Epoietin

BACKGROUND/AIMS: Cardiovascular disease (CVD) is a major cause of mortality in patients with mild to moderate chronic kidney disease (CKD) and end-stage renal disease (ESRD). Dyslipidemia has been established as a well-known traditional risk factor for CVD in the general population and it is well known that patients with CKD exhibit significant alterations in lipoprotein metabolism. In this review the pathogenesis and treatment of renal dyslipidemia are discussed. METHODS: Studies on lipid abnormalities in CKD stages 1-4, in nephrotic syndrome, and in hemodialysis and peritoneal dialysis patients are analyzed, as well as the lipid profile of kidney graft recipients...

OBJECTIVE: Cognitive dysfunction is a potential side effect of chemotherapy, and erythropoietin might be protective. A previously reported study compared quality-of-life in women undergoing chemotherapy for breast cancer who were randomized to receive epoetin-alpha or standard care. Here, we report a non-randomized sub-study in which cognitive function of participants was evaluated at 12-30 months after chemotherapy. METHODS: The primary endpoint was the proportion of women with moderate-severe cognitive impairment, as measured by the High Sensitivity Cognitive Screen (HSCS)...

UNLABELLED: Cancer-related anemia is common and multifactorial in origin. Functional iron deficiency (FID) is now recognized as a cause of iron-restricted erythropoiesis and may be one of the major reasons for lack of response to treatment with Erythropoietic Stimulating Agents (ESAs). Numerous studies have shown that intravenous (IV), but not oral, iron therapy effectively provides sufficient iron for optimal erythropoiesis in anemic patients with chronic renal disease receiving ESA therapy...

No abstract text is available yet for this article.

There are several new erythropoiesis stimulating agents that may potentially improve in the near future the management of anaemia in patients with chronic kidney disease. Some of the new erythropoiesis stimulating agents were synthesised by modification of the aminoacide sequence of the erythropoietin (EPO) molecule and hyperglycosylation and therefore they have improved pharmacokinetics (darbopoietin or CERA) by prolongation of the serum elimination half-life compared to epoietins. These agents may be administered less frequently with better stabilisation of blood haemoglobin concentration...

OBJECTIVE: Anaemia is a common complication of renal failure. It can be treated with erythropoietin (EPO) administration, red blood cell transfusion (RBCT), or a combination of both. EPO has been registered for the treatment of renal anaemia in Sweden since the beginning of the 1990s, and is the primary treatment regimen for anaemia related to renal failure. The objective of this study was to carry out a cost-effectiveness analysis from a provider perspective of a treatment strategy comprising EPO and complementary RBCT compared to the traditional treatment of RBCT alone for patients with anaemia associated with renal failure in Sweden...

BACKGROUND: Epoetin delta, unlike recombinant erythropoietins, is produced in a human cell line and therefore has a human-type glycosylation profile. OBJECTIVES: The pharmacokinetics of epoetin delta were examined in 2 studies in healthy volunteers and 2 studies in patients with chronic kidney disease. METHODS: In study 1, 21 healthy men were randomized to receive epoetin delta 15, 40, or 100 IU/kg IV tiw or placebo for 4 weeks. In study 2, an open-label, cross-over study, 32 healthy volunteers were randomized to receive single doses of epoetin delta 75 IU/kg IV or SC...

PURPOSE: Anemia of critical illness is common among intensive care unit patients. A blood management pilot program was initiated to study the pharmacodynamic response of epoetin alfa in critically ill patients and assess the impact of the use of a standardized order set of pharmaceuticals, including epoetin alfa and intravenous iron sucrose, on the quantity of red blood cell units transfused in the adult intensive care unit. SUMMARY: A pre-printed order set was developed which included baseline and follow-up laboratory monitoring and pharmaceutical options for iron, either intravenous and/or oral, folic acid, ascorbic acid, cyancobalamin, and weight-based epoietin alfa...

BACKGROUND: The topic of this article is the quantitative and semiquantitative assessment of bone marrow signal alteration in magnetic resonance imaging (MRI) of the lumbar spine in patients with tumor anemia during therapy with epoietin beta or placebo. PATIENTS AND METHODS: We examined 32 patients with head or neck cancer (16 epoietin beta, 16 placebo) during radiotherapy in a double-blind multicenter trial. During radiotherapy, the patients underwent epoietin beta therapy for 7-9 weeks...

BACKGROUND: Laboratory abnormalities at the start of treatment of end-stage renal disease (ESRD) have been reported as worse in racial/ethnic minorities than in white patients, suggesting racial disparities in care. It is not known whether these differences are attributable to racial/ethnic differences in socioeconomic status (SES). METHODS: We tested associations between race/ethnicity, SES, and type of medical insurance and serum creatinine level, estimated glomerular filtration rate, serum albumin level, and hematocrit at the start of treatment of ESRD and use of epoietin before ESRD treatment in a large national population-based sample...

