{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T16:04:15Z","timestamp":1791475455375,"version":"4.3.4"},"reference-count":51,"publisher":"American Society of Hematology","issue":"7","content-domain":{"domain":["ashpublications.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2020,8,13]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Anemia is a frequent complication of kidney disease. When severe, it causes symptoms that can be debilitating. The course of anemia tends to track the decline in kidney function, with prevalence increasing in more advanced disease. Although the most common cause is relative erythropoietin deficiency, other factors such as reduced iron availability contribute to the pathobiology. In this review, we use cases to explore the surprising complexity of decision-making in management of renal anemia.<\/jats:p>","DOI":"10.1182\/blood.2019004330","type":"journal-article","created":{"date-parts":[[2020,6,19]],"date-time":"2020-06-19T01:59:27Z","timestamp":1592531967000},"page":"783-789","update-policy":"https:\/\/doi.org\/10.1182\/blood.2019cm0000","source":"Crossref","is-referenced-by-count":31,"title":["How I treat renal anemia"],"prefix":"10.1182","volume":"136","author":[{"given":"Steven","family":"Fishbane","sequence":"first","affiliation":[{"name":"Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra\/Northwell, Great Neck, NY; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel W.","family":"Coyne","sequence":"additional","affiliation":[{"name":"Division of Nephrology, School of Medicine, Washington University, St. Louis, MO"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"234","reference":[{"key":"2020081311243458000_B1","first-page":"340","article-title":"Cases and observations illustrative of renal disease accompanied with the secretion of albuminous urine","volume":"1","author":"Bright","year":"1836","journal-title":"Guys Hosp Rep"},{"issue":"10","key":"2020081311243458000_B2","doi-asserted-by":"crossref","first-page":"1631","DOI":"10.1681\/ASN.2011111078","article-title":"Mechanisms of anemia in CKD","volume":"23","author":"Babitt","year":"2012","journal-title":"J Am Soc Nephrol"},{"issue":"1","key":"2020081311243458000_B3","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1038\/s41581-019-0191-y","article-title":"Measured and estimated glomerular filtration rate: current status and future directions","volume":"16","author":"Levey","year":"2020","journal-title":"Nat Rev Nephrol"},{"issue":"1","key":"2020081311243458000_B4","first-page":"1","article-title":"KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease","volume":"3","author":"Levin","year":"2013","journal-title":"Kidney Int Suppl"},{"issue":"9","key":"2020081311243458000_B5","doi-asserted-by":"crossref","first-page":"1501","DOI":"10.1185\/030079904X2763","article-title":"The prevalence of anemia in patients with chronic kidney disease","volume":"20","author":"McClellan","year":"2004","journal-title":"Curr Med Res Opin"},{"key":"2020081311243458000_B6","unstructured":"Arbor Research Collaborative for Health . DOPPS Practice Monitor. National sample: weekly IV epoetin dose received (30 day average), categories. https:\/\/www.dopps.org\/DPM\/DPMSlideBrowser.aspx?type=Topic&id=1&g=sum_EPOIV30DAY_c_overall. Accessed 6 September 2019."},{"issue":"1","key":"2020081311243458000_B7","doi-asserted-by":"crossref","first-page":"35","DOI":"10.2215\/CJN.04690511","article-title":"Timing and determinants of erythropoietin deficiency in chronic kidney disease","volume":"7","author":"Mercadal","year":"2012","journal-title":"Clin J Am Soc Nephrol"},{"issue":"1","key":"2020081311243458000_B8","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1159\/000098522","article-title":"Hepcidin in anemia and inflammation in chronic kidney disease","volume":"30","author":"Malyszko","year":"2007","journal-title":"Kidney Blood Press Res"},{"issue":"9","key":"2020081311243458000_B9","doi-asserted-by":"crossref","first-page":"E1173","DOI":"10.3390\/nu10091173","article-title":"Impact of inflammation on ferritin, hepcidin and the management of iron deficiency anemia in chronic kidney disease","volume":"10","author":"Ueda","year":"2018","journal-title":"Nutrients"},{"issue":"3","key":"2020081311243458000_B10","doi-asserted-by":"crossref","first-page":"783","DOI":"10.1182\/blood-2003-03-0672","article-title":"Hepcidin, a key regulator of iron metabolism and mediator of anemia of inflammation","volume":"102","author":"Ganz","year":"2003","journal-title":"Blood"},{"issue":"4","key":"2020081311243458000_B11","doi-asserted-by":"crossref","first-page":"548","DOI":"10.1053\/j.ajkd.2015.11.012","article-title":"Diagnosis