Analysis of the effectiveness of anemia correction in CKD stage 5 on the basis of the "V.A. Baranov Republican Hospital" in Karelia Republic

Abstract

BACKGROUND. Nephrogenic anemia is a serious problem in patients with chronic kidney disease, requiring a careful approach and adequate treatment. This condition manifests at the first stage and steadily progresses as GFR decreases. Therefore, timely correction of renal anemia with iron supplements and erythropoiesis stimulate agents (ESA) in CKD C5 is an integral component of therapy to reach target Hb values. THE AIM . This paper provides an analysis of the effectiveness of erythropoiesis-stimulating therapy among patients with end-stage CKD (C5d) receiving treatment with program hemodialysis on the basis of the Republican hospital named V.A. Baranov. PATIENTS AND METHODS. During the year 2022, 107 patients with end-stage CKD were observed. All of them had been receiving renal replacement therapy through a hemodialysis program (1284 patientmonths) and erythropoiesis-stimulating therapy with monthly monitoring of hemoglobin levels, following the clinical guidelines «Anemia in chronic kidney disease – 2020-2021-2022». RESULTS . The median hemoglobin level for 2022 was 107.8 g/L. The average annual increase was 8.9 g/l. Overall, the hemoglobin level in patients who did not receive EPO was 115.5 g/l. Patients receiving EPO who did not reach the target hemoglobin level (IR: 100-120 g/L) had a median hemoglobin of 92.5 g/L. To achieve the presented levels of anemia correction, the average weekly dose was 6,785 IU when calculated for the entire year 2022, including those patient months when EPO was not used. CONCLUSIONS . During treatment with EPO drugs, an increase in hemoglobin levels is observed, patients' quality of life improves, the risks of cardiovascular complications decrease, performance and physical endurance increase, the frequency and duration of hospitalizations decrease, and the need for blood transfusions decreases. The main challenges in solving the problem of refractory anemia involve individualizing treatment, considering drug response, and identifying additional factors.

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