The
Kidney Disease Improving Global Outcomes (KDIGO)-2012 on the treatment of
anemia emit suggestions (which differ from recommendations) based on a scientific evidence of low level. The first rule is no harm; physicians must take into account the profile of the patient and its associated morbidities and remember on the potential risks to begin a treatment by
erythropoiesis stimulating agents (ESA) (
thrombosis of
arteriovenous fistula,
hypertension,
stroke). All correctable causes of
anemia other than
erythropoietin deficiency should be actively sought. It is necessary to individualize the treatment by ESA and assess the clinical improvement expected. The ESA will be used in the following way: initiate at 10 g/dL of
hemoglobin level with the aim of 11.5 g/dL, without exceeding 13 g/dL. In case of ESA resistance, it seems suitable to assess the risks and benefits of ESA versus
blood transfusion. The ERBP-2013 have endorsed the KDIGO-2012 except the proposals dealing with the treatment by IV
iron. The use of intravenous
iron must be more cautious in the future taking into account the results of a recent French study published in the American Journal of Medicine showing the high frequency of
iron overload at quantitative hepatic MRI among haemodialysis patients receiving
iron IV following the current guidelines. It is appropriate to use oral
iron in first intention as recommended by the ANSM (French
Drug Agency) in a recent information note and respect the dosage regimen of the label. The realization of a quantitative hepatic MRI to evaluate
iron overload and monitor the treatment by
iron IV must also be considered on a case by case basis.