VIDEO: Inflammation, socioeconomic barriers major challenges of anemia care

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Within my particular specialty of nephrology and chronic kidney disease, I would probably say that there's two, number one again, relates to what I spoke to you about and that's the role of inflammation and hepcidin. So as I said, many of our patients with chronic kidney disease are inflamed. They may be inflamed from the chronic kidney disease itself or they may be inflamed from the comorbidities that often accompany chronic kidney disease. Diabetes, for instance, may not only be inflammatory on its own, but many patients who have microvascular disease from their diabetes, they may have leg ulcers that are inflamed, et cetera, or patients who have other comorbidities like heart failure, et cetera, can have a sufficient level of inflammation that it stimulates the hepcidin and again, paralyzes the absorption and transport of iron to the bone marrow. So even if you give plenty of oral iron to these patients or plenty of erythropoietin stimulating agents to these patients, you just can't get enough iron to the bone marrow to support red cell production and therefore you ultimately fail in raising the hemoglobin which of course is your therapeutic goal in treating a patient with anemia. So that's a very challenging group of patients. Sometimes giving them intravenous iron to a certain extent overcomes part of that blockade in terms of iron absorption from the GI tract and may promote more iron delivered to the bone marrow. But it's often a losing battle, especially if the patients have a very high degree of inflammation. So that would be one group.

The other group in patients with chronic kidney disease who are not yet on dialysis is socioeconomic impairment, patients who don't have good insurance, patients who don't have transportation to a healthcare provider, patients who may not have the resources, whatever they may be to get to a doctor to get the diagnosis of anemia and then get the proper treatment for anemia. So it can be very, very frustrating not only for the patient, but also for the provider who has the best of intentions in terms of improving the quality of life of these patients with symptoms that patients with anemia get. But you like to feel that the patient is benefiting from whatever treatment you're giving in terms of the improved quality of life. And yet because of a variety of socioeconomic barriers, they can't get the treatment and ultimately they don't benefit from our intentions to raise their hemoglobin level and improve their functional status.