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Esa hyporesponsiveness

Zhun Sui, Mi Wang, Li Zuo
Erythropoiesis-stimulating agents (ESAs) are frequently used among patients with renal anemia, while a significant proportion of patients exhibit ESA hyporesponsiveness despite adequate dosing. Previous studies have suggested an inverse association between ESA hyporesponsiveness and statin use among patients receiving dialysis therapy. However, studies based on predialysis patients are extremely limited.Based on electronic medical records of a tertiary hospital in Beijing, China between April 2010 and April 2015, we investigated the association between statin use and ESA hyporesponsiveness among patients with predialysis-chronic kidney disease (CKD)...
January 2019: Medicine (Baltimore)
D A El Sewefy, B A Farweez, M A Behairy, N R Yassin
PURPOSE: Anaemia and resistance to erythropoiesis-stimulating agents (ESAs) are common complications in haemodialysis (HD) patients. We investigated the role of hepcidin in the development of anaemia and ESA resistance/hyporesponsiveness and its relation to the plasma levels of the inflammatory markers interleukin 6 (IL-6) and high-sensitivity C-reactive protein (hsCRP). METHODS: This study included 60 maintenance HD patients attending Ain Shams University Hospital and 30 age- and sex-matched healthy subjects as a control group...
January 2, 2019: International Urology and Nephrology
Takahiro Kuragano, Takeshi Nakanishi
Recent large clinical trials have reported that despite the maintenance of target hemoglobin (Hb) levels, higher doses of erythropoiesis-stimulating agents (ESAs) and/or iron preparations are significantly associated with higher risks of adverse events and death in maintenance hemodialysis (MHD) patients. Higher doses of ESAs have been demonstrated to result in a higher risk for cardiovascular disease due to elevated blood pressure or increased thrombogenicity. In addition, a high dose of iron might enhance inflammatory responses to infection and impair the phagocytic function of neutrophils...
2018: Contributions to Nephrology
Ari H Pollack, Assaf P Oron, Joseph T Flynn, Raj Munshi
BACKGROUND: Erythropoietin-stimulating agent hyporesponsiveness (ESAH) is associated with increased cardiovascular mortality in patients with end-stage renal disease (ESRD) on hemodialysis. Dynamic treatment regimes (DTR), a clinical decision support (CDS) tool that guides the prescription of specific therapies in response to variations in patient states, have been used to guide treatment for chronic illnesses that require frequent monitoring and therapy changes. Our objective is to explore the role of utilizing a DTR to reduce ESAH in pediatric hemodialysis patients...
August 2018: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
Ala Ali, Riyadh M Salih
Anemia is common in patients on hemodialysis (HD). Adequate iron stores are essential for achieving the best hemoglobin level through maximum benefit from erythropoiesis-stimulating agents (ESA). Decreased iron stores or decreased availability of iron are the most common reasons for resistance to the effect of these agents. Our objective was to categorize a group of Iraqi HD patients according to absolute or functional iron deficiency anemia (IDA); this study was conducted in the HD unit of the Baghdad Teaching Hospital from October 2012 to January 2013...
January 2018: Saudi Journal of Kidney Diseases and Transplantation
Masaomi Nangaku
Chronic kidney disease leads to dysfunction of renal erythropoietin-producing cells, resulting in a decrease in erythrocyte production. A decrease in oxygen delivery to vital organs due to anemia results in worse quality of life and is associated with poor prognosis of the patients. Treatment with human recombinant erythropoietin or its improved version of erythropoiesis-stimulating agent (ESA) with a longer half-life is effective. However, some patients show hyporesponsiveness to ESA. Hyporesponsiveness to ESA, which can be induced by factors such as inflammation and uremic toxins, is associated with poor prognosis...
2017: [Rinshō Ketsueki] the Japanese Journal of Clinical Hematology
Hideki Kato, Masaomi Nangaku, Hideki Hirakata, Takashi Wada, Terumasa Hayashi, Hiroshi Sato, Yasushi Yamazaki, Takao Masaki, Tatsuo Kagimura, Hiroyasu Yamamoto, Hiroki Hase, Masahiro Kamouchi, Enyu Imai, Kyoichi Mizuno, Manabu Iwasaki, Tadao Akizawa, Yoshiharu Tsubakihara, Shoichi Maruyama, Ichiei Narita
BACKGROUND: Renal anemia is an important complication in non-dialysis chronic kidney disease (CKD) patients as well as in dialysis patients. Although recombinant human erythropoietin has dramatically improved prognosis and quality of life in these patients, there have been issues among non-dialysis CKD patients who exhibit hyporesponsiveness to erythropoiesis-stimulating agent (ESA). The causes and definition of ESA hyporesponsiveness, as well as the incidence of renal and cardiovascular disease (CVD) events in such patients, are yet to be clarified...