BACKGROUND: Nephrogenic systemic fibrosis may be caused by gadolinium (Gd)-containing magnetic resonance imaging contrast agents. Most reported cases were associated with one particular agent, gadodiamide. Yet, unidentified cofactors might explain why only a minority of renal failure patients exposed to gadodiamide develop nephrogenic systemic fibrosis. METHODS: We conducted a case-control study of 19 histologically verified cases and 19 sex- and age-matched controls...

Pure red cell aplasia (PRCA) emerged recently as the potentially life-threatening condition secondary to anti-Epo antibodies. Vast majority of cases were reported from Western European countries and were secondary to subcutaneous injections of Epoietin alpha. Here we describe possibly for the first time in the literature the case of PRCA from Poland or even Central and Eastern Europe in patient treated exclusively with Epoietin beta from multi-dose vial. In the last section of the paper the current epidemiological, diagnostic and therapeutic aspect of PRCA were discussed...

We present a case of a thrombus formation within the left ventricle of a patient with a normal heart, who had previously been receiving high doses of erythropoietin for an inappropriately prolonged period.

OBJECTIVE: Assessment of a pharmacist-run anaemia educational programme for patients with chronic renal insufficiency. SETTING: Nephrology Department, Grenoble Hospital, France. METHOD: A 12-week prospective study, using a before-after intervention design. Included in the study were predialysis outpatients with a haemoglobin level < 10 g/dl, de novo EPO prescription; judged qualified by the nephrologist for self-injections; accepting self-injections...

BACKGROUND: Platelet dysfunction is a well-established disturbance in haemodialysis (HD) patients. Propyl gallate is a synthetic platelet activator with the property to stimulate platelet aggregation. The aim of the present study was to evaluate the influence of a single haemodialysis session on propyl gallate-induced platelet aggregation. METHODS: Thirty-nine HD patients were enrolled in the study and 20 healthy volunteers were studied as controls. Cellulose diacetate (CD) dialysers were used in 20 patients and polysulphone dialysers in 19...

The current implementation into nephrology clinical practice of guidelines on treatment of cardiovascular (CV) risk factors in chronic kidney disease (CKD) is unknown. We designed a cross-sectional analysis to evaluate the prevalence and treatment of eight modifiable CV risk factors in 1058 predialysis CKD patients (stage 3: n=486; stage 4: n=430, stage 5: n=142) followed for at least 1 year in 26 Italian renal clinics. The median nephrology follow-up was 37 months (range: 12-391 months). From stages 3 to 5, hypertension was the main complication (89, 87, and 87%), whereas smoking, high calcium-phosphate product and malnutrition were uncommon...

BACKGROUND: Anemia after heart transplantation is common; however, there are scant data on etiology and treatment. This study evaluates type of anemia and the effects of erythropoietin therapy. METHODS: In 37 anemic heart transplant recipients (31 male/59.1+/-10.3 years/hemoglobin <12.0 g/dl), complete anemia work-up was performed including erythropoietin determination. For three months, 12 anemic patients with renal failure (9 male/64.1+/-13.6 years) were treated with 1-3x4000 IU of epoietin beta/week; treatment endpoints were hemoglobin levels and quality of life as determined by questionnaire...

Treatment of myelodysplastic syndrome (MDS) with epoietin is costly. However, cardiac morbidity associated with anemia has not been investigated in MDS. We studied this aspect in 39 patients. Echocardiography detected cardiac remodeling in 11 of 12 transfusion-dependent versus 13 of 27 transfusion-free patients (P=0.017). Hemoglobin independently indicated cardiac hypertrophy (P=0.004); each unit increase predicted a 49% reduction in the risk of remodeling confirmed by the area under the ROC curve (0.84, P<0...

Cancer in the older person is an increasingly common problem, due to the progressive prolongation of the life-expectancy of the Western population. This article reviews the mechanisms associating aging and cancer, age-related changes in cancer biology, assessment of the older person to estimate life-expectancy, treatment tolerance, and medical and social conditions that may interfere with cancer treatment, effectiveness of cancer prevention and cancer treatment in older individuals. A comprehensive geriatric assessment (CGA) is commonly used to predict life-expectancy and functional reserve and to unearth conditions that may jeopardize cancer prevention and treatment...

The preparation and establishment of the 2nd European Pharmacopoeia (Ph. Eur.) Biological Reference Preparation (BRP) for erythropoietin was the goal of a project run within the framework of the European Biological Standardisation Programme. The project, coded BSP062, was carried out between October 2002 and July 2003. The candidate preparation (cBRP2) was prepared in a similar manner to the first BRP batch (BRP1), as follows: -50:50 (weight/weight) blending of the two erythropoietin preparations currently available on the European market (epoietin-alpha and epoietin-beta), -lyophilisation using a protein-free carrier formulation to allow use of the standard for both biological and physico-chemical assay methods, -each vial contains approximately 250 microg erythropoietin...