Anemia Management in Peritoneal Dialysis

Anemia in end-stage kidney disease (ESKD) is a complex problem involving iron metabolism, deficient erythropoiesis, and inflammatory responses due to uremia and persistence of associated middle molecule molecular toxins. With the advent of the kidney X initiative, growth of peritoneal dialysis (PD) is expected to greatly increase the number of patients on home therapies. In this chapter, the pathophysiology of anemia in ESKD is discussed in detail, and the rational basis for anemia therapy is described. The use of various agents in the treatment of anemia of ESKD is outlined. Evidence-based guidelines from the literature are also reviewed in a matter useful to the clinician. The latest developments in ESKD anemia therapy are discussed (hypoxia-inducible factor-prolyl hydroxylase inhibitors). Finally factors unique to PD are discussed to crystalize the unique challenges and opportunities inherent in treating ESKD-associated anemia in PD patients.