oalib
Search Results: 1 - 10 of 100 matches for " "
All listed articles are free for downloading (OA Articles)
Page 1 /100
Display every page Item
Iron and erythropoiesis-stimulating agents in anaemia
Thomas Rath
European Journal of Oncology Pharmacy , 2010,
Abstract: Anaemia is a frequent and clinically relevant problem in patients with malignancy and may be aggravated in patients receiving chemotherapy. Blood transfusions, iron supplementation, and erythropoiesis-stimulating agents (ESAs) are established treatment options for anaemic patients.
Transfusion burden in non-dialysis chronic kidney disease patients with persistent anemia treated in routine clinical practice: a retrospective observational study
Kathleen M Fox, Jerry Yee, Ze Cong, John M Brooks, Jeffrey Petersen, Lois Lamerato, Shravanthi R Gandra
BMC Nephrology , 2012, DOI: 10.1186/1471-2369-13-5
Abstract: A retrospective cohort study of electronic medical record data from the Henry Ford Health System identified 374 adult, ND-CKD patients with severe anemia (Hb < 10 g/dL and subsequent use of erythropoiesis-stimulating agents [ESA] therapy, blood transfusions, or a second Hb < 10 g/dL) between January 2004 and June 2008. Exclusions included those with prior diagnoses of cancer, renal or liver transplant, end-stage renal disease, acute bleeding, trauma, sickle cell disease, or aplastic anemia. A gap of ≥ 1 days between units of blood transfused was counted as a separate transfusion.At least 1 transfusion (mean of 2 units; range, 1-4) was administered to 20% (75/374) of ND-CKD patients with mean (± SD) follow-up of 459 (± 427) days. The mean (± SD) Hb level closest and prior to a transfusion was 8.8 (± 1.5) g/dL. Patients who were hospitalized in the 6 months prior to their first anemia diagnosis were 6.3 times more likely to receive a blood transfusion than patients who were not hospitalized (p < 0.0001). Patients with peripheral vascular disease (PVD) were twice as likely to have a transfusion as patients without PVD (p = 0.04).Transfusions were prevalent and the trigger hemoglobin concentration was approximately 9 g/dL among ND-CKD patients with anemia. To reduce the transfusion burden, clinicians should consider other anemia treatments including ESA therapy.Chronic kidney disease (CKD) affects about 26 million adults (11%) in the United States, with the early stages (stages 3-4) being approximately 100 times more prevalent than kidney failure [1]. Persistent anemia is a consequence of the declining endogenous erythropoietin production seen in progressive CKD [2]. Anemia of CKD can be successfully treated by administration of an erythropoiesis-stimulating agent (ESA) [3]. Blood transfusion in non-dialysis (ND) CKD occurs in nearly 10% of Medicare-insured CKD patients per year despite the availability of ESA therapy, a rate four times as great as in older patients wit
Erythropoiesis-stimulating agents in the treatment of chemotherapy-induced anaemia
Phebe Si, BScPharm (Hons),Alexandre Chan PharmD, Assistant Professor
European Journal of Oncology Pharmacy , 2011,
Abstract: Erythropoiesis-stimulating agent(ESA)-related safety concerns mean that clinicians must be vigilant when prescribing ESAs in cancer patients.
