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CKD Anemia

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29 papers 0 to 25 followers
By Isabel Acosta-Ochoa Nephrology senior staff. Valladolid. Spain
https://www.readbyqxmd.com/read/28328097/markers-of-iron-status-in-chronic-kidney-disease
#1
Adam E Gaweda
Anemia is one of the main comorbidities related to chronic kidney disease (CKD). Until the advent of erythropoiesis stimulating agents (ESA), endogenous erythropoietin deficiency has been thought to be the main culprit of anemia in CKD patients. The use of ESAs has shed new light on the physiology of CKD anemia, where iron homeostasis plays an increasingly important role. Disorders of iron homeostasis occurring in CKD turn the anemia management in those patients into a complex multifactorial therapeutic task, where ESA and Iron dose must be properly balanced to achieve the desired outcome without exposing the patients to the risk of serious adverse events...
March 22, 2017: Hemodialysis International
https://www.readbyqxmd.com/read/28320343/targets-for-adapting-intravenous-iron-dose-in-hemodialysis-a-proof-of-concept-study
#2
N O Peters, N Jay, J Cridlig, G Rostoker, L Frimat
BACKGROUND: Intravenous iron is widely used to control anemia in dialysis patients and limits costs related to erythropoiesis-stimulating agents (ESA). Current guidelines do not clearly set upper limits for serum ferritin (SF) and transferrin saturation (TSAT). International surveys such as the Dialysis Outcomes and Practice Patterns Study (DOPPS) showed that this lack of upper limits potentially led nephrologists to prescribe iron infusions even for patients with a high SF. Recent publications have suggested a risk of short- and long-term adverse effects related to iron overload...
March 20, 2017: BMC Nephrology
https://www.readbyqxmd.com/read/28306566/anemia-management-in-chronic-kidney-disease-and-dialysis-a-narrative-review
#3
David Collister, Claudio Rigatto, Navdeep Tangri
PURPOSE OF REVIEW: This review describes the current state of anemia management with erythropoietin (EPO)-stimulating agents and iron supplementation in both chronic kidney disease and dialysis patients, with a focus on novel therapies. RECENT FINDINGS: We review the benefits and risks of EPO-stimulating agents, focusing on health-related quality of life and the uncertainties regarding optimal iron utilization in patients with kidney disease. We discuss novel therapies for iron supplementation including iron-based phosphate binders and dialysate iron delivery as well as alternatives to EPO-stimulating agents including hypoxia-inducible factor prolyl hydroxylase inhibitors...
March 16, 2017: Current Opinion in Nephrology and Hypertension
https://www.readbyqxmd.com/read/28110585/anemia-in-the-elderly-a-consequence-of-aging
#4
Racha Halawi, Hassan Moukhadder, Ali Taher
Anemia in the elderly is a common finding that is associated with a poorer quality of life, worse outcomes, and increased mortality. While this entity is frequently overlooked, there is often an underlying cause that is correctable. Areas covered: In this review, we shed light on the prevalence of anemia in the elderly population, review the most common causes, particularly iron deficiency anemia and anemia of chronic disease, and describe the available treatment modalities. When a clear etiology for the anemia is ruled-out, the term unexplained anemia may be utilized; while still an under-explored field, one of the underlying pathophysiological mechanisms appears to be associated with an age-related inflammatory process...
January 21, 2017: Expert Review of Hematology
https://www.readbyqxmd.com/read/28063734/safety-of-intravenous-iron-in-hemodialysis-longer-term-comparisons-of-iron-sucrose-versus-sodium-ferric-gluconate-complex
#5
Wolfgang C Winkelmayer, Benjamin A Goldstein, Aya A Mitani, Victoria Y Ding, Medha Airy, Sreedhar Mandayam, Tara I Chang, M Alan Brookhart, Steven Fishbane
BACKGROUND: Controversy exists about any differences in longer-term safety across different intravenous iron formulations routinely used in hemodialysis (HD) patients. We exploited a natural experiment to compare outcomes of patients initiating HD therapy in facilities that predominantly (in ≥90% of their patients) used iron sucrose versus sodium ferric gluconate complex. STUDY DESIGN: Retrospective cohort study of incident HD patients. SETTING & PARTICIPANTS: Using the US Renal Data System, we hard-matched on geographic region and center characteristics HD facilities predominantly using ferric gluconate with similar ones using iron sucrose...
