Brief Comment - You've Just Gotta Have Faith

The anemia debacle rightly questions our collective faith in the motives of the big pharma companies that work in the CKD anemia space. An article by writer Peter Whoriskey published recently in the Washington Post and a follow-up blog by Daniel Hoffman in the Philadelphia Inquirer should make us pause and think about how we got got into the mess that we are in. Thirteen years after the FDAs approval of epogen we still don't know whether the large doses we are using in our dialysis patients are safe. We don't know if it's aiming for a high hemoglobin, i.e., correcting anemia, or exposure to ESA that is the problem. We haven't established definitively the target range. We suspect but haven't proven that correcting anemia is associated with improvements in quality of life. Nor, for that matter, do we know the mechanisms underlying the heightened risk of cardiovascular complications in anemic CKD patients treated with ESAs. Yet, billions of dollars have been spent by US taxpayers for ESAs.

Yet, I believe, that the KDIGO anemia guidelines targeted for publication in KI as a supplement in a few days (in the August issue) do move us forwards. The guidelines are well written, balanced, and seem free from conflict of interest. I will be writing about the guidelines next week, but recommend that they are a must-read!