July 29, 2026

Study examines changes in anemia treatment for people with kidney disease

A new study in the Canadian Journal of Kidney Health and Disease examines how changes in anemia treatment coincided with an increase in more severe cases of anemia among people with kidney disease in British Columbia between 2007 and 2018.

People living with CKD often develop anemia, a condition in which the blood has lower-than-normal levels of hemoglobin, the protein that carries oxygen throughout the body. Severe anemia can lead to health problems, including tiredness, lower exercise tolerance, and in some cases, heart problems. Some people are treated with medications called erythropoiesis-stimulating agents (ESAs), which help increase the body's production of red blood cells and raise hemoglobin levels.

In the late 2000s, several major clinical trials found that using ESAs at high doses—or to raise hemoglobin to normal levels—in patients with CKD was associated with an increased risk of complications such as stroke. Some studies also found an increased risk of cancer-related complications in people with a history of cancer.

In response to these findings, treatment guidelines for patients with CKD receiving ESA therapy changed. Doctors became more cautious about when to prescribe ESAs and aimed for lower hemoglobin targets rather than trying to return hemoglobin to normal levels.

In the new study, clinician-researcher Dr. Peter Birks and colleagues analyzed the anonymous health records of more than 29,000 people with kidney disease in British Columbia between 2007 and 2018 to examine changes in ESA prescribing and patients' hemoglobin levels over time.

They found that as the use of ESAs among patients with CKD declined from 35 per cent of patients in 2007 to 18 per cent in 2017, patients’ average hemoglobin levels also declined. Among patients who received ESA treatment for the first time during the period being studied, average hemoglobin levels were much lower (below 90 g/L) in 2017 as compared to 2008.

The researchers note that the landmark clinical trials published in the late 2000s led to more cautious use of ESAs. However, they also point out that many people in those studies had multiple health conditions, so the findings may not apply equally to all people with kidney disease. They say more research is needed to determine the best approach to treating anemia while balancing the potential benefits and risks of ESA therapy.