A need for an individualized approach to end-stage renal disease patients

Evidence suggests that an individualized and flexible approach may be beneficial to end-stage renal disease (ESRD) patients. This article discusses this approach in relation to three issues: target haemoglobin (Hb) level, epoetin dosing frequency/administration and patient management/education programmes. Trial data indicate that each patient's condition should be taken into account when assigning target Hb values. Normalization of Hb is unlikely to be protective in patients with well-established cardiac disease. However, in patients without severe cardiac conditions, normalization is associated with benefits, such as reduction of cardiovascular risk factors and improved quality of life. Data are awaited from trials examining the impact of anaemia correction in patients not yet on renal replacement therapy (RRT). Two large, randomized controlled trials of haemodialysis patients have demonstrated that once-weekly epoetin beta is as effective and as well tolerated as administration two or three times weekly. Additionally, one of these trials showed that once-weekly and three times weekly administrations were equivalent therapeutically in terms of maintaining both stable haematocrit levels and epoetin beta dose requirements. These results suggest that the epoetin beta route and frequency of administration can be individualized according to patient/physician preference. Renal management programmes, which incorporate a multidisciplinary team approach, strategies for early referral of patients and patient education, have an impact on patient outcomes and on RRT modality choice. An individualized programme will help to optimize the use of treatments aimed at delaying the progression of renal failure and its co-morbidities. In conclusion, evidence suggests that an individualized and flexible approach to target Hb values, epoetin beta route and frequency of administration, and patient education/management programmes may be beneficial to patients with ESRD. As early intervention has an impact on patient outcome and the progression of risk factors, this approach may also be appropriate for patients who are not yet receiving RRT.