Erythropoietin stimulating agents in the management of anemia of chronic kidney disease

Anemia is a very common clinical problem in patients with chronic kidney disease (CKD) and is associated with increased morbidity and mortality in these patients. Erythropoietin is a hormone synthesized in the kidney responsible for red blood cell maturation in the bone marrow. It is deficient in the majority of patients with advanced kidney disease thereby predisposing to anemia. Since the approval of recombinant human erythropoietin (epoetin alfa) by the US FDA in 1989, epoetin alfa and similar agents now collectively known as erythropoietin stimulating agents (ESA) have become the standard of care for the treatment of the erythropoietin-deficient anemia that occurs in most patients with CKD. In this review, we have outlined the considerations that need to be taken into account when prescribing ESA for the treatment of anemia in CKD.