How to optimise anaemia therapy in peritoneal dialysis patients

As with other groups of chronic kidney disease patients, the treatment of anaemia is of paramount importance in the general management of patients receiving regular peritoneal dialysis. The availability of agents able to stimulate erythropoiesis has transformed the management of anaemia in CKD, but questions are still raised as to the optimum means of using these drugs. Iron management is also pivotal to the satisfactory correction of anaemia, and again there is much discussion as to whether oral or intravenous iron is the preferred mode of administration in peritoneal dialysis patients. On the basis of the published evidence to date, PD patients should maintain a haemoglobin above 11 g/dL in line with the US and the European Anaemia guidelines, and intravenous iron should be used to correct any iron deficiency. Oral iron may be effective in a minority of patients. This article aims to explore some of these issues in greater detail so that patients on peritoneal dialysis can derive the greatest benefits from correction of anaemia and maintenance of an adequate haemoglobin.