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Understanding Anemia of Chronic Kidney Disease (CKD), Chemotherapy Induced Anemia (CIA) and Myelodysplastic Syndromes (MDS)

Anemia is a medical condition characterized by the reduced capacity of the blood to carry oxygen. Patients suffering from anemia may have insufficient levels of or impaired red blood cells and low levels of hemoglobin (Hb), an essential protein in red blood cells responsible for transporting oxygen to cells throughout the body. Anemia is associated with increased risks of hospitalization, cardiovascular complications, the need for blood transfusion, exacerbation of other serious medical conditions, and death. Even in milder forms, anemia can lead to significant fatigue, cognitive dysfunction, and decreased quality of life. The more severe the anemia, the greater the health impact on patients. 

Severe anemia is common in patients with chronic kidney disease (CKD), cancer, myelodysplastic syndromes (MDS), inflammation, and other chronic illnesses and conditions. Despite its prevalence, when anemia develops in association with a disease for which a patient receives separate treatment, the associated anemia is often left untreated.

Anemia is particularly prevalent in patients with CKD, a critical healthcare problem most commonly caused by diabetes and hypertension. CKD affects more than 200 million people worldwide (KDIGO Kidney Int Suppl. 2013:S1–150), and anemia significantly increases medical care costs for those patients. CKD is generally a progressive disease characterized by the gradual loss of kidney function that may eventually lead to kidney failure, also known as end-stage renal disease (ESRD). Patients with ESRD require renal replacement therapy: either dialysis treatment or kidney transplantation. CKD accompanied by anemia is associated with worse health outcomes than CKD alone, including more rapid progression of CKD and increased death rate. 

Although chemotherapy-induced anemia (CIA) is one of the most common side effects of chemotherapy, it is often not recognized and is frequently undertreated. CIA can adversely affect long-term patient outcomes, as the anemic environment may limit the effectiveness of some chemotherapy agents. The incidence and severity of CIA depends on a variety of factors, including the type, schedule, and intensity of therapy administered, or whether the patient has received prior myelosuppressive chemotherapy, radiation therapy, or both. An estimated 30% to 90% of cancer patients receiving chemotherapy develop anemia. Approximately 650,000 cancer patients undergo chemotherapy every year in the United States.

Myelodysplastic syndromes (MDS) are a group of disorders characterized by poorly formed or dysfunctional blood cells, resulting in chronic anemia in most patients. Anemia in MDS patients is associated with increased risk of hospitalization, cardiovascular complication, need for blood transfusion, exacerbation of other serious medical conditions, and death. In addition, anemia frequently leads to significant fatigue, cognitive dysfunction, and decreased quality of life. Currently, there are few options available for treating anemia in MDS. Patients with MDS typically rely on repeated blood transfusions. Further, in most MDS patients in China, anemia is under-treated due to limited blood supply and challenges in accessing transfusions.

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