and management of iron deficiency in CKD: a summary of the NICE guideline recommendations and their rationale","volume":"67","author":"Ratcliffe","year":"2016","journal-title":"Am J Kidney Dis"},{"issue":"6","key":"2020081311243458000_B12","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1002\/jcla.21634","article-title":"Hepcidin-25 concentrations are markedly increased in patients with chronic kidney disease and are inversely correlated with estimated glomerular filtration rates","volume":"27","author":"Troutt","year":"2013","journal-title":"J Clin Lab Anal"},{"issue":"suppl 6","key":"2020081311243458000_B13","doi-asserted-by":"crossref","first-page":"1559S","DOI":"10.3945\/ajcn.117.155804","article-title":"Current understanding of iron homeostasis","volume":"106","author":"Anderson","year":"2017","journal-title":"Am J Clin Nutr"},{"issue":"4","key":"2020081311243458000_B14","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1053\/j.ajkd.2009.10.043","article-title":"Bone marrow iron, iron indices, and the response to intravenous iron in patients with non-dialysis-dependent CKD","volume":"55","author":"Stancu","year":"2010","journal-title":"Am J Kidney Dis"},{"issue":"12","key":"2020081311243458000_B15","doi-asserted-by":"crossref","first-page":"2654","DOI":"10.1681\/ASN.V7122654","article-title":"The evaluation of iron status in hemodialysis patients","volume":"7","author":"Fishbane","year":"1996","journal-title":"J Am Soc Nephrol"},{"issue":"11","key":"2020081311243458000_B16","doi-asserted-by":"crossref","first-page":"2075","DOI":"10.1093\/ndt\/gfu201","article-title":"FIND-CKD: a randomized trial of intravenous ferric carboxymaltose versus oral iron in patients with chronic kidney disease and iron deficiency anaemia","volume":"29","author":"Macdougall","year":"2014","journal-title":"Nephrol Dial Transplant"},{"issue":"4","key":"2020081311243458000_B17","doi-asserted-by":"crossref","first-page":"905","DOI":"10.1038\/ki.2015.163","article-title":"A randomized trial of intravenous and oral iron in chronic kidney disease","volume":"88","author":"Agarwal","year":"2015","journal-title":"Kidney Int"},{"issue":"5","key":"2020081311243458000_B18","doi-asserted-by":"crossref","first-page":"1694","DOI":"10.1038\/ki.1996.487","article-title":"A randomized controlled study of iron supplementation in patients treated with erythropoietin","volume":"50","author":"Macdougall","year":"1996","journal-title":"Kidney Int"},{"issue":"1","key":"2020081311243458000_B19","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1016\/0272-6386(95)90151-5","article-title":"Reduction in recombinant human erythropoietin doses by the use of chronic intravenous iron supplementation","volume":"26","author":"Fishbane","year":"1995","journal-title":"Am J Kidney Dis"},{"issue":"1","key":"2020081311243458000_B20","doi-asserted-by":"crossref","first-page":"33","DOI":"10.2215\/CJN.00630208","article-title":"Health-related quality of life and hemoglobin levels in chronic kidney disease patients","volume":"4","author":"Finkelstein","year":"2009","journal-title":"Clin J Am Soc Nephrol"},{"issue":"4","key":"2020081311243458000_B21","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1053\/j.ackd.2019.04.003","article-title":"The impact of anemia treatment on health-related quality of life in patients with chronic kidney disease in the contemporary era","volume":"26","author":"Finkelstein","year":"2019","journal-title":"Adv Chronic Kidney Dis"},{"issue":"21","key":"2020081311243458000_B22","doi-asserted-by":"crossref","first-page":"2019","DOI":"10.1056\/NEJMoa0907845","article-title":"A trial of darbepoetin alfa in type 2 diabetes and chronic kidney disease","volume":"361","author":"Pfeffer","year":"2009","journal-title":"N Engl J Med"},{"issue":"7","key":"2020081311243458000_B23","doi-asserted-by":"crossref","first-page":"472","DOI":"10.7326\/M15-1839","article-title":"The effect of erythropoietin-stimulating agents on health-related quality of life in anemia of chronic kidney disease: a systematic review and meta-analysis","volume":"164","author":"Collister","year":"2016","journal-title":"Ann Intern Med"},{"issue":"4","key":"2020081311243458000_B24","first-page":"345","article-title":"Impact of hematocrit on morbidity and mortality","volume":"20","author":"Collins","year":"2000","journal-title":"Semin Nephrol"},{"issue":"20","key":"2020081311243458000_B25","doi-asserted-by":"crossref","first-page":"2085","DOI":"10.1056\/NEJMoa065485","article-title":"Correction of anemia with epoetin alfa in chronic kidney disease","volume":"355","author":"Singh","year":"2006","journal-title":"N