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Hemoglobin variability hyporesponsiveness

Lucia Del Vecchio, Francesco Locatelli
Following the publication of the TREAT study, the treatment of anemia in patients with chronic kidney disease (CKD) has become much more complicated than before. The nephrologist needs to analyze the individual patient and prescribe the best treatment option for that patient. Treatment individualization has thus become the mainstay of anemia management. This paradigm needs to take into account the hemoglobin (Hb) level at the start and during erythropoiesis-stimulating agent (ESA) therapy, ESA dose, patient comorbidities and concomitant iron therapy...
2013: Blood Purification
Baris Afsar
INTRODUCTION: Resistance to erythropoietin (EPO) treatment has been associated with inflammation and malnutrition in hemodialysis (HD) patients. Depression has also been associated with both inflammation and malnutrition; however, the specific relationship between depressive symptoms and EPO resistance is not known. In the current study, the relationship between depressive symptoms and EPO resistance as evaluated by erythropoiesis stimulating agent (ESA) hyporesponsiveness index (EHRI) was analyzed...
May 17, 2013: International Journal of Artificial Organs
Jacques B Rottembourg, Aurélie Dansaert
Darbepoetin alfa is a recombinant erythropoiesis-stimulating agent, with a longer half-life leaving the possibility to extending dosing administration in haemodialysis patients. A protocol of injection every 2weeks was initiated in the dialysis unit. From 2005 to 2007, 176 dialysis patients were studied with a target haemoglobin level between 11 and 12.5g/dL: the median haemoglobin level was ranged from 11.32 and 11.72g/dL during the study with a median darbepoetin alfa dose injected between 60 and 64μg per injection (0...
December 2011: Néphrologie & Thérapeutique
Kamyar Kalantar-Zadeh, Grace H Lee, Jessica E Miller, Elani Streja, Jennie Jing, John A Robertson, Csaba P Kovesdy
BACKGROUND: Identification of predictors of hyporesponsiveness to erythropoietin-stimulating agents (ESAs) in hemodialysis (HD) patients may help improve anemia management and reduce hemoglobin level variability. STUDY DESIGN: We conducted repeated-measure and logistic regression analyses in a retrospective cohort of long-term HD patients to examine the association of iron markers and measures of renal osteodystrophy with ESA responsiveness. The ESA response coefficient at the individual level, ie, the least confounded dose-response association, was separated from the population level, assumed to represent confounding by medical indication...
May 2009: American Journal of Kidney Diseases
Kamyar Kalantar-Zadeh, Elani Streja, Jessica E Miller, Allen R Nissenson
Patients with chronic kidney disease (CKD), especially those requiring maintenance hemodialysis treatments, may lose up to 3 g of iron each year because of frequent blood losses. Higher doses of erythropoiesis-stimulating agents (ESAs) may worsen iron depletion and lead to an increased platelet count (thrombocytosis), ESA hyporesponsiveness, and hemoglobin variability. Hence, ESA therapy requires concurrent iron supplementation. Traditional iron markers such as serum ferritin and transferrin saturation ratio (TSAT) (ie, serum iron divided by total iron-binding capacity [TIBC]), may be confounded by non-iron-related conditions...
March 2009: Advances in Chronic Kidney Disease
Jerry Yee, Gerard Zasuwa, Stanley Frinak, Anatole Besarab
Hemoglobin (Hb) variability is considered a discrete clinical entity that when present may presage poor clinical outcomes. However, Hb variability is an intrinsic property of biological systems and is present in all patients, those with and without the anemia of chronic kidney disease. Taken together, variability actually represents the integration of multiple influences at multiple levels in the life of a red cell, namely the summation of positive and negative influences on erythropoiesis. Thus, Hb variability may be interpreted as a mathematic function of time and is the result of a host of influences including definition of the normal Hb range, native erythron responsiveness/hyporesponsiveness, temporal changes in endogenous and exogenous erythropoiesis-stimulating agent (ESA) levels, the algorithms used to dose ESAs and their duration of action, the presence of biologically available iron, red cell turnover, and recyclable and non-recyclable blood loss and gain...
