Condition
Renal Anemia
Renal anemia happens when damaged kidneys make too little erythropoietin, the hormone that tells bone marrow to build red blood cells, leaving people with low hemoglobin, fatigue and breathlessness. Iron has the strongest evidence among supplements, and in dialysis trials a once-monthly drug, peginesatide, kept hemoglobin as steady as epoetin over a year. The supplement research is thinner: a single study of 14 people found L-carnitine made no clear difference to hematocrit.
Sources: PMID 23343061; PMID 11114574
- Supplements studied
- 1
- Medicines and peptides
- 1
- Graded outcomes
- 5
- Trials
- 1
- People studied
- 14
Evidence by supplement
- Strong
- Moderate
- Limited
- Very limited
| Grade | Outcome | Effect | Size | Studies | People | Studies list |
|---|---|---|---|---|---|---|
| Hematocrit No effect | NoneNo effect | 1 study | 14 people | |||
Studies that measured hematocrit | ||||||
| Total Iron Binding Capacity | Improves (the measure goes up) | 14 people | ||||
Prescription medicines and peptides studied, for context
Peginesatide (Omontys)
- Hemoglobin Maintenance (Dialysis)
- Cardiovascular Safety (Non-Dialysis): worsens
- Anaphylaxis Risk: worsens
| Grade | Outcome | Effect | Size | Studies | People | Studies list |
|---|---|---|---|---|---|---|
| Hemoglobin Maintenance (Dialysis) EMERALD 1+2 trials (n=1608): Once-monthly peginesatide noninferior to epoetin (1-3x weekly) for maintaining Hgb 10-12 g/dL over 52+ weeks. Similar mean Hgb levels. Similar transfusion requirements. Approved only for dialysis patients. | NoneNo effect | 8 studies | ||||
| Cardiovascular Safety (Non-Dialysis) SAFETY CONCERN - PEARL trials (n=1066 non-dialysis CKD): Cardiovascular events and mortality INCREASED with peginesatide vs darbepoetin. FDA declined approval for non-dialysis patients. Mechanism unclear - may relate to higher dose requirements. | Worsens (the measure goes down) | Moderate effect | 5 studies | |||
| Anaphylaxis Risk SAFETY CONCERN - DRUG WITHDRAWN: Post-marketing: 0.2% severe allergic reactions, 0.02% fatal anaphylaxis rate. 13 cases of serious hypersensitivity within 30 min of first dose reported. Voluntary worldwide recall February 2013 - 11 months after FDA approval. | Worsens (the measure goes up) | Moderate effect | ||||
| Pure Red Cell Aplasia Treatment Unique application: Effective in anti-EPO antibody-mediated pure red cell aplasia (PRCA) due to no structural homology to EPO. Could stimulate erythropoiesis in heavily transfusion-dependent PRCA patients who failed all recombinant EPO therapies. | Improves (the measure goes up) | Large effect |
Key findings
- Hematocrit
The Renal Anemia (Anemia of Chronic Kidney Disease) Supportive Care protocol
2 primary supplements · 6 supporting supplements
Studies cited
10 studies from PubMed
- Peginesatide to manage anemia in chronic kidney disease patients on peritoneal dialysis
- On peginesatide and anemia treatment in CKD
- Managing dialysis patients who develop anemia caused by chronic kidney disease: focus on peginesatide
- Peginesatide for the treatment of renal disease-induced anemia
- Peginesatide for anemia in patients with chronic kidney disease not receiving dialysis
- Peginesatide in patients with anemia undergoing hemodialysis
- Dose-finding study of peginesatide for anemia correction in chronic kidney disease patients
- Peginesatide: a potential erythropoiesis stimulating agent for the treatment of anemia of chronic renal failure
- Efficacy and safety of Tinospora cordifolia lotion in Sarcoptes scabiei var hominis-infected pediatric patients: A single blind, randomized controlled trial
- Effects of L-carnitine supplementation on renal anemia in poor responders to erythropoietin