AllMed Webinar Helps Health Plans Determine Medical Necessity Of ESAs In The Treatment Of Chronic Kidney Disease

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AllMed webinar provides in-depth review of the latest standard of care for the use of ESAs in the treatment of Chronic Kidney Disease.

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Many healthcare plans cover ESAs for the treatment of CKD when specific criteria are met. This may change, however, as some studies have suggested that ESAs may increase the risk of potentially life-threatening complications

The use of ESAs to treat anemia of CKD can improve quality of life and may eliminate the need for blood transfusion and associated risks, but not without controversy. During a recent AllMed webinar, Dr. Zanhua Yi, board certified in hematology, oncology, and internal medicine, discussed issues related to determining medical necessity of erythropoiesis-stimulating agents (ESAs) in the treatment of anemia of chronic kidney disease (CKD).

The U.S. Food and Drug Administration (FDA) has approved three ESAs for the treatment of anemia due to CKD. In 2011, the FDA issued a safety announcement with modified recommendations for more conservative dosing of ESAs. Dr. Yi said that these recommendations were based on data showing increased risk of cardiovascular events with ESAs. The FDA modified dosing recommendations also state that physicians and patients with CKD should weigh the benefits of ESAs to decrease the need for transfusions against the increased risks for serious adverse cardiovascular events.

Many healthcare plans cover ESAs for the treatment of CKD when specific criteria are met. “This may change, however,” said Dr. Yi, “as some studies have suggested that ESAs may increase the risk of potentially life-threatening complications.” This has resulted in a shift toward a more cautious approach to prescribing ESAs for patients with anemia of CKD. This makes it essential for healthcare plans to position themselves to be able to make timely updates to their coverage criteria and medical policies in order to optimize care and treatment outcomes.

Dr. Yi gave an overview of anemia of CKD, including the factors that likely contribute to anemia of CKD. He noted that the most important contributing cause is erythropoietin (EPO) deficiency. As renal disease progresses, the specialized cells that produce EPO are partially or completely depleted/injured. While CKD may cause obvious symptoms, the anemia itself is often associated with nonspecific symptoms. A number of laboratory tests are vital in the evaluation of anemia of CKD, including RBC indices, peripheral blood smear, reticulocyte count, and bone marrow biopsy, which is optional in most cases. There are also numerous laboratory tests to eliminate other common causes of anemia.

Dr. Yi reviewed the primary therapeutic options for anemia of CKD, which include RBC transfusions, ESAs, and, much less commonly, androgens. Red blood cell transfusions often can ameliorate symptoms and improve health-related quality of life, but they may be associated with significant complications. Although androgens were used regularly in the treatment of anemia in dialysis patients, they require intramuscular injection and carry the potential for numerous side effects. Currently, ESAs are the preferred initial form of therapy for anemia of CKD. These agents reduce the need for red cell transfusions, but the potential benefits of reducing blood transfusions and anemia-related symptoms should be balanced against the potential for serious side effects, such as stroke, vascular access loss, and hypertension.

About AllMed
AllMed Healthcare Management provides physician review outsourcing solutions to leading health plans, medical management organizations, TPAs and integrated health systems, nationwide. AllMed offers MedReview(sm), MedCert(sm), and MedDirector(sm) staffing services that cover initial pre-authorizations and both internal and external appeals, drawing on a panel of over 400 board-certified specialists in all areas of medicine. Services are deployed through PeerPoint(R), AllMed's state-of-the-art medical review portal. For more information on how AllMed can help your organization improve the quality and integrity of healthcare, contact us today at info(at)allmedmd(dot)com, or visit us at

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Kiki Grant
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