February 2018: Clinical and Experimental Nephrology
Takeshi Hasegawa, Junhui Zhao, Douglas S Fuller, Brian Bieber, Jarcy Zee, Hal Morgenstern, Norio Hanafusa, Masaomi Nangaku
BACKGROUND: Hypothesizing that statins may be useful as adjuvant treatment for renal anemia, we examined the association between statin prescription (Rx) and erythropoiesis-stimulating agent (ESA) hyporesponsiveness in Japanese hemodialysis (HD) patients prescribed ESAs. METHODS: We examined 3,602 patients in 60 HD facilities dialyzed 3 times/week for ≥4 months from the Japan Dialysis Outcomes and Practice Patterns Study phases 3-5 (2005-2015). Statin Rx was reported at the end of a 4-month interval (baseline) for each patient...
2017: American Journal of Nephrology
Soichiro Nagata, Naoki Ikegaya, Shuhei Ogino, Shinichi Uchida, Mikiko Itaya, Aoi Momita, Shingo Shinozaki, Masaharu Ohura, Ken Kuriki, Satoshi Kono, Hiroaki Miyajima, Akira Hishida
We herein report the case of a hemodialysis patient whose response to an erythropoiesis-stimulating agent (ESA) improved following the resection of thyroid cancer. Her hemoglobin level remained below 7 g/dL, despite the use of ESA. During the search for the causes of her hyporesponsiveness to ESA, papillary thyroid cancer and aceruloplasminemia were found. The existence of other potential causes, such as iron deficiency, infectious disease, severe hyperparathyroidism and malnutrition were ruled out. Following the resection of the thyroid cancer tumor, her hemoglobin level increased to 10...
2017: Internal Medicine
Gabriela Cobo, Paloma Gallar, Cristina Di Gioia, Concepción García Lacalle, Rosa Camacho, Isabel Rodriguez, Olimpia Ortega, Carmen Mon, Ana Vigil, Bengt Lindholm, Juan Jesús Carrero
BACKGROUND: Testosterone deficiency (hypogonadism) is common among men undergoing haemodialysis, but its clinical implications are not well characterized. Testosterone is an anabolic hormone that induces erythrocytosis and muscle synthesis. We hypothesized that testosterone deficiency would be associated with low muscle mass, physical inactivity and higher dosages of erythropoietin-stimulating agents (ESA). METHODS: Single-center cross-sectional study of 57 male haemodialysis patients...
January 2017: Nefrología: Publicación Oficial de la Sociedad Española Nefrologia
Jiacong Luo, Donna E Jensen, Bradley J Maroni, Steven M Brunelli
BACKGROUND: Hemodialysis patients with erythropoiesis-stimulating agent (ESA) hyporesponsiveness have been a topic of active research. However, there have been no studies of ESA hyporesponsiveness among US patients following the dramatic change in anemia management that resulted from the 2011 changes in ESA product labeling and bundling of dialysis remuneration. STUDY DESIGN: Retrospective observational study. SETTING & PARTICIPANTS: We studied prevalent hemodialysis patients treated at a large dialysis organization in calendar years 2012 to 2013 (N=98,972)...
November 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Takatoshi Kakuta, Hirotaka Komaba, Nobuyoshi Takagi, Yuichiro Takahashi, Hajime Suzuki, Toru Hyodo, Mikako Nagaoka, Reika Tanaka, Soichiro Iwao, Mari Ishida, Hiroyuki Kobayashi, Akira Saito, Masafumi Fukagawa
We compared interleukin-6 (IL-6) removal and induction between conventional polysulfone (Con) and TORAYLIGHT NV (NV) dialyzers in hemodialysis patients. Twenty patients on Con with high IL-6 concentrations (2.7-8.5 pg/mL) were randomized to Con or NV group. Dialyzer performance was determined in NV group while patients were on Con and after being switched onto NV. Erythropoiesis-stimulating agent (ESA) response index (ERI) was assessed every 4 months for one year. IL-6 clearance was comparable between Con and NV...
December 2016: Therapeutic Apheresis and Dialysis
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
Kazuhiko Tsuruya, Yukari Uemura, Hideki Hirakata, Takanari Kitazono, Yoshiharu Tsubakihara, Masashi Suzuki, Yasuo Ohashi
AIM: The association between responsiveness to continuous erythropoietin-receptor activator (CERA) and renal survival in patients with non-dialysis-dependent chronic kidney disease (NDD-CKD) is uncertain. METHODS: We performed a pooled analysis of individual patient-level data drawn from five clinical trials involving CERA administration. Based on the responsiveness to CERA, patients were classified into poor- or good-response groups. Primary endpoints were defined as the initiation of dialysis or a 30% decrease in the estimated glomerular filtration rate (eGFR) from baseline...
