Highlights
- •ESA usage in anemia care is decreasing due to recent unfavorable clinical results.
- •Iron therapy has gained more significance, although long-term safety is unknown.
- •Insufficient evidence is available in anemia therapy of CKD patients with cancer.
- •Individualized therapy is recommended based on current guidelines.
Abstract
Anemia is a common complication of cancer and chronic kidney disease (CKD) associated
with decreased physical performance as well as poor prognosis for life expectancy.
Renal and cancer-induced anemia share common features regarding pathogenesis and therapeutic
strategies. It is typically treated with iron substitution, erythropoiesis-stimulating
agents (ESA) and in refractory cases with red blood cell transfusions. However, studies
of the past few years unveiled numerous setbacks in the use of ESAs. These included
a higher risk of cerebrovascular events and increased mortality without the improvement
of cardiovascular outcomes in patients with CKD. Moreover, particularly negative results
were observed in patients with previous cancer history under ESA therapy. These unfavorable
findings have forced the clinicians to reevaluate the management of renal anemia.
This led to decrease of ESA usage, while iron substitution and alternative therapeutic
options gained more significance. Iron supplementation is also accompanied with certain
risks ranging from gastrointestinal complications to severe allergic reactions and
increased rate of infections. Furthermore, the evaluation of the long-term safety
of excessive iron therapy is still lacking, especially in CKD patients with cancer.
In the absence of these clinical studies, this review aims to summarize the currently
available therapeutic strategies in anemia management of CKD patients with concomitant
cancer.
Abbreviations:
AID (absolute iron deficiency), CKD (chronic kidney disease), eGFR (estimated glomerular filtration Rate), ESA (erythropoiesis-stimulating agents), FID (functional iron deficiency), Hb (hemoglobin), IU (international units), IV (intravenous), TSAT (transferrin saturation)Keywords
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Article info
Publication history
Published online: September 15, 2016
Accepted:
August 19,
2016
Received in revised form:
August 6,
2016
Received:
May 31,
2016
Identification
Copyright
© 2016 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
