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Lost Without Directions: Lessons from the Anemia Debate and the Drive Study

David M. Spiegel^*, and Glenn M. Chertow

^* University of Colorado Denver Health Sciences Center, Division of Renal Diseases and Hypertension, Aurora, Colorado; and Stanford University School of Medicine, Division of Nephrology, Stanford, California

Correspondence: Dr. David M. Spiegel, University of Colorado Denver Health Sciences Center, Division of Renal Diseases and Hypertension, 12700 East 19th Avenue, C281, Aurora, CO 80045. Phone: 303-399-6997; Fax: 303-399-3131; E-mail: david.spiegel{at}ucdenver.edu

Growing concerns related to the potential hazards of erythropoiesis stimulating agents have led to downward adjustment in hemoglobin targets for patients with chronic kidney disease, including patients with ESRD on dialysis. These concerns, coupled with economic pressures and shifting cost structures in dialysis funding, have prompted new strategies directed toward the optimal management of anemia, including the call for more liberal use of intravenous iron (1). This article highlights the limited evidence base in support of alternative anemia management strategies and cautions against the injudicious use of iron in this patient population in the absence of sufficient data on long-term safety.