Renal anemia and its treatment - actual standards and guidelines

Management of renal anemia is a key area of care of patients with chronic r enal insufficiency. Although the availability of epoetin, a recombinant ana logon of erythropoeitin, offers an efficient option for therapy. Discussion concerning indication for starting of therapy, target-hemoglobin levels an d dosages is still equivocal. Newer studies and published therapy guideline s suggest an earlier begin of epoetin-therapy in the process of progressive renal failure to avoid adaptive structural changes in the cardiovascular s ystem, that contribute to the high cardiovascular morbidity and mortality o f patients on chronic dialysis. Assessing and optimizing iron stores as wel l as diagnosis of other factors possibly contributing to anemia are essenti al for effective therapy of anemia in patients with renal insufficiency. Th e article reviews the literature and discusses new guidelines concerning di agnosis, indication for therapy, target hemoglobin levels, supplementation of iron, administration of epoetin, evaluation of an adequate response as w ell as side effects of therapy in patients with anemia of chronic renal fai lure. Evidence from the literature shows that effective and early treatment of anemia of chronic renal failure has major effects on the quality of lif e, decreases morbidity and hospitalisation rate and morbidity increases sur vival of patients with renal insufficiency.