Abstract
Anemia is a major complication of chronic kidney disease (CKD) that leads to many symptoms of this disease and worsens cardiovascular health. Treatment of this condition was revolutionized three decades ago by the commercial availability of recombinant human erythropoietin which held the promise of completely eliminating the need for red blood cell transfusion (RBCT). Despite specific therapy now available for anemia in CKD, clinical data accumulated in the last 2 decades suggests that there is a continued need for RBCT, which, we surmise, is due to underutilization of Erythropoietin Stimulating Agents (ESA) or clinical settings such as active bleed, bone marrow resistance such as myelofibrosis or infections where ESAs are ineffective. The purpose of this narrative review is to highlight the adverse effects and summarize the current patterns of RBCT use in all stages of CKD while elaborating on the clinical characteristics of patients that increases their risks of transfusion exposure. We discuss, briefly, salient features of the pathophysiology of anemia in CKD and its contemporary therapies while presenting our perspectives on how to optimize transfusion strategies without compromising patient safety.
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We wish to sincerely thank Drs Elizabeth Adams-Eilers and Dr Robert P. Eilers for their valuable comments and suggestions in preparing this manuscript.
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Brenner, N., Kommalapati, A., Ahsan, M. et al. Red cell transfusion in chronic kidney disease in the United States in the current era of erythropoiesis stimulating agents. J Nephrol 33, 267–275 (2020). https://doi.org/10.1007/s40620-019-00680-5
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DOI: https://doi.org/10.1007/s40620-019-00680-5