Saudi Journal of Kidney Diseases and Transplantation

LETTER TO THE EDITOR
Year
: 2009  |  Volume : 20  |  Issue : 6  |  Page : 1090-

Survey of attitude of physicians on updates in the management of anemia in chronic kidney disease patients - An eye-opener


Pooja G Binnani 
 Senior Resident Nephrology, Jaslok Hospital and Research Centre, Mumbai, India

Correspondence Address:
Pooja G Binnani
Senior Resident Nephrology, Jaslok Hospital and Research Centre, Mumbai
India




How to cite this article:
Binnani PG. Survey of attitude of physicians on updates in the management of anemia in chronic kidney disease patients - An eye-opener.Saudi J Kidney Dis Transpl 2009;20:1090-1090


How to cite this URL:
Binnani PG. Survey of attitude of physicians on updates in the management of anemia in chronic kidney disease patients - An eye-opener. Saudi J Kidney Dis Transpl [serial online] 2009 [cited 2020 Oct 30 ];20:1090-1090
Available from: https://www.sjkdt.org/text.asp?2009/20/6/1090/57274


Full Text

To the Editor,

We read with great interest the published re­port by Souqiyyeh et al about Survey of attitude of physicians on updates in the management of anemia in chronic kidney disease patients. [1] The authors' results showed inadequate awareness of physicians of the mechanisms of action of ESAs and the new agents such as the CERA. Anemia is a severe and common complication of chronic kidney disease (CKD seen in more than 80% of patients with impaired renal func­ion. [2] Despite the successes of epoetin alfa and darbepoetin alfa, the management of anemia of CKD is poised for further clinical advancement. Several new anemia therapies are in various stages of development. There are still shades of grey in the treatment of CKD related anemia. CREATE and CHOIR were 2 recent pivotal trials that suggested that hemoglobin levels may largely impact cardiovascular outcomes. [3],[4] Both of these trials assessed the impact that the correction of anemia had on the occurrence of cardiovascular events in patients with CKD. [3],[4] Lack of knowledge and awareness of the me­chanism of action of the protein ESAs, the half-life and the dosing interval of the ESAs and data of the other nonprotein agents is one of the contributory factor behind inadequate response in managing CKD related anemia. Most common cause of erythropoietin hypo­responsiveness is actually pseudohyporespon­siveness related to inadequate dosing and in­correct interval.

Apart from this, it will be interesting to check awareness about biosimilars, especially in de­veloping countries like India where biosimilars are freely available at a cheaper cost and awareness of batch-to-batch variability in ma­nufacturing of many such ESAs. Awareness of black box warnings given by FDA like, in­creased mortality, serious cardiovascular and thromboembolic events, and increased risk of tumour progression or recurrence need to be checked as well.

References

1Souqiyyeh MZ, Shaheen FA. Survey of attitude of physicians on updates in the management of anemia in chronic kidney disease patients. Saudi J Kidney Dis Transpl 2009;20(3):410-6.
2Melnikova I. Anaemia therapies. Nat Rev Drug Discov 2006;5:627-8.
3Singh AK, Szczech L, Tang KL, et al. Correc­tion of anemia with epoetin alfa in chronic kidney disease. N Engl J Med 2006;355:2085­-98.
4Drueke TB, Locatelli F, Clyne N, et al. Norma­lization of hemoglobin level in patients with chronic kidney disease and anemia. N Engl J Med 2006;355:2071-84.