Erythropoiesis Stimulating Agents (ESAs) in the Treatment of Cardio-Renal Syndrome Anaemia  [PDF]
Ioannis Koulouridis, Efstathios Koulouridis
Open Journal of Nephrology (OJNeph) , 2012, DOI: 10.4236/ojneph.2012.23004
Abstract: Coexistence of chronic kidney disease (CKD) and chronic heart failure (CHF) define a recently recognized clinical entity known as cardio-renal syndrome. Sufficient evidence suggests that the two pathological conditions share common pathogenic etiology which is not yet fully defined. Superimposed anaemia is a common finding among patients suffering from cardio-renal syndrome. The combination of CKD, CHF and anaemia increase the probability of death by 6 times compared to normal individuals. Early attempts to restore anaemia either by iron supplementation, erythropoiesis stimulating agents (ESAs) or combination of the two have reported to improve quality of life, morbidity and mortality especially among patients treated by cardiologists. Recent publications of well controlled epidemiological studies failed to prove convincing beneficial effect of the above mentioned therapy moreover skepticism has raised concerning the safety of restoring anaemia among patients with cardio-renal syndrome as well as used medications. There are still unresolved problems concerning the definition of anaemia, by means of hemoglobin level among these patients, the target hemoglobin level and the therapeutic regimen of ESAs administration and iron supplementation. We need much more evidence in order to define an effective and safe treatment strategy correcting anaemia among patients with cardio-renal syndrome.
Erythropoiesis-stimulating agents in patients with chronic kidney disease  [cached]
Mario Eandi
Reviews in Health Care , 2012, DOI: 10.7175/rhc.v3i2.194
Abstract: Anemia is a frequent complication of chronic kidney disease (CKD) due to the inability of the kidneys to release sufficient erythropoietin to regulate the production of red blood cells. Administration of erythropoiesis-stimulating agents (ESAs) is highly effective in correcting anemia of CKD. The ESAs currently approved in Italy are epoetin alfa, epoetin beta, epoetin theta, darbepoetin alfa, CERA and biosimilars epoetin alfa and epoetin zeta. All the ESAs are effective in correcting renal anemia and increasing hemoglobin levels, but the choice of which to use should also take into account their pharmacokinetics and pharmacodynamics, their administration route, and economic issues. However, regarding the optimal use of ESAs an issue that remains controversial is the most appropriate dose conversion between epoetin alfa and darbepoetin alfa. In fact clinical experience demonstrates that the dose relationship between epoetin alfa and darbepoetin alfa is non proportional across the dosing spectrum. In this review is presented an update on the latest available evidence in the treatment of anemia in CKD patients, with particular reference to the definition of the correct conversion ratio EPO:DARB.
Differential Modulation of Angiogenesis by Erythropoiesis-Stimulating Agents in a Mouse Model of Ischaemic Retinopathy  [PDF]
Carmel M. McVicar,Liza M. Colhoun,Jodie L. Abrahams,Claire L. Kitson,Ross Hamilton,Reinhold J. Medina,Dash Durga,Tom A. Gardiner,Pauline M. Rudd,Alan W. Stitt
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0011870
Abstract: Erythropoiesis stimulating agents (ESAs) are widely used to treat anaemia but concerns exist about their potential to promote pathological angiogenesis in some clinical scenarios. In the current study we have assessed the angiogenic potential of three ESAs; epoetin delta, darbepoetin alfa and epoetin beta using in vitro and in vivo models.