January 4, 2017: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/28049235/the-prevalence-and-management-of-anemia-in-chronic-kidney-disease-patients-result-from-the-korean-cohort-study-for-outcomes-in-patients-with-chronic-kidney-disease-know-ckd
#6
Sang Ryol Ryu, Sue K Park, Ji Yong Jung, Yeong Hoon Kim, Yun Kyu Oh, Tae Hyun Yoo, Suah Sung
Anemia is a common and significant complication of chronic kidney disease (CKD). However, its prevalence and current management status has not been studied thoroughly in Korea. We examined the prevalence of anemia, its association with clinical and laboratory factors, and utilization of iron agents and erythropoiesis stimulating agents using the baseline data from the large-scale CKD cohort in Korea. We defined anemia when hemoglobin level was lower than 13.0 g/dL in males and 12.0 g/dL in females, or received by erythropoiesis stimulating agents...
February 2017: Journal of Korean Medical Science
https://www.readbyqxmd.com/read/27951566/new-strategies-for-anaemia-management-in-chronic-kidney-disease
#7
Francesco Locatelli, Lucia Del Vecchio
Erythropoiesis-stimulating agents (ESAs) and iron therapy are the standard of care for normocytic normochromic anaemia, which is a frequent comorbidity of patients with chronic kidney disease. In a large percentage of patients, ESAs and iron increase haemoglobin levels, thus reducing the risk of blood transfusions and improving patient quality of life. However, randomised trials have raised some concerns about higher haemoglobin targets and/or high ESA dose use. These concerns include higher cardiovascular and thrombosis risk, cancer progression, and increased mortality...
2017: Contributions to Nephrology
https://www.readbyqxmd.com/read/27760419/relationship-between-anemia-and-serum-concentrations-of-calcium-and-phosphorus-in-advanced-non-dialysis-dependent-chronic-kidney-disease
#8
Mauro Boronat, Ángelo Santana, Elvira Bosch, Dionisio Lorenzo, Marta Riaño, César García-Cantón
BACKGROUND/AIMS: Different biochemical abnormalities of metabolic bone disease have been associated with anemia of chronic kidney disease (CKD), mainly in hemodialysis patients. However, all of these abnormalities are closely inter-related and their individual effect on the development of anemia is uncertain. This study was aimed to assess the relationship between anemia and a set of metabolic bone disease biomarkers in a cohort of adult patients with advanced non-dialysis-dependent CKD...
2017: Nephron
https://www.readbyqxmd.com/read/27699922/intravenous-iron-and-erythropoiesis-stimulating-agents-in-haemodialysis-a-systematic-review-and-meta-analysis
#9
S D Roger, M Tio, H C Park, H L Choong, B Goh, T R Cushway, V Stevens, I C Macdougall
AIM: Higher dosages of erythropoiesis-stimulating agents (ESAs) have been associated with adverse effects. Intravenous iron is used to optimise ESA response and reduce ESA doses in haemodialysis patients; this meta-analysis evaluates the magnitude of this effect. METHODS: A literature search was performed using MEDLINE, Embase and the Cochrane Collaboration Central Register of Clinical Trials from inception until December 2014, to identify randomised controlled trials (RCTs) of intravenous iron and ESA, in patients undergoing haemodialysis for end-stage kidney disease...
October 3, 2016: Nephrology
https://www.readbyqxmd.com/read/27650732/vadadustat-a-novel-oral-hif-stabilizer-provides-effective-anemia-treatment-in-nondialysis-dependent-chronic-kidney-disease
#10
Pablo E Pergola, Bruce S Spinowitz, Charlotte S Hartman, Bradley J Maroni, Volker H Haase
Current treatment of anemia in chronic kidney disease (CKD) with erythropoiesis-stimulating agents can lead to substantial hemoglobin oscillations above target range and high levels of circulating erythropoietin. Vadadustat (AKB-6548), a novel, titratable, oral hypoxia-inducible factor prolyl hydroxylase inhibitor induces endogenous erythropoietin synthesis and enhances iron mobilization. In this 20-week, double-blind, randomized, placebo-controlled, phase 2b study, we evaluated the efficacy and safety of once-daily vadadustat in patients with stages 3a to 5 non-dialysis-dependent CKD...
November 2016: Kidney International
https://www.readbyqxmd.com/read/27604984/intravenous-iron-administration-strategies-and-anemia-management-in-hemodialysis-patients
#11
Wieneke M Michels, Bernard G Jaar, Patti L Ephraim, Yang Liu, Dana C Miskulin, Navdeep Tangri, Deidra C Crews, Julia J Scialla, Tariq Shafi, Stephen M Sozio, Karen Bandeen-Roche, Courtney J Cook, Klemens B Meyer, L Ebony Boulware
BACKGROUND: The effect of maintenance intravenous (IV) iron administration on subsequent achievement of anemia management goals and mortality among patients recently initiating hemodialysis is unclear. METHODS: We performed an observational cohort study, in adult incident dialysis patients starting on hemodialysis. We defined IV administration strategies over a 12-week period following a patient's initiation of hemodialysis; all those receiving IV iron at regular intervals were considered maintenance, and all others were considered non-maintenance...
