Anemia Management in Peritoneal Dialysis: Perspectives From the Asia Pacific Region

ABSTRACT Anemia is an important complication in patients with chronic kidney disease. Peritoneal dialysis (PD) is one of the most common modalities of kidney replacement therapy for end stage kidney disease patients. PD is particularly prevalent in the Asian Pacific region. Among the different countries and regions including mainland China, Hong Kong, Japan, Malaysia, Singapore, South Korea and Thailand, PD accounts for 2.8% to 74.6% of the dialysis population. In addition, 82% to 96% of the PD populations from these countries and regions are on erythropoiesis stimulating agents (ESA). Asian Pacific countries and regions follow the latest KDIGO guidelines for the initiation of treatment of anemia in PD patients. The types of ESAs commonly used include shorter acting (Epoietin alpha and beta) and longer-acting agents including darbepoetin alfa or methoxy polyethylene glycol-epoetin beta. The most commonly used ESAs in Mainland China, Malaysia, Singapore and Thailand are the shorter acting agents, while in Hong Kong, Japan and South Korea longer-acting ESAs are most common. Oral iron therapy is still the most commonly used iron supplement. The route and dosage of iron administration in PD requires more research studies. With the introduction of oral Hypoxia-Inducible Factor Prolyl Hydroxylase Inhibitors into clinical use, the landscape of treatment of anemia in PD population in the Asia Pacific region may change in the coming years.