SOTA: The Case for Treating Anemia Earlier in Feline Chronic Kidney Disease (CKD)

Presentation Description / Session Abstract: Anemia associated with feline CKD is well recognised, associated particularly with the more advanced stages of the disease (IRIS CKD stage 4). However, mild reductions in red cell mass are evident in earlier stages (IRIS CKD stages 2 and 3) and are associated with increased risk of progression of CKD. Current guidelines suggest treatment with erythrocyte stimulating agents (ESAs) should begin when haematocrit is below 0.20 l/l. The rationale for selecting this level of red cell mass is that the clinical signs of anemia are evident at this haematocrit and so the benefits of treatment for the animal outweigh the risks of adverse effects of the treatment. As the safety of ESAs becomes better characterised and safer agents are produced, serious consideration should be given to commencing treatment at haematocrit values in the low end of the reference range (0.27 to 0.30 l/l). There are theoretical reasons why starting treatment early may slow progressive kidney injury. With the advent of safer products, the conduct of multi-centre randomised clinical trials to establish their effects on CKD progression is warranted.