Erithropoyesis stimulating agents in chronic renal failure

Abstract

The treatment of anemia in patients with chronic renal failure (CRF) with erythropoietin (EPO) has been one of the most relevant therapeutic advances in this population. This has allowed the reduction of the transfusional required and the complications that stem from this practice (iron overload, infectious risk and sensitivity in patients who are candidates for renal transplant) as well as improving the quality of life. Despite years of experience in the use of these agents still remain controversies over the optimal hemoglobin targets in predialysis and dialysis patients treated with EPO. The controlled studies carried out in these populations, have not been able to demonstrate clearly benefits (reduced cardiovascular events, hospitalization, diminished chronic kidney disease progression, improving survival) in patient that achieve higher hemoglobin levels compared with those who reach lower levels with EPO treatment, presented a greater number of adverse events such as a higher risk of vascular and thrombotic complications. The interaction between the adverse effects with EPO in patient who received higher doses and the co-morbidities would explain the results of these studies. There are a number of clues which lead to the presumption that more individualized treatments regarding levels of hemoglobin and EPO dose are needed in these patients. The extraerythropoietic, antiapoptotic and cytoprotective actions of these agents, mainly about the kidney, cardiac muscle, and brain would appear to open a therapeutic expectation in those with ischemic lesions of these organs. More studies are needed, designed to evaluate whether or not these effects have clinical implications.