September 6, 2016: Nephrology, Dialysis, Transplantation
https://www.readbyqxmd.com/read/27458564/diabetes-mellitus-increases-the-prevalence-of-anemia-in-patients-with-chronic-kidney-disease-a-nested-case-control-study
#12
Charalampos Loutradis, Alexandra Skodra, Panagiotis Georgianos, Panagiota Tolika, Dimitris Alexandrou, Afroditi Avdelidou, Pantelis A Sarafidis
AIM: To compare anemia prevalence between matched chronic kidney disease (CKD) patients with and without diabetes mellitus (DM) and to assess factors associated with anemia development. METHODS: This is a nested case-control study of 184 type-2 diabetic and 184 non-diabetic CKD patients from a prospectively assembled database of a Nephrology outpatient clinic, matched for gender, age and estimated glomerular filtration rate (eGFR). Prevalence of anemia (hemoglobin: Men: < 13 g/dL, women: < 12 g/dL and/or use of recombinant erythropoietin) was examined in comparison, in the total population and by CKD Stage...
July 6, 2016: World Journal of Nephrology
https://www.readbyqxmd.com/read/27318465/novel-masters-of-erythropoiesis-hypoxia-inducible-factors-and-recent-advances-in-anemia-of-renal-disease
#13
REVIEW
Yalcin Solak, Mustafa Cetiner, Dimitrie Siriopol, Kayhan Tarim, Baris Afsar, Adrian Covic, Mehmet Kanbay
Anemia seen in patients with chronic kidney disease is a particular form of 'anemia of chronic disease'. Although multifactorial in origin, erythropoiesis-stimulating agents (ESAs) and adjuvant iron therapy represent the primary treatment for anemia in chronic kidney disease. Subsequent clinical observations revealed that these ESA hyporesponsive patients often had increased systemic inflammation as a consequence of their comorbidities. Use of high ESA doses to overcome this ESA hyporesponsiveness posed some concerns regarding associated adverse events of therapy and increased mortality in this special patient population...
2016: Blood Purification
https://www.readbyqxmd.com/read/26881842/the-effect-of-erythropoietin-stimulating-agents-on-health-related-quality-of-life-in-anemia-of-chronic-kidney-disease-a-systematic-review-and-meta-analysis
#14
REVIEW
David Collister, Paul Komenda, Brett Hiebert, Ravindi Gunasekara, Yang Xu, Fredrick Eng, Blake Lerner, Kerry Macdonald, Claudio Rigatto, Navdeep Tangri
BACKGROUND: The efficacy of erythropoietin-stimulating agents (ESAs) for improving health-related quality of life (HRQOL) in anemia of chronic kidney disease (CKD) is unclear. PURPOSE: To determine the effect of ESAs on HRQOL at different hemoglobin targets in adults with CKD who were receiving or not receiving dialysis. DATA SOURCES: Searches of PubMed, EMBASE, the Cochrane Library, and ClinicalTrials.gov from inception to 1 November 2015, supplemented with manual screening...
April 5, 2016: Annals of Internal Medicine
https://www.readbyqxmd.com/read/27083270/higher-hemoglobin-levels-and-quality-of-life-in-patients-with-advanced-chronic-kidney-disease-no-longer-a-moving-target
#15
COMMENT
Christina M Wyatt, Tilman B Drueke
International clinical practice guidelines for the management of anemia in chronic kidney disease suggest target hemoglobin levels ≤ 11.5 g/dl (115 g/l), with individualized consideration of slightly higher hemoglobin targets to improve quality of life. An updated meta-analysis of randomized trials demonstrates no significant improvement in quality of life with erythropoietin-stimulating agent therapy targeting higher hemoglobin levels. Limitations of the available data suggest that individualized targets should nonetheless remain an option in future clinical practice guidelines...
