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      Erythropoietin Therapy in Pre-Dialysis Patients with Chronic Renal Failure: Lack of Need for Parenteral Iron

      a , b

      American Journal of Nephrology

      S. Karger AG

      Kidney failure, Chronic, Anemia, Erythropoietin, Recombinant

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          Abstract

          Background: During erythropoietin therapy, scant information exists regarding the optimal target percent saturation of transferrin (TSAT), ferritin and the mode and amount of iron supplementation in pre-dialysis patients with anemia due to chronic kidney disease (CKD). Hypothesis: Pre-dialysis CKD patients may have different needs for iron supplementation than end-stage renal disease subjects during erythropoietin therapy. Methods: Retrospective analysis of pre-dialysis CKD subjects (n = 31) treated with erythropoietin at our institution. Results: In this population our results showed that target hematocrit (33–36%) was achievable with erythropoietin (mean subcutaneous dose 86 ± 17 [SD] units/kg/week) without parenteral iron therapy. The hematocrit increased from a mean baseline value of 28.4 ± 2.7 to 33.6 ± 3.4% at time 1 (4–9 weeks, p < 0.0001), and to 37.7 ± 4.5% at time 2 (10–20 weeks, p < 0.0001). The hemoglobin concentration increased from 9 ± 0.9 g/dl at baseline to 10.7 ± 1.1 g/dl at time 1 (p < 0.0001) and to 12 ± 1.5 g/dl at time 2 (p < 0.0001). Subgroup analyses of patients prescribed <200 mg oral elemental iron per day (n = 10), those with TSAT <20% and/or ferritin <100 ng/ml (n = 19), and those prescribed erythropoietin <80 units/kg/week (n = 12), all showed a significant increase in hematocrit and hemoglobin. Conclusions: Our data show that pre-dialysis CKD subjects respond adequately to erythropoietin at or lower than recommended erythropoietin doses without parenteral iron. This response extends even to subgroups with TSAT and/or ferritin levels deemed to indicate iron deficiency in CKD subjects, and may be due to lack of existence of functional iron deficiency in this group of patients.

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          Most cited references 4

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          Inflammation, not hyperhomocysteinemia, is related to oxidative stress and hemostatic and endothelial dysfunction in uremia

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            C-Reactive Protein as a Marker of Chronic Inflammation in Uremic Patients

            Cardiovascular complications caused by an accelerated atherosclerotic disease represent the largest single cause of mortality in chronic renal failure patients. The rapidly developing atherosclerosis of the uremic syndrome appears to be caused by a synergism of different mechanisms, such as malnutrition, oxidative stress and genetic factors. Recent studies provide evidence that chronic inflammation plays an important role in the pathogenesis of cardiovascular diseases. Elevated serum levels of plasma C-reactive protein (CRP) are associated with an increased risk of experiencing myocardial infarction and sudden cardiac death in apparently healthy subjects. Several recently published papers have confirmed this strong association between CRP and the extent and severity of the atherosclerotic processes. In patients affected by predialytic renal failure, increased levels of CRP and interleukin (IL)-6 were recorded in 25% of our population; CRP and IL-6 were inversely related with renal function. These data suggest the activation – even in the predialytic phase of renal failure – of mechanisms known to contribute to the enhanced cardiovascular morbidity and mortality of the uremic syndrome. In recent years we have investigated the hypothesis that the chronic inflammatory state of the uremic patient could at least in part be due to the dialytic technique. We provide evidence suggesting that the increase of CRP in stable dialytic patients may be due to the stimulation of monocyte/macrophage by backfiltration of dialysate contaminants.
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              Factors determining the percentage of hypochromic red blood cells in hemodialysis patients

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                Author and article information

                Journal
                AJN
                Am J Nephrol
                10.1159/issn.0250-8095
                American Journal of Nephrology
                S. Karger AG
                0250-8095
                1421-9670
                2003
                April 2003
                17 January 2003
                : 23
                : 2
                : 78-85
                Affiliations
                aNephrology Section, Harry S. Truman Memorial Veterans’ Hospital, and bPost-Doctoral fellow, Division of Nephrology, University of Missouri-Columbia, Columbia, Mo., USA
                Article
                68033 Am J Nephrol 2003;23:78–85
                10.1159/000068033
                12481145
                © 2003 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                Page count
                Figures: 3, Tables: 2, References: 34, Pages: 8
                Product
                Self URI (application/pdf): https://www.karger.com/Article/Pdf/68033
                Categories
                Original Article: Patient-Oriented, Translational Research

                Cardiovascular Medicine, Nephrology

                Kidney failure, Recombinant, Erythropoietin, Anemia, Chronic

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