Treatment of Anemia in Elderly Patients with CKD

Recombinant human erythropoietin (epoetin) therapy revolutionized the treatment of anemia in patients on dialysis with CKD not receiving dialysis (44, 45). More recently, a longer-acting darbepoetin alfa erythro-poiesis stimulating agent (ESA) has become available (46-49), and soon, newer form with varying mechanisms of action will likely become available for clinical use (46, 50). The risks and benefits of epoetin and darbepoetin therapy in the general population of patients with CKD have been...

Erythropoietin

EPO, a glycoprotein secreted by interstitial cells in the kidney (3), has a major role in regulating erythropoiesis in humans. EPO is primarily regulated by blood oxygen content and secretion is stimulated by hypoxia (4, 5). EPO stimulates hematopoiesis by increasing proliferation (6) and preventing apoptosis (3, 7) of erythroid progenitor cells. The primary site of action of EPO in the bone marrow is the late stage colony-forming unit erythroid (CFU-E). EPO induces these cells to both...

Consequences of Anemia

The clinical consequences of anemia are listed in Table 2.3. At least seven cohort studies demonstrated that anemia is an independent risk factor for mortality in older individuals (8, 30, 44-48). Of these, the most provocative are the WHAS and the study by Zakai et al. The WHAS reported an increased risk of mortality for hemoglobin levels < 13.4 gm dl home dwelling women aged 65 and over followed for an average of 11 years, and may mandate a revision of the WHO definition of anemia in older...

Impaired Response of Erythroid Progenitor Cells to

Cultures of erythroid colony-forming cells (CFU-E) were used to determine the effect of the same inflammatory cytokines on the progenitor cell response to Epo. Means et al. showed that many of the same inflammatory cytokines previously shown to blunt Epo production in response to hypoxia also impaired progenitor growth in the presence of Epo (5-8). Again, hierarchies based on dose and the inflammatory cytokine employed could be established. In important experiments, increasing concentrations of...

Assessment of Kidney Function in the Elderly

Kidney function commonly declines with age, although not universally (6-9). Approximately one-third of elderly adults do not exhibit an age-related decline in kidney function (6). This has led to the suggestion that a decline in GFR is not a normal accompaniment of aging, but rather due at least in part to concomitant hypertension, cardiovascular disease, and diabetes mellitus. By the age of 80 years, mean GFR, depending on how it is measured or estimated, is approximately 50-80 mL min,...

Anemia due to CKD in the Elderly

A normochromic normocytic anemia is a well-known complication of CKD (4, 5). Recent findings from the NHANES III study (in which the mean age was 48 years) indicate that Hgb levels typically begin to decline as the GFR falls below 70 mL min in men and 50 mL min in women, and that the prevalence and severity of anemia increase as kidney function falls below a level of about 60 mL min. The prevalence of Hgb levels below 11 g dL increases as GFR falls below about 30 mL min 1.73 m2 (5, 14, 23-25)....