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1. Diagnosis of exclusion - patients should be evaluated for other causes of anemia, especially iron deficiency.

2. THE normochromic-normocytic anemia in CKD responds dramatically to recombinant erythropoietin.

3. The 2012 KDIGO (kidney disease improving global outcomes) guidelines suggest that ESAs not be started among adult non-dialysis patients with Hgb concentrations of > 10g/dL.

4. Clinical trials that incorporate ESAs have shown no improvement in outcome and an increased morbidity and mortality if the hemoglobin is corrected to normal (> 13).

5. ESA may increase the risk of tumor growth, and thus these agents should be used with caution in patients with active malignancy.


1. Wilkinson, I. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press.
2. Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
3. Image: no reference available.

Ⓒ A. Manickam 2018

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