May 27, 2026

Study highlights need for clearer guidance on anemia treatment in kidney disease

Many people with kidney disease also have severe anemia (low hemoglobin in their blood). To treat anemia, health-care providers may prescribe medications called erythropoiesis-stimulating agents (ESAs).

In some patients—including those with a history of stroke or certain cancers—health-care providers may use lower doses of these medications because of concerns about possible risks and complications. However, there are currently no clear guidelines on the best approach in these situations.

A recent survey of health-care providers from across Canada found differences in how ESAs are prescribed to people with kidney disease who have experienced stroke or cancer. The results, published in the Canadian Journal of Kidney Health and Disease, highlight the need for guidelines to manage ESA prescribing in these populations.

In the study, Halifax-based nephrologist and researcher Rammdeep Saini and colleagues surveyed 127 health-care professionals across Canada about their ESA prescribing practices. Most respondents reported using lower hemoglobin targets and lower ESA doses for kidney patients who also had a history of stroke or cancer, compared to patients without these conditions.

Many respondents (84 per cent) said they had prescribed ESAs to patients with kidney disease and a history of stroke, and 41 per cent said they continued prescribing the medications in the period immediately following a stroke.

For kidney patients with active cancer, many health-care providers reported stopping or lowering ESA treatment temporarily, then restarting it once the cancer had been treated or when the focus of care shifted to improving quality of life.

The authors say the wide range of prescribing practices seen in the survey likely reflects a lack of clear evidence and guidance in this area. They note that future studies could help improve anemia management for people living with kidney disease.