Chronic kidney disease (CKD) affects 20 million Americans, and an additional 20 million are at increased risk for developing CKD. Anemia is a common complication in patients with CKD. Continuous erythropoiesis receptor activator (CERA) is a new erythropoiesis-stimulating agent (ESA) that is undergoing FDA review for the treatment of anemia in patients with CKD, including in those undergoing dialysis.
Dr O'Mara is a clinical pharmacist at Dialysis Clinics, Inc, North Brunswick, NJ. Dr Kapoian is assistant professor of medicine, University of Medicine and Dentistry of New Jersey (UMDNJ)-Robert Wood Johnson Medical School, New Brunswick, NJ.
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Anemia (defined by the National Kidney Foundation as a hemoglobin concentration <12 g/dL in women and <13.5 g/dL in men) is a common complication in patients with CKD.1 The primary cause of anemia in this population is a deficiency in erythropoietin. Approximately 90% of erythropoietin is produced in the kidneys, and the remainder is produced in the liver. In patients with normal renal function, erythropoietin concentrations can increase up to 100-to 1,000-fold during hypoxia or anemia. However, in patients with impaired renal function, the kidneys are unable to respond with the appropriate physiologic increase in erythropoietin concentration. In addition to erythropoietin deficiency, other factors may contribute to anemia in patients with CKD, including a shortened red blood cell survival time (from approximately 120 days in patients with normal renal function to 40–90 days in patients with impaired renal function); iron and vitamin deficiencies; and blood loss, especially in patients who are undergoing hemodialysis.2