Anemia In Chronic Renal Failure Patients Research Articles

The Impact of Genetic Polymorphisms in (STIM1 and ORAI1) on Erythropoietin Resistance in Patients with Chronic Renal Failure on Hemodialysis in Iraq

Objective: This study aims to investigate the correlation between genetic polymorphisms in store-operated calcium channels (SOCs) signaling and resistance to erythropoietin treatment in patients with chronic renal failure (CRF). Anemia is a significant complication of CRF, and understanding the genetic factors contributing to resistance could provide insights into potential mechanisms influencing treatment outcomes. Specifically, the focus is on exploring the relationship between SOCs, a pathway activated by erythropoietin, and resistance to address the challenges associated with anemia in CRF patients.
 Methods: In this study, a single nucleotide polymorphism in each STIM1 and ORAI1 gene was selected. Genotyping was done by using allele specific polymerase chain reaction technique and the data was analyzed through the Statistical Package for the Social Sciences. 112 patients with CRF on hemodialysis were enrolled 58.9% of them were men and the mean age was 50.94±13.42.
 Results: We found that CC genotype of ORAI1 gene has a higher hemoglobin level, AA genotype of STIM1 has a higher EPO level, the interaction of the two genes showed that CCGG group has a higher Hb level and is considered good responder but represents only 4.5% of the patients
 Conclusion: After all the genetic polymorphisms of SOCs genes ORAI1 and STIM1 have no significant impact on erythropoietin resistance in patients with CRF on hemodialysis in Iraq.

Serum Iron Profile in Chronic Renal Failure Patients

Background & objective: Chronic Renal Failure (CRF) is a serious condition with a worldwide impact. Anemia is a common complication of CRF leading to significant morbidity. Iron deficiency may be a contributing factor for developing anemia in CRF patients. It may be particularly problematic during erythropoietin therapy. This study was intended to find the serum iron status in CRF patients.
 Method: This cross sectional study was conducted on 100 consecutive patients of CRF in the Department of Medicine, Rangpur Medical College & Hospital, Rangpur and Hypertension & Research Centre, Rangpur between July 2010 to June 2012.
 Result: 40% of the patients were 40-59 years old, 28% were 20 - 39 years and 32% >60 years old. Males were predominant (64%) than the females (36%). None of the biochemical variables (serum creatinine, haemoglobin and serum iron profile), except total iron binding capacity (TIBC) differ by sex. TIBC was significantly higher in females than that males (p = 0.029). Of the 100 patients 40% were iron deficient; of them 12(30%) had absolute iron deficiency and 28(70%) relative iron deficiency. Iron deficiency was not influenced by sex (p = 0.519). It was not even affected by the degree of renal insufficiency (p = 0.524). However, the incidence of severe anemia increases significantly with the degree of renal insufficiency (p = 0.037).
 Conclusion: Serum iron profile remains normal in most of the cases of CRF patients. It should be investigated in every CRF patients before deciding for iron therapy.
 Ibrahim Cardiac Med J 2012; 2(2): 8-13

ASAIO 52nd annual conference, Chicago, Illinois, June 8–10, 2006

ASAIO 52nd annual conference, Chicago, Illinois, June 8–10, 2006

Reasons for Producing Guidelines on Anemia of Chronic Renal Failure: Dialysis Outcome Quality Initiative of the National Kidney Foundation

Guidelines for the treatment of anemia in chronic renal failure (CRF) patients were recently published by NKF-DOQI. The background was provided by the fact that anemia in CRF patients fulfills all the criteria requested for the outlining of guidelines. In fact: 1) anemia is a clinically relevant problem for CRF patients; 2) it may be prevented by adequate erythropoietin (EPO) therapy; 3) a great variability in its management exists, not only concerning the optimal hematocrit (HCT) level, but also the treatment schedule as well as iron supplementation. More than eight hundred forty five scientific articles were retrieved in full text, eventually leading to 530 structurally reviewed papers (349 cited in the final text) thus providing the basis for the strength of recommendations (evidence or opinions): all topics were subdivided into 7 main issues (diagnostic and therapeutic). Main results were the following: HCT, hemoglobin (Hb), red blood cell, serum iron binding capacity, percent transferrin saturation (TSAT) and serum ferritin (FERR), to evaluate the degree of anemia and iron status; HCT 33 to 36% and Hb 11 to 12 g/dl as possible target levels; TSAT >20% and FERR >100 ug/dl as acceptable lower values for iron status; oral iron administration not <200 mg/day of elemental iron and intravenous iron 50-100 mg/week or 500-100 mg/month (for patients on predialysis or peritoneal dialysis) as therapeutic schedules; subcutaneous route for EPO administration at 80-120 U/kg body weight/week as starting doses. Some issues may be debatable, such as, the underestimation of dialysis efficacy among the causes of inadequate response to EPO as well as the risk of thrombosis among the possible side effects of EPO therapy, or the lack of recommendation for upper limits of FERR values. However, this exhaustive study is an important demonstration of efforts to improve the quality of care in CRF patients.

Intravenous iron supplementation for the treatment of the anemia of moderate to severe chronic renal failure patients not receiving dialysis

Iron deficiency may develop in hemodialysis patients, especially when erythropoietin is given. The role of iron deficiency in the anemia of predialysis chronic renal failure (CRF), however, is much less clear. We have intravenously (IV) administered iron as ferric saccharate in a total dose of 200 mg elemental iron monthly for 5 months to 33 CRF patients who remained anemic despite oral iron supplementation and who had no laboratory signs of iron overload. None was receiving erythropoietin therapy. In 22 of the patients there was an increase in the hematocrit values by the end of the study. These patients were considered responders to intravenous iron (IV Fe) therapy. In 11 patients the iron administration was not associated with improvement of the anemia (nonresponders). Before onset of the IV Fe therapy there were no differences between the responders and nonresponders with regard to degree of anemia, serum ferritin, iron saturation, renal function, or blood pressure. One additional patient was excluded from the study because of a mild reaction during an IV test dose before the study. No worsening of kidney function and no other side effects were noted. In four patients (three responders and one nonresponder) the control of blood pressure necessitated antihypertensive drug therapy adjustment. In conclusion, IV Fe supplementation in two thirds of anemic CRF patients not receiving dialysis resulted in a significant improvement of the anemia, thus avoiding the necessity of erythropoietin or blood administration. This could be achieved by increasing the plasma ferritin levels to 200 to 400 μg/L and/or increasing the iron saturation to 25% to 35%. Intravenous ferric saccharate appears to be a safe and effective method of administering iron for the correction of anemia in CRF patients not receiving dialysis.