[Erythropoesis-stimulating agents: past, present and future]

Renal anemia is a well-recognized complication of chronic kidney disease (CKD). The primary cause is the deficiency of erythropoietin (EPO). There is an evident association between low hemoglobin with adverse outcomes of CKD patients. Many morbidity conditions observed in CKD patients are cardiovascular complications including left ventricular hypertrophy, ischemic heart disease, chronic heart failure, generalized atherosclerosis, and stroke. It is suggested that renal anemia, chronic renal failure, and chronic heart failure all interact to cause or worsen each other (anemia-renalcardio syndrome). Treatment of renal anemia may be successfully achieved with the use of erythropoesis-stumulating agents (ESAs), but the therapeutic benefits of ESA could be far beyond the correction of anemia. ESA can protect organs via hematopoiesis-dependent and -indemendent manner. A pleiotropic affect of EPO has been shown in the kidney, the central nervous system, and the cardiovacular system. Alarge number of CKD patients will benefit from early recognition and appropriate correction of renal anemia with ESA. Research during the past years has clearly demostrated that the administration of ESA reduced brain injury associated with stroke, blunt trauma, cytotoksicity, and prevented spinal cord injury. The correcting of anemia with ESA in patients suffering from congestive heart failure caused an improvement in cardiac function. The renal function may be improved, at least, in selected subjects, by the ESA treatment of anemia.