In general, erythropoiesis-stimulating agents are used to maintain a hemoglobin level of 11 to 12 g/dL. The target should not exceed 13 g/dL. In patients receiving this treatment, iron stores should be assessed and replenished as needed to avoid apparent erythropoietin resistance. Oral iron supplements, such as iron sulfate or iron gluconate, are commonly given. If patients are resistant to these supplements because of impaired intestinal absorption, intravenous iron preparations may be used instead.

Cardiovascular Disease. Cardiovascular disease is the leading cause of death among patients with chronic kidney disease, and it affects 40% of dialysis patients compared with 10% of the general population. Patients with CKD are more likely to have classic risk factors for cardiovascular disease, such as hypertension, diabetes mellitus, and hyperlipidemia. CKD itself, however, also appears to be an independent risk factor for CVD, and recent studies have shown a strong correlation between declines in eGFR and increased cardiovascular events.

Numerous factors are responsible for this association. Vascular calcification appears to result from the use of calcium-based phosphate binders and vitamin D analogues. It may affect the intimal layer, leading to atherosclerotic plaques, and/or the medial layer, leading to vessel stiffening. The inflammation and secondary hypertension associated with CKD also accelerate vascular disease.

In addition to increasing the risk for cardiovascular disease, CKD also increases the risk of left ventricular hypertrophy by causing hypertension, anemia, and hypervolemia. The prevalence of left ventricular hypertrophy is much higher among dialysis patients than the general population.