Erythropoiesis-stimulating agents: past and future

Area of Science:

• Nephrology
• Hematology
• Cardiology

Background:

• Renal anemia is a common complication of chronic kidney disease (CKD).
• Erythropoietin (EPO) deficiency is the primary cause of renal anemia.
• The cardio-renal anemia syndrome describes the interplay between cardiac failure, renal failure, and anemia.

Purpose of the Study:

• To discuss the role of erythropoiesis-stimulating agents (ESAs) in treating renal anemia.
• To explore the potential pleiotropic, or multifaceted, effects of EPO beyond anemia correction.
• To highlight the benefits of early anemia recognition and treatment in CKD patients.

Main Methods:

• Review of observational population-based studies.
• Analysis of findings from randomized controlled trials.
• Discussion of mechanistic insights into EPO's cellular effects.

Main Results:

• Low hemoglobin levels in CKD are associated with adverse outcomes.
• ESAs are effective in treating renal anemia.
• EPO exhibits pleiotropic effects on the central nervous system, cardiovascular system, and kidneys, influencing progenitor stem cell development, cellular integrity, and angiogenesis.

Conclusions:

• While normalizing hemoglobin in CKD patients is not consistently supported by recent trials, ESAs may offer renoprotective benefits.
• Early identification and treatment of anemia in CKD patients with ESAs can be beneficial.
• The therapeutic potential of ESAs extends beyond correcting anemia, impacting multiple cellular processes.