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Invited Commentary
May 2014

Anemia in Chronic Kidney DiseaseTreating the Numbers, Not the Patients

Author Affiliations
  • 1Renal Division, Department of Medicine, Washington University School of Medicine, Washington University, St Louis, Missouri
JAMA Intern Med. 2014;174(5):708-709. doi:10.1001/jamainternmed.2013.13305

Epoetin alfa, the first erythropoiesis-stimulating agent (ESA), was approved in 1989 for the treatment of anemia in patients with chronic kidney disease (CKD). By 1991, in dialysis, there were no longer patients requiring regular transfusions for severe anemia (eg, hemoglobin concentration, <7 g/dL [to convert to grams per liter, multiply by 10]), and dialysis center–based transfusions had decreased by more than 65%.1 For many reasons, including the establishment of financial incentives that rewarded overuse, aggressive treatment of anemia in dialysis-requiring patients with increasingly higher doses of ESA became the norm, and mean hemoglobin concentrations in patients receiving dialysis increased from 10.5 g/dL in 1995 to 12.0 g/dL in 2005.1,2

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