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Updated: Jun 24, 2026
05:35
A Point-of-Care Method with Integrated Decision Support Tool to Estimate Anemia at Population Level
Published on: January 19, 2024
Lost without directions: lessons from the anemia debate and the drive study
David M Spiegel1, Glenn M Chertow
1University of Colorado Denver Health Sciences Center, Division of Renal Diseases and Hypertension, 12700 East 19th Avenue, C281, Aurora, CO 80045, USA. david.spiegel@ucdenver.edu
Summary
Concerns about erythropoiesis stimulating agents have lowered hemoglobin targets for dialysis patients. This review cautions against increased intravenous iron use due to limited evidence and unknown long-term safety.
Area of Science:
- Nephrology
- Hematology
- Pharmacology
Background:
- Growing concerns regarding erythropoiesis stimulating agents (ESAs) have led to revised hemoglobin targets in chronic kidney disease (CKD) patients.
- Patients with end-stage renal disease (ESRD) on dialysis face adjusted anemia management strategies.
- Economic factors and dialysis funding shifts influence anemia treatment approaches.
Purpose of the Study:
- To review the evidence base for alternative anemia management strategies in CKD patients.
- To evaluate the safety and efficacy of increased intravenous iron use.
- To provide guidance on optimal anemia management in ESRD patients on dialysis.
Main Methods:
- Literature review of studies on anemia management in CKD and ESRD.
- Analysis of evidence supporting current anemia treatment guidelines.
- Assessment of data on intravenous iron use and long-term safety.
Main Results:
- Limited evidence supports alternative anemia management strategies.
- Current data on the long-term safety of liberal intravenous iron use is insufficient.
- Existing strategies may not be optimal without further research.
Conclusions:
- Caution is advised regarding the injudicious use of intravenous iron in CKD patients.
- Further research is needed to establish the long-term safety of current anemia management trends.
- Optimal anemia management requires a careful balance of efficacy, safety, and economic considerations.
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