Table 2.

Advantages and disadvantages of therapies for anemia of chronic kidney disease

Anemia treatment	Advantages	Disadvantages
Oral iron	•Oral agent, so patient may self-administer at home	•Decreased efficacy relative to i.v. iron in dialysis patients5 •Gastrointestinal adverse effects5 •Variable gastrointestinal absorption5
i.v. Iron	•Increased efficacy relative to oral iron5	•Administration is typically performed at a center •Doses must be managed to avoid iron overload and systemic inflammation63
Short-acting ESAs	•May reduce fatigue and improve HRQOL64 •Reduced need for RBC transfusions65	•Administration is typically performed at a center •Frequent (3-times-weekly) administration •Supplemental iron is often needed5 •Higher doses to reach Hb targets may increase risk of adverse CV outcomes64
Long-acting ESAs	•May reduce fatigue and improve HRQOL64 •Reduced need for RBC transfusions66 •Potentially more cost-effective than short-acting ESAs64,67	•Administration is typically performed at a center •Supplemental iron is often needed5 •Higher doses to reach Hb targets may increase risk of adverse CV outcomes64 •May increase risk of mortality compared with short-acting ESAs68
Red blood cell transfusion	•An alternative for patients in whom ESAs are ineffective5	•Administration is performed at a center •Adverse events such as allosensitization, blood volume overload, blood-borne infections, fever, hyperkalemia, iron overload5
HIF-PH inhibitors	•Oral agent, so patient may self-administer at home •Noninferior to ESAs in raising or maintaining Hb levels62,69,70 •May reduce need for supplemental iron71	•Long-term safety data needed

CV, cardiovascular; ESA, erythropoiesis-stimulating agent; Hb, hemoglobin; HIF-PH, hypoxia-inducible factor-prolyl hydroxylase; HRQOL, health-related quality of life; RBC, red blood cell.