Health experts warn against the non-judicious use of erythropoiesis-stimulating agents (ESA) for chronic kidney patients, as clinical trials have revealed that the patients are far better off without the use of ESA. Even though leading health institutions around the world, including the American Society of Nephrology, reject non-judicious ESA use as an “unsafe medical practice”, many doctors in India continue to use ESAs for patients with kidney disease. ESAs not only drain a patient’s health, but also the hard-earned money, it doctors have stated.
A senior nephrologist explains: “Its over use is probably pharma company or physician-driven, as a patient spends between Rs 1200 and Rs 5000 every week on ESAs” In its latest guidelines for kidney doctors, the American Board of Internal Medicine points out: “ESAs have no survival or cardiovascular disease benefit and may be harmful. They should be used to maintain haemoglobin at lowest levels that minimise need for transfusion.”
Referring to the new American guidelines, Dr Mohammad Rafay, kidney specialist at Apollo Hospitals, Hyderabad, said they were more relevant in the Indian context. The use of ESA should be re-examined by all nephrologists and each prescription should be tailored to individual patient needs. Moreover, non-steroidal anti-inflammatory drugs (NSAIDS) should not be used for patients with hypertension or heart failure or chronic kidney disease of all causes, including diabetes, he said.
Dr Rafay warns that the use of NSAIDS can raise blood pressure, make anti-hypertensive drugs less effective, cause fluid retention and worsen kidney function. In his view, it is not safe to perform routine cancer screening for dialysis patients with limited life expectancies unless they are transplant candidates. It does not improve survival chances. As dialysis therapy is more readily available now, more patients are going for dialysis therapy than in the past.