Anemia management in cancer patients with chronic kidney disease

• Published in: European journal of internal medicine Vol. 36; pp. 13 - 19
• Main Authors: Deak, Andras T, Troppan, Katharina, Rosenkranz, Alexander R
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01-12-2016
• Subjects: Anemia - complications; Anemia - drug therapy; Anemia, Iron-Deficiency - complications; Anemia, Iron-Deficiency - drug therapy; Cancer; Chronic kidney disease; Disease Management; Erythropoiesis-stimulating agent; Hematinics - therapeutic use; Humans; Internal Medicine; Iron - therapeutic use; Iron supplementation; Neoplasms - complications; Practice Guidelines as Topic; Renal anemia; Renal Insufficiency, Chronic - complications; Trace Elements - therapeutic use; eGFR; FID; transferrin saturation; international units; chronic kidney disease; functional iron deficiency; Erythropoiesis-stimulating agent; absolute iron deficiency; IU; IV; hemoglobin; Renal anemia; Iron supplementation; estimated glomerular filtration Rate; ESA; intravenous; TSAT; Hb; AID; CKD; erythropoiesis-stimulating agents; Cancer; Chronic kidney disease
• ISSN: 0953-6205; 1879-0828
• DOI: 10.1016/j.ejim.2016.08.036

Abstract Anemia is a common complication of cancer and chronic kidney disease (CKD) associated with decreased physical performance as well as poor prognosis for life expectancy. Renal and cancer-induced anemia share common features regarding pathogenesis and therapeutic strategies. It is typically treated with iron substitution, erythropoiesis-stimulating agents (ESA) and in refractory cases with red blood cell transfusions. However, studies of the past few years unveiled numerous setbacks in the use of ESAs. These included a higher risk of cerebrovascular events and increased mortality without the improvement of cardiovascular outcomes in patients with CKD. Moreover, particularly negative results were observed in patients with previous cancer history under ESA therapy. These unfavorable findings have forced the clinicians to reevaluate the management of renal anemia. This led to decrease of ESA usage, while iron substitution and alternative therapeutic options gained more significance. Iron supplementation is also accompanied with certain risks ranging from gastrointestinal complications to severe allergic reactions and increased rate of infections. Furthermore, the evaluation of the long-term safety of excessive iron therapy is still lacking, especially in CKD patients with cancer. In the absence of these clinical studies, this review aims to summarize the currently available therapeutic strategies in anemia management of CKD patients with concomitant cancer.