May 2016: Kidney International
https://www.readbyqxmd.com/read/26894799/the-safety-of-erythropoiesis-stimulating-agents-for-the-treatment-of-anemia-resulting-from-chronic-kidney-disease
#16
REVIEW
Nicolas Roberto Robles
Chronic kidney disease (CKD) anemia treatment was revolutionized in the late 1980s with the introduction of recombinant human erythropoietin. This and related erythropoiesis-stimulating agents (ESAs) greatly benefited patients by decreasing debilitating symptoms, improving their quality of life, and freeing them from dependence on blood transfusions with their associated complications such as infections, sensitization impeding transplantation, and secondary iron overload. However, even in the initial studies, untoward effects were noted in patients receiving ESAs, including worsening hypertension, seizures, and dialysis access clotting...
June 2016: Clinical Drug Investigation
https://www.readbyqxmd.com/read/26790135/recombinant-human-erythropoietin-versus-placebo-or-no-treatment-for-the-anaemia-of-chronic-kidney-disease-in-people-not-requiring-dialysis
#17
REVIEW
June D Cody, Elisabeth M Hodson
BACKGROUND: Treatment with recombinant human erythropoietin (rHuEPO) in dialysis patients has been shown to be highly effective in terms of correcting anaemia and improving quality of life. There is debate concerning the benefits of rHuEPO use in predialysis patients which may accelerate the deterioration of kidney function. However the opposing view is that if rHuEPO is as effective in predialysis patients, improving the patient's sense of well-being may result in the onset of dialysis being delayed...
2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/26779906/a-prospective-observational-study-of-early-intervention-with-erythropoietin-therapy-and-renal-survival-in-non-dialysis-chronic-kidney-disease-patients-with-anemia-jet-stream-study
#18
MULTICENTER STUDY
Tadao Akizawa, Yoshiharu Tsubakihara, Hideki Hirakata, Yuzo Watanabe, Hiroki Hase, Shinichi Nishi, Tetsuya Babazono, Michiko Kumagai, Shingo Katakura, Yukari Uemura, Yasuo Ohashi
BACKGROUND: There is limited data showing that early treatment for anemia could prolong renal survival in non-dialysis chronic kidney disease (CKD) patients. We therefore investigated the relationship between hemoglobin (Hb) levels at initiation of epoetin beta therapy and renal outcome in non-dialysis CKD patients with anemia. METHODS: In this prospective, multi-center, observational study, non-dialysis CKD patients with anemia who were naïve to erythropoiesis-stimulating agents (ESAs) were divided into three groups based on their Hb levels at initiation of epoetin beta therapy (Group I: 10 ≤ Hb < 11 g/dL, Group II: 9 ≤ Hb < 10 g/dL, and Group III: Hb < 9 g/dL)...
December 2016: Clinical and Experimental Nephrology
https://www.readbyqxmd.com/read/26759045/iron-management-in-chronic-kidney-disease-conclusions-from-a-kidney-disease-improving-global-outcomes-kdigo-controversies-conference
#19
Iain C Macdougall, Andreas J Bircher, Kai-Uwe Eckardt, Gregorio T Obrador, Carol A Pollock, Peter Stenvinkel, Dorine W Swinkels, Christoph Wanner, Günter Weiss, Glenn M Chertow
Before the introduction of erythropoiesis-stimulating agents (ESAs) in 1989, repeated transfusions given to patients with end-stage renal disease caused iron overload, and the need for supplemental iron was rare. However, with the widespread introduction of ESAs, it was recognized that supplemental iron was necessary to optimize hemoglobin response and allow reduction of the ESA dose for economic reasons and recent concerns about ESA safety. Iron supplementation was also found to be more efficacious via intravenous compared to oral administration, and the use of intravenous iron has escalated in recent years...
January 2016: Kidney International
https://www.readbyqxmd.com/read/26763385/diagnosis-and-management-of-iron-deficiency-in-ckd-a-summary-of-the-nice-guideline-recommendations-and-their-rationale
#20
Laura E K Ratcliffe, Wayne Thomas, Jessica Glen, Smita Padhi, Ben A J Pordes, David Wonderling, Roy Connell, Suzanne Stephens, Ashraf I Mikhail, Damian G Fogarty, Jan K Cooper, Belinda Dring, Mark A J Devonald, Chris Brown, Mark E Thomas
The UK-based National Institute for Health and Care Excellence (NICE) has updated its guidance on iron deficiency and anemia management in chronic kidney disease. This report outlines the recommendations regarding iron deficiency and their rationale. Serum ferritin alone or transferrin saturation alone are no longer recommended as diagnostic tests to assess iron deficiency. Red blood cell markers (percentage hypochromic red blood cells, reticulocyte hemoglobin content, or reticulocyte hemoglobin equivalent) are better than ferritin level alone at predicting responsiveness to intravenous iron...
April 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
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