Anemia Management in Hemodialysis: Erythropoiesis-Stimulating Agents

Abstract

Introduction: Anemia is universal in hemodialysis patients, requiring erythropoiesis-stimulating agents (ESAs) and iron supplementation. Methods: Literature review of 35 studies on hemoglobin targets, ESA resistance, and adverse cardiovascular events. Results: Targeting hemoglobin 10–11.5 g/dL minimized cardiovascular risk while reducing transfusions. Higher targets (>13 g/dL) increased stroke and thrombosis risk by 30%. Hyporesponsiveness (high ESA doses) associated with inflammation, iron deficiency, and hyperparathyroidism. Discussion: IV iron (ferric carboxymaltose) reduces ESA dose by 30–50% without safety signals. Conclusion: Conservative hemoglobin targets with adjunctive iron therapy balance efficacy and safety.