Hepcidin-25 in Chronic Hemodialysis Patients Is Related to Residual Kidney Function and Not to Treatment with Erythropoiesis Stimulating Agents  [PDF]
Neelke C. van der Weerd, Muriel P. C. Grooteman, Michiel L. Bots, Marinus A. van den Dorpel, Claire H. den Hoedt, Albert H. A. Mazairac, Menso J. Nubé, E. Lars Penne, Carlo A. Gaillard, Jack F. M. Wetzels, Erwin T. Wiegerinck, Dorine W. Swinkels, Peter J. Blankestijn, Piet M. ter Wee, CONTRAST investigators
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0039783
Abstract: Hepcidin-25, the bioactive form of hepcidin, is a key regulator of iron homeostasis as it induces internalization and degradation of ferroportin, a cellular iron exporter on enterocytes, macrophages and hepatocytes. Hepcidin levels are increased in chronic hemodialysis (HD) patients, but as of yet, limited information on factors associated with hepcidin-25 in these patients is available. In the current cross-sectional study, potential patient-, laboratory- and treatment-related determinants of serum hepcidin-20 and -25, were assessed in a large cohort of stable, prevalent HD patients. Baseline data from 405 patients (62% male; age 63.7±13.9 [mean SD]) enrolled in the CONvective TRAnsport STudy (CONTRAST; NCT00205556) were studied. Predialysis hepcidin concentrations were measured centrally with matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. Patient-, laboratory- and treatment related characteristics were entered in a backward multivariable linear regression model. Hepcidin-25 levels were independently and positively associated with ferritin (p<0.001), hsCRP (p<0.001) and the presence of diabetes (p = 0.02) and inversely with the estimated glomerular filtration rate (p = 0.01), absolute reticulocyte count (p = 0.02) and soluble transferrin receptor (p<0.001). Men had lower hepcidin-25 levels as compared to women (p = 0.03). Hepcidin-25 was not associated with the maintenance dose of erythropoiesis stimulating agents (ESA) or iron therapy. In conclusion, in the currently studied cohort of chronic HD patients, hepcidin-25 was a marker for iron stores and erythropoiesis and was associated with inflammation. Furthermore, hepcidin-25 levels were influenced by residual kidney function. Hepcidin-25 did not reflect ESA or iron dose in chronic stable HD patients on maintenance therapy. These results suggest that hepcidin is involved in the pathophysiological pathway of renal anemia and iron availability in these patients, but challenges its function as a clinical parameter for ESA resistance.
Utilization Patterns of IV Iron and Erythropoiesis Stimulating Agents in Anemic Chronic Kidney Disease Patients: A Multihospital Study  [PDF]
Avani D. Joshi,David A. Holdford,Donald F. Brophy,Spencer E. Harpe,Darcy Mays,Todd W. B. Gehr
Anemia , 2012, DOI: 10.1155/2012/248430
Abstract: Intravenous (IV) iron and Erythropoiesis Stimulating Agents (ESAs) are recommended for anemia management in chronic kidney disease (CKD). This retrospective cohort study analyzed utilization patterns of IV iron and ESA in patients over 18 years of age admitted to University Health System Hospitals with a primary or secondary diagnosis of CKD between January 1, 2006 to December 31, 2008. A clustered binomial logistic regression using the GEE methodology was used to identify predictors of IV iron utilization. Only 8% (n = 6678) of CKD patients on ESA therapy received IV iron supplementation in university hospitals. Those receiving iron used significantly less amounts of ESAs. Patient demographics (age, race, primary payer), patient clinical conditions (admission status, severity of illness, dialysis status), and physician specialty were identified as predictors of IV iron use in CKD patients. Use of IV iron with ESAs was low despite recommendations from consensus guidelines. The low treatment rate of IV iron represents a gap in treatment practices and signals an opportunity for healthcare improvement in CKD anemic patients.
Utilization Patterns of IV Iron and Erythropoiesis Stimulating Agents in Anemic Chronic Kidney Disease Patients: A Multihospital Study  [PDF]
Avani D. Joshi,David A. Holdford,Donald F. Brophy,Spencer E. Harpe,Darcy Mays,Todd W. B. Gehr
Anemia , 2012, DOI: 10.1155/2012/248430
