The kidney produces a protein called erythropoietin which is a class of Erythropoietic Stimulating Agents (ESA’s) – Epogen (EPO), Procrit and Aranesp are ESA’s – and are responsible for maintaining normal hemoglobin levels to prevent anemia (low blood hemoglobin level). With the development of chronic kidney disease including patients on dialysis, Erythropoietin levels fall and anemia develops. A normal hemoglobin level is 13gm% to 15gm%. Patients with anemia have complained of weariness,fatigue and other symptoms suggestive of a poor quality of life. When hemoglobin levels fall below 10gm%, the chance of hospitalization increases and the need for red blood cell transfusions significantly increase. A major risk of red blood cell transfusion is a decreased chance of receiving a kidney transplant.
Erythropoietins have been created and given to patients with kidney disease since 1989. Erythropoietin increases hemoglobin levels above 10gm% and can actually totally correct anemia. Erythropoietins are given intravenously while on dialysis and are given under your skin in patients with chronic kidney disease who are not on dialysis. Raising hemoglobin levels above 10gm% decreases the risk of transfusions. In addition patients with hemoglobins above 10gm% have been observed to have a better quality of life and less hospitalizations.
On the other hand, recent studies have raised issues of increased risks associated with aiming for a high hemoglobins (13gm%). These risks include a higher incidence of heart attack, congestive heart failure, strokes, and clotting of your access (if you are on dialysis). All of the studies that demonstrate these risks have aimed for a hemoglobin greater than 13gm%. Because of these studies the FDA has mandated that we inform you of the risks and benefits of the use of Erythropoietins to treat your anemia.
We do not aim for hemoglobins of 13gm%, rather the goal is to achieve a hemoglobin between 10-12gm%. At this level we feel the benefits outweigh the risks that are noted when targeted hemoglobins are 13gm%. By keeping your hemoglobin above 10gm% you can avoid transfusions. In addition achieving higher quality of life and less chance of hospitalization was noted with hemoglobins above 10gm%.
We are including the patient “medication guide” as recommended by the FDA but like any package insert it is intended to alert you to the risk and benefits of a drug. In our opinion,when administering Erythropoietins in the correct way,the benefits outweigh the risk. If you have further questions feel free to ask us.