Patients with anemia had a higher risk of mortality and cardiovascular complications, as well as reducing their quality of life and increased hospitalizations. So the treatment of anemia in patients with chronic renal failure is a priority of his therapy

Chronic renal failure (CRF) is an irreversible disease characterized by kidney damage and deterioration of their function, which progresses with time. Chronic Kidney Disease (CKD) is classified into five phases, which are defined by the level of renal function, which is measured by the estimated glomerular filtration rate (eGFR). The lower the GFR, the more severe CRF.

There are several factors that contribute to the progression of CRF. The four most common causes of CRF are diabetes, hypertension, glomerulonephritis, or inflammation of the filtering units of the kidney, and polycystic kidney disease, a hereditary disease. An aging population along with the increasing number of patients with type 2 diabetes associated with obesity has led to increasing numbers of people with CKD or risk of suffering, which is estimated to affect 10% of our population.

Over time, the IRC generally progresses to a phase in which patients have impaired renal function so that they could not live without the aid of dialysis or kidney transplant. Without these treatments, the IRC will lead to the death of patients.

The early stages of CKD are difficult to diagnose because symptoms are less apparent until the disease has progressed significantly. With this progression are emerging symptoms: nausea, vomiting, bad breath and itchy skin, because of the toxic metabolites that would normally be filtered and removed from the blood through the kidneys, but in the presence of IRC accumulate to levels harmful.

Anemia

One of the most common symptoms of CKD is anemia, which occurs when the kidneys, because of their impaired function, stop producing enough eritripoyetina, the hormone that stimulates production of red blood cells that carry oxygen to whole organism. The anemia in these patients is a serious disease, but it is diagnosed and treated little bit. In the presence of anemia, the number of red blood cells is decreased below normal levels.

Red blood cells contain hemoglobin, a red protein, rich in iron, which is what carries oxygen from the lungs to other tissues. The oxygen helps provide the energy needed by the body to all normal activities. In the presence of anemia, hemoglobin levels are also low, below normal levels.

With anemia, the body gets less oxygen, so it has less energy than needed to function properly. The main symptoms of anemia include fatigue, weakness, shortness of breath, difficulty concentrating or confusion, dizziness or fainting, pale skin, tachycardia, and constant feeling of cold.

Recent data suggest that in elderly patients, anemia is associated with impaired mental function, decreased exercise capacity, reduced quality of life and development of left ventricular hypertrophy. If untreated, severe anemia is also associated with more frequent hospitalizations and increased costs of treatment.

Anemia develops early in CKD, some studies suggest that most patients are anemic and the first consultation with the nephrologist. Studies also suggest that one in three patients in our country has low hemoglobin values. The IRC patients with anemia have a higher risk of complications and mortality from cardiovascular disease than the general population. Recent data suggest that most patients with CKD die before they undergo dialysis.

Treatment of anemia

The erythropoiesis-stimulating agents play an important role in the treatment of anemia of CKD, because they stimulate production of red blood cells. Treatment with these agents is recent, dating from the 1980s, with the isolation of the gene for erythropoietin (EPO), human, followed by the introduction of the first innovator, epoetin alfa, in 1989.

Subsequently introduced darbepoetin alfa, a novel recombinant erythropoietic protein. Darbepoetin alfa has a different structure that provides greater biological activity, ie that allows the protein to remain longer in the blood. This is important because it reduces the frequency of administration, two or three times a week to once or twice a month, which is done by injection. This provides greater convenience for patients.

The treatment of anemia in CRF allows for correction of hemoglobin levels and the number of red blood cells, thereby reducing mortality, reducing complications and hospitalizations, and improves quality of life of patients.

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