Engl J Med"},{"issue":"9","key":"2020081311243458000_B26","doi-asserted-by":"crossref","first-page":"584","DOI":"10.1056\/NEJM199808273390903","article-title":"The effects of normal as compared with low hematocrit values in patients with cardiac disease who are receiving hemodialysis and epoetin","volume":"339","author":"Besarab","year":"1998","journal-title":"N Engl J Med"},{"issue":"2","key":"2020081311243458000_B27","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1038\/ki.2012.76","article-title":"The health-related quality of life was not improved by targeting higher hemoglobin in the Normal Hematocrit Trial","volume":"82","author":"Coyne","year":"2012","journal-title":"Kidney Int"},{"issue":"4","key":"2020081311243458000_B28","first-page":"282","article-title":"KDIGO clinical practice guideline for anemia in chronic kidney disease","volume":"2","author":"Kidney Disease: Improving Global Outcomes (KDIGO)","year":"2012","journal-title":"Kidney Int Suppl"},{"issue":"7","key":"2020081311243458000_B29","doi-asserted-by":"crossref","first-page":"1320","DOI":"10.2337\/dc08-0779","article-title":"Anemia, diabetes, and chronic kidney disease","volume":"32","author":"Mehdi","year":"2009","journal-title":"Diabetes Care"},{"issue":"8","key":"2020081311243458000_B30","doi-asserted-by":"crossref","first-page":"704","DOI":"10.1161\/CIRCULATIONAHA.119.044235","article-title":"Effect of empagliflozin on erythropoietin levels, iron stores, and red blood cell morphology in patients with type 2 diabetes mellitus and coronary artery disease","volume":"141","author":"Mazer","year":"2020","journal-title":"Circulation"},{"key":"2020081311243458000_B31","unstructured":"US Food and Drug Administration . Aranesp (darbepoetin alfa): for injection. https:\/\/www.accessdata.fda.gov\/drugsatfda_docs\/label\/2010\/103951s5197lbl.pdf. Accessed 19 November 2019."},{"issue":"5","key":"2020081311243458000_B32","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1097\/01.tp.0000437435.19980.8f","article-title":"Red blood cell transfusions and the risk of allosensitization in patients awaiting primary kidney transplantation","volume":"97","author":"Leffell","year":"2014","journal-title":"Transplantation"},{"issue":"20","key":"2020081311243458000_B33","doi-asserted-by":"crossref","first-page":"2071","DOI":"10.1056\/NEJMoa062276","article-title":"Normalization of hemoglobin level in patients with chronic kidney disease and anemia","volume":"355","author":"Dr\u00fceke","year":"2006","journal-title":"N Engl J Med"},{"issue":"6","key":"2020081311243458000_B34","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1038\/ki.2008.295","article-title":"Secondary analysis of the CHOIR trial epoetin-alpha dose and achieved hemoglobin outcomes","volume":"74","author":"Szczech","year":"2008","journal-title":"Kidney Int"},{"key":"2020081311243458000_B35","unstructured":"Arbor Research Collaborative for Health . DOPPS Practice Monitor. National sample: hemoglobin (most recent), categories. https:\/\/www.dopps.org\/dpm\/DPMSlideBrowser.aspx?type=Topic&id=1. Accessed 26 February 2020."},{"issue":"22","key":"2020081311243458000_B36","doi-asserted-by":"crossref","first-page":"2433","DOI":"10.1016\/j.jacc.2015.04.024","article-title":"Cardio-pulmonary-renal interactions: a multidisciplinary approach","volume":"65","author":"Husain-Syed","year":"2015","journal-title":"J Am Coll Cardiol"},{"key":"2020081311243458000_B37","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1016\/j.ijcard.2019.08.049","article-title":"Prevalence of, associations with, and prognostic role of anemia in heart failure across the ejection fraction spectrum","volume":"298","author":"Savarese","year":"2020","journal-title":"Int J Cardiol"},{"issue":"25","key":"2020081311243458000_B38","doi-asserted-by":"crossref","first-page":"2436","DOI":"10.1056\/NEJMoa0908355","article-title":"Ferric carboxymaltose in patients with heart failure and iron deficiency","volume":"361","author":"Anker","year":"2009","journal-title":"N Engl J Med"},{"key":"2020081311243458000_B39","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1016\/j.ijcard.2018.03.039","article-title":"Impact of iron deficiency on long-term clinical outcomes of hospitalized patients with heart failure","volume":"261","author":"Nakano","year":"2018","journal-title":"Int J Cardiol"},{"key":"2020081311243458000_B40","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1016\/j.ijcard.2015.11.178","article-title":"The impact of iron deficiency and anaemia on exercise capacity and outcomes in patients with chronic heart failure. Results from the Studies Investigating