[Anemia and its treatment in peritoneal dialysis patients]

The need for erythropoietin (rhuEPO) or darbepoetin-alpha and iron is lower in patients undergoing peritoneal dialysis (PD) than in patients treated with hemodialysis (HD) because blood losses are reduced, residual renal function and elimination of inhibitors of erythropoiesis are improved and inflammation is less than in HD treatment. In addition, comorbidities of PD patients are probably lower than those of HD patients, and this factor may also contribute to anemia being less in PD patients than in those on HD. Furthermore, the frequency of blood transfusions is lower in PD patients, with or without rhuEPO treatment. However, in PD patients also, anemia is associated with hospitalization rate and mortality. Anemia can be corrected by subcutaneous injections of rhuEPO-beta (1-3 times per week) or darbepoetin-alpha (once a week or twice a month). Adjuvant treatment of anemia includes correction of iron deficiency by oral or intravenous iron, androgen substitution in elderly male PD patients and adequate calcitriol supplementation. Factors that may negatively influence anemia in PD patients are inflammation, infection, antihypertensive therapy with ACE inhibitors or angiotensin II blockers and neutralizing antibodies against rhuEPO or darbepoetin-alpha.