October 2017: Nephrology
Joel Gummer, Robert Trengove, Elaine M Pascoe, Sunil V Badve, Alan Cass, Philip Clarke, Stephen P McDonald, Alicia T Morrish, Eugenie Pedagogos, Vlado Perkovic, Donna Reidlinger, Anish Scaria, Rowan Walker, Liza A Vergara, Carmel M Hawley, David W Johnson, John K Olynyk, Paolo Ferrari
BACKGROUND: Pentoxifylline has been shown to increase haemoglobin levels in patients with chronic kidney disease (CKD) and erythropoietin-stimulating agent (ESA)-hyporesponsive anaemia in the Handling Erythropoietin Resistance with Oxpentifylline multicentre double-blind, randomized controlled trial. The present sub-study evaluated the effects of pentoxifylline on the iron-regulatory hormone hepcidin in patients with ESA-hyporesponsive CKD. METHODS: This sub-study included 13 patients in the pentoxifylline arm (400 mg daily) and 13 in the matched placebo arm...
July 2017: Nephrology
Takahiro Kuragano, Kenichiro Kitamura, Osamu Matsumura, Akihiko Matsuda, Taiga Hara, Hideyasu Kiyomoto, Toshiaki Murata, Shouichi Fujimoto, Hiroki Hase, Nobuhiko Joki, Atushi Fukatsu, Toru Inoue, Yukihiro Itakura, Takeshi Nakanishi
OBJECTIVE: It has been reported that hyporesponsiveness to erythropoiesis-stimulating agent (ESA) is associated with adverse events in patients on maintenance hemodialysis (MHD). However, it has not been determined whether higher iron storage is associated with an improved response, including better survival, to ESA. DESIGN AND METHOD: We measured serum ferritin, hemoglobin (Hb), and transferrin saturation (TSAT) levels every three months for two years in 1,095 MHD patients...
2016: PloS One
Dilek Güven Taymez, Esma Ucar, Kultigin Turkmen, Ramazan Ucar, Baris Afsar, Abduzhappar Gaipov, Suleyman Turk
The most important cause of anemia in CKD is relative deficiency of erythropoietin (EPO) secretion from the diseased kidney and EPO therapy has become the standard treatment for anemia of CKD. However, some patients do not respond well to erythropoiesis stimulating agent (ESA), so-called ESA resistance. One of the most important causes of ESA resistance is chronic inflammation in hemodialysis (HD) patients. ESA hyporesponsiveness index (EHRI), calculated as the weekly dose of EPO divided by kilograms of body weight divided by the hemoglobin level, and has been considered useful to assess the EPO resistance...
April 2016: Therapeutic Apheresis and Dialysis
Shinji Tanaka, Tetsuhiro Tanaka
Iron deficiency is a major cause of hyporesponsiveness to erythropoiesis-stimulating agents (ESAs) and is often observed in chronic kidney disease (CKD) patients with anemia. With iron supplementation, ESA doses can be decreased, resulting in lower treatment costs and possibly lower cardiovascular risks that are associated with high-dose ESA therapy. The 2012 Kidney Disease: Improving Global Outcomes Guideline specified ferritin ≤ 500 ng/ml and transferrin saturation (TSAT) ≤ 30% as thresholds of iron parameters for CKD patients...
2015: Nephron
Miho Kimachi, Shingo Fukuma, Shin Yamazaki, Yosuke Yamamoto, Tadao Akizawa, Takashi Akiba, Akira Saito, Shunichi Fukuhara
BACKGROUND: Hemodialysis (HD) patients occasionally experience minor asymptomatic elevation in C-reactive protein (CRP) levels, which may be associated with difficulty in managing renal anemia using erythropoiesis-stimulating agents (ESAs). Here, we assessed whether elevation of CRP predicts future incidences of ESA hyporesponsiveness. METHODS: A total of 2,956 HD patients lacking ESA hyporesponsiveness and infectious diseases were enrolled, and the association between CRP levels and incidence of ESA hyporesponsiveness was assessed...
2015: Nephron
Scott P Sibbel, Carol E Koro, Steven M Brunelli, Alexander R Cobitz
BACKGROUND: Some patients with chronic kidney disease do not respond adequately to erythropoiesis-stimulating agent (ESA) treatment; these patients are referred to as ESA hyporesponders. There is no widely accepted contemporary definition for chronic ESA hyporesponse. The study objective was to propose and validate an operational definition for chronic ESA hyporesponse. METHODS: This was a retrospective cohort study using electronic health care records. Participants were anemic hemodialysis patients treated during February 2012 and were followed for 15 months...
August 18, 2015: BMC Nephrology
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