Co-morbidities Aggravating Heart Failure","volume":"205","author":"Ebner","year":"2016","journal-title":"Int J Cardiol"},{"issue":"1","key":"2020081311243458000_B41","doi-asserted-by":"crossref","first-page":"35","DOI":"10.2174\/1871529X11313010004","article-title":"Outcomes of patients with chronic heart failure and iron deficiency treated with intravenous iron: a meta-analysis","volume":"13","author":"Kapoor","year":"2013","journal-title":"Cardiovasc Hematol Disord Drug Targets"},{"issue":"4","key":"2020081311243458000_B42","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1016\/j.ahj.2013.01.017","article-title":"Iron deficiency in chronic heart failure: an international pooled analysis","volume":"165","author":"Klip","year":"2013","journal-title":"Am Heart J"},{"issue":"4","key":"2020081311243458000_B43","doi-asserted-by":"crossref","first-page":"522","DOI":"10.1002\/ejhf.640","article-title":"Myocardial iron content and mitochondrial function in human heart failure: a direct tissue analysis","volume":"19","author":"Melenovsky","year":"2017","journal-title":"Eur J Heart Fail"},{"issue":"1","key":"2020081311243458000_B44","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1002\/ejhf.823","article-title":"Effects of ferric carboxymaltose on hospitalisations and mortality rates in iron-deficient heart failure patients: an individual patient data meta-analysis","volume":"20","author":"Anker","year":"2018","journal-title":"Eur J Heart Fail"},{"issue":"13","key":"2020081311243458000_B45","doi-asserted-by":"crossref","first-page":"1210","DOI":"10.1056\/NEJMoa1214865","article-title":"Treatment of anemia with darbepoetin alfa in systolic heart failure","volume":"368","author":"Swedberg","year":"2013","journal-title":"N Engl J Med"},{"issue":"2","key":"2020081311243458000_B46","doi-asserted-by":"crossref","first-page":"e004431","DOI":"10.1161\/CIRCHEARTFAILURE.117.004431","article-title":"Hyporesponsiveness to darbepoetin alfa in patients with heart failure and anemia in the RED-HF study (reduction of events by darbepoetin alfa in heart failure): clinical and prognostic associations","volume":"11","author":"van der Meer","year":"2018","journal-title":"Circ Heart Fail"},{"issue":"5","key":"2020081311243458000_B47","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1053\/j.ajkd.2014.12.013","article-title":"Cancer incidence among US Medicare ESRD patients receiving hemodialysis, 1996-2009","volume":"65","author":"Butler","year":"2015","journal-title":"Am J Kidney Dis"},{"issue":"7","key":"2020081311243458000_B48","doi-asserted-by":"crossref","first-page":"1249","DOI":"10.1038\/bjc.2012.42","article-title":"Effects of erythropoietin receptors and erythropoiesis-stimulating agents on disease progression in cancer","volume":"106","author":"Aapro","year":"2012","journal-title":"Br J Cancer"},{"issue":"11","key":"2020081311243458000_B49","doi-asserted-by":"crossref","first-page":"1930","DOI":"10.2215\/CJN.03370414","article-title":"Intravenous iron exposure and mortality in patients on hemodialysis","volume":"9","author":"Miskulin","year":"2014","journal-title":"Clin J Am Soc Nephrol"},{"issue":"5","key":"2020081311243458000_B50","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1056\/NEJMoa1810742","article-title":"Intravenous iron in patients undergoing maintenance hemodialysis","volume":"380","author":"Macdougall","year":"2019","journal-title":"N Engl J Med"},{"issue":"5","key":"2020081311243458000_B51","doi-asserted-by":"crossref","first-page":"590","DOI":"10.1111\/j.1525-139X.2009.00635.x","article-title":"Seeking safe and efficacious anemia management","volume":"22","author":"Coyne","year":"2009","journal-title":"Semin Dial"}],"container-title":["Blood"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/ashpublications.org\/blood\/article-pdf\/136\/7\/783\/1752642\/bloodbld2019004330c.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/ashpublications.org\/blood\/article-pdf\/136\/7\/783\/1752642\/bloodbld2019004330c.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,10,29]],"date-time":"2022-10-29T11:02:18Z","timestamp":1667041338000},"score":1,"resource":{"primary":{"URL":"https:\/\/ashpublications.org\/blood\/article\/136\/7\/783\/461033\/How-I-treat-renal-anemia"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,8,13]]},"references-count":51,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2020,8,13]]}},"URL":"https:\/\/doi.org\/10.1182\/blood.2019004330","relation":{},"ISSN":["0006-4971","1528-0020"],"issn-type":[{"value":"0006-4971","type":"print"},{"value":"1528-0020","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,8,13]]}}}