March 2009: Advances in Chronic Kidney Disease
Angela D Ferguson, Hisham Dokainish, Nasser Lakkis
Antiplatelet resistance has been proposed as a possible mechanism to explain recurrent cardiovascular events in patients who have coronary artery disease and who are undergoing dual antiplatelet therapy. A comprehensive search on PubMed was conducted for literature that was printed in the English language between January 1996 and November 2007 on aspirin and clopidogrel resistance. Significant traits for aspirin hyporesponsiveness were female sex, older age, and lower levels of hemoglobin. Diabetes mellitus and elevated body mass index showed trends toward a higher incidence of resistance in some aspirin trials but did not reach statistical significance...
2008: Texas Heart Institute Journal
Jérôme Rossert, Cristiana Gassmann-Mayer, Dieter Frei, William McClellan
BACKGROUND: The required erythropoiesis-stimulating agent (ESA) dose varies when correcting anaemia in chronic kidney disease (CKD) patients. This analysis was performed to identify the prevalence of and factors associated with ESA hyporesponsiveness. METHODS: This analysis was a post hoc evaluation of epoetin alfa dosage requirements in a subgroup of patients from the Effect of early Correction of Anemia on the Progression of CKD study. The patients in this subgroup were randomly assigned to the high haemoglobin target group (14-15 g/dl for men and 13-14 g/dl for women) and completed a 4-month haemoglobin stabilization phase with complete epoetin dosage data...
March 2007: Nephrology, Dialysis, Transplantation
A Gascón, R Virto, L M Lou, R Pernaute, R Moreno, J Pérez, M J Aladrén, B Moragrega, E Castillón, R Gómez, P J Vives, R Alvarez, F J García, J Castilla, J A Gutiérrez Colón
Patients receiving recombinant human erythropoietin (rHuEPO) therapy show wide variability in their responsiveness to the drug. Variables that affect rHuEPO dose requirements can be broadly divided into modificable and immutable characteristics. Most of the scientific research on rHuEPO hyporesponsiveness has focused on modificable variables (iron status, dialysis adequacy), while immutable variables such as gender, etiology of chronic renal failure (CRF) and age have been insufficiently explored. A cross sectional study was performed in order to evaluate if immutable patient characteristics determine rHuEPO dose requirements among 215 patients (52% males; mean age 66 +/- 14 years) on hemodialysis (HD) for more than twelve months...
2005: Nefrología: Publicación Oficial de la Sociedad Española Nefrologia
M Martone, R Zanchi, G Panzetta
BACKGROUND: Chronic inflammation is a well-known cause of hyporesponsiveness of the bone marrow to erythropoietin (Epo). Factors which contribute to Epo resistance in the presence of inflammation include inhibition of erythroid precursor proliferation and functional iron deficiency induced by inflammatory cytokines. The specific role of iron deficiency in this clinical context, however, has not yet been clarified. METHODS: Our dialysis population consisted of 200 patients, from which 163 (91 males, mean age 67 +/- 12 years) who had been in dialysis for at least 4 (mean 62...
January 2003: Giornale Italiano di Nefrologia: Organo Ufficiale Della Società Italiana di Nefrologia
N Tessitore, G P Solero, G Lippi, A Bassi, G B Faccini, V Bedogna, L Gammaro, G Brocco, G Restivo, P Bernich, A Lupo, G Maschio
BACKGROUND: Iron deficiency (ID) is the main cause of hyporesponsiveness to erythropoietin in haemodialysis patients and its detection is of value since it is easily corrected by intravenous iron. Markers of iron supply to the erythron, including erythrocyte zinc protoporphyrin (Er-ZPP), percentage of hypochromic erythrocytes (Hypo), reticulocyte haemoglobin content (CHr) and soluble transferrin receptor (sTfR), may be more accurate predictors of ID than ferritin (Fer) and transferrin saturation (TSat), but relative diagnostic power and best threshold values are not yet established...
July 2001: Nephrology, Dialysis, Transplantation
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