Abstract: Intravenous (IV) iron and Erythropoiesis Stimulating Agents (ESAs) are recommended for anemia management in chronic kidney disease (CKD). This retrospective cohort study analyzed utilization patterns of IV iron and ESA in patients over 18 years of age admitted to University Health System Hospitals with a primary or secondary diagnosis of CKD between January 1, 2006 to December 31, 2008. A clustered binomial logistic regression using the GEE methodology was used to identify predictors of IV iron utilization. Only 8% (n = 6678) of CKD patients on ESA therapy received IV iron supplementation in university hospitals. Those receiving iron used significantly less amounts of ESAs. Patient demographics (age, race, primary payer), patient clinical conditions (admission status, severity of illness, dialysis status), and physician specialty were identified as predictors of IV iron use in CKD patients. Use of IV iron with ESAs was low despite recommendations from consensus guidelines. The low treatment rate of IV iron represents a gap in treatment practices and signals an opportunity for healthcare improvement in CKD anemic patients. 1. Introduction In the United States, Chronic kidney disease (CKD) affects approximately 26 million Americans and is the cause of significant morbidity and mortality in 1 of 9 adults [1]. Anemia is a common comorbidity of CKD–prevalent in 47% of patients who are not on dialysis [2]. Anemia of CKD results from underproduction of endogenous erythropoietin by the kidneys [3]. In patients with CKD not requiring dialysis, untreated anemia increases cardiovascular risk, hospitalization [4], all-cause mortality [5], and impaired cognitive function [1], and diminishes health-related quality of life [6] and exercise capacity [7, 8]. Heightened risk for progression of kidney failure has also been linked to untreated anemia of CKD. Thus, management of anemia in CKD patients is essential [9–11]. Erythropoiesis-stimulating agents (ESAs), such as epoetin alfa (EPO) and darbepoetin, are used to treat anemia. Use of ESAs substantially reduces the need for transfusions and therefore are a first line of therapy for anemia of CKD [12]. Despite their benefits, use of ESAs has inherent risks. ESAs have been associated with increased risk of adverse events, such as cardiovascular complications [13–16], hypertension [17], and pure red cell aplasia [18]. The US Food and Drug Administration (FDA) added a black box warning to the labeling of all epoetin and darbepoetin products advising prescribers to adjust ESA dosing to maintain the lowest hemoglobin level
Association between high-dose erythropoiesis-stimulating agents, inflammatory biomarkers, and soluble erythropoietin receptors
Jula K Inrig, Suzanne K Bryskin, Uptal D Patel, Murat Arcasoy, Lynda A Szczech
BMC Nephrology , 2011, DOI: 10.1186/1471-2369-12-67
Abstract: A cross-sectional cohort of anemic 32 CKD participants receiving ESA were enrolled at a single center and cytokine profiles, adipokines, and sEpoR were compared between participants stratified by ESA dose requirement (usual-dose darbepoetin-α (< 1 μg/kg/week) and high-dose (≥1 μg/kg/week)).Baseline characteristics were similar between groups; however, hemoglobin was lower among participants on high-dose (1.4 μg/kg/week) vs usual-dose (0.5 μg/kg/week) ESA.In adjusted analyses, high-dose ESA was associated with an increased odds for elevations in c-reactive protein and interleukin-6 (p < 0.05 for both). There was no correlation between high-dose ESA and adipokines. Higher ESA dose correlated with higher levels of sEpoR (rs = 0.39, p = 0.03). In adjusted analyses, higher ESA dose (per μcg/kg/week) was associated with a 53% greater odds of sEpoR being above the median (p < 0.05).High-dose ESA requirement among anemic CKD participants was associated with elevated inflammatory biomarkers and higher levels of circulating sEpoR, an inhibitor of erythropoiesis. Further research confirming these findings is warranted.Clinicaltrials.gov NCT00526747Clinical trials in patients with chronic kidney disease (CKD) have demonstrated that attempting to achieve a higher hemoglobin with erythropoiesis-stimulating agents (ESA) leads to adverse cardiovascular outcomes [1-4]. Recently, secondary analyses have suggested the increased cardiovascular morbidity and mortality among anemic CKD participants randomized to higher hemoglobin targets may be partially explained by the use of high-doses of ESA [5,6]. While it has been suggested that ESA therapy may be proinflammatory [7] or have direct toxic effects on the cardiovascular system [8,9], the underlying mechanism of the elevated cardiovascular risk associated with high-dose ESA has yet to be elucidated.Inflammation and malnutrition among patients with CKD have been demonstrated to be significant contributors to accelerated atherosclerosis
Page 1 /100
Display every page Item


Home
Copyright © 2008-2017 Open Access Library. All rights reserved.