the pre-CRF concentration of 6-9 g/dl. There is no convincing evidence of any effect of previous epoetin treatment on the long-term outcome of renal transplantation. In patients with a failing or failed transplant, the requ ired dose of epoetin may be higher than in pre-transplantation patients. In such cases, transplant nephrectomy might be considered.