We recommend that treatment with Erythropoiesis Stimulating Agents (ESAs) should be offered to people with anaemia of CKD, who are likely to benefit in terms of quality of life and physical function and to avoid blood transfusion; especially in people considered suitable for transplantation. (1B)
Rationale
Treatment of anaemia in CKD with ESA can be expensive (1), takes time to work and carries a small but significant risk to the patient. It is therefore reasonable, as with any therapy, to treat only those who are expected to benefit in the time frame that therapy is being considered. For example, people with severe sepsis/inflammation/acute bleeding are unlikely to respond.
People with a very short life expectancy (days or weeks) are not likely to survive long enough for therapy to provide benefit in terms of an increase in Hb. The clinician and patient should agree on a therapeutic plan and, at an appropriate time, review whether therapy is providing enough benefit to continue treatment.
References
- National Collaborating Centre for Chronic Conditions, Royal College of Physicians. Chronic kidney disease: assessment and management. 2021. National Institute for Clinical Excellence.