Anemia In Hemodialysis Patients Research Articles

Erythropoietin Treatment Improves Peak VO2 and Oxygen Uptake Efficiency Slope without Changing VE vs. VCO2 Slope in Anemic Patients

Background: While the improvement of anemia with erythropoietin (EPO) treatment increases peak VO 2 in anemic patients, the effects of EPO on minute ventilation (VE), VO 2 , and VCO 2 kinetics are not well described. Objectives: The aim of this study was to evaluate the improvement in hemodynamic, metabolic, and ventilatory response during exercise along with the improvement of anemia with EPO treatment in anemic hemodialysis patients. Methods: Thirty-seven hemodialysis patients with anemia (48.8 ± 13.6 years) received EPO (1500 or 3000 unit, 3 times a week). Parameters measured prospectively before and after EPO treatment included hemoglobin, cardiac output by dye dilution method, echocardiography, and cardiopulmonary exercise parameters. Results: With EPO treatment, hemoglobin increased from 6.4 ± 0.9 to 10.3 ± 0.9g/dl (p<0.001), with concomitant improvements of O 2 delivery at rest (from 663.8 ± 161.1 to 793.4 ± 188.5ml/min, p=0.004) and high output state (from 8.0 ± 1.6 to 5.6 ± 1.2l/min, p<0.001). Peak heart rate, peak systolic blood pressure, and peak VE did not change. Peak VO2 increased from 15.7 ± 5.3 to 18.8 ± 5.3ml/min/kg (p=0.017), and oxygen uptake efficiency slope (OUES) improved from 1,255 ± 375 to 1,517 ± 357 (p<0.001). However, VE vs. VCO 2 slope (from 34.3 ± 7.3 to 31.8 ± 7.2, p=0.86) and VE-VCO 2 curve did not change. Conclusion: The treatment of anemia improved peak VO 2 and OUES without affecting VE vs. VCO 2 slope significantly. In evaluating the efficacy of treatment for patients with renal failure and anemia, the VE vs. VO 2 relation rather than the VE vs. VCO 2 should be used.

Evaluation of a biosimilar recombinant alpha epoetin in the management of anemia in hemodialysis patients

Background: The efficacy of human recombinant erythropoietins (rHuEPOs) in the treatment of anemia with different etiologies is proven. Development of biosimilar rHuEPO products with lower cost and wider availability is important for the care of anemic patients. Objective: The aim of the present study was to determine the bioequivalence and safety of a biosimilar rHuEPO (Pastopoitin®) and compare it with the innovator product Eprex®, as a standard rHuEPO. Methods: One hundred and seven anemic patients on stable hemodialysis were recruited to this randomized double-blind comparative trial and assigned to either subcutaneous Pastopoitin (n=50) or Eprex (n=57). Each study group received rHuEPO at a dose of 80–120IU/kg/week in 2–3 divided doses for a period of 3months. Hematologic parameters including Hemoglobin, hematocrit, RBC, EBC, platelet, MCV, MCH and MCHC were checked every 2weeks. Blood iron, ferritin, TIBC, creatinine, BUN and electrolytes (Na, K, Ca and P) were evaluated monthly over the 3months. Results: A significant increase in hemoglobin, hematocrit and RBC was observed by the end of study in both Pastopoitin and Eprex groups (p<0.001). However, these factors were not significantly different between the groups, neither at baseline nor at the end of study (p>0.05). Likewise, the groups were comparable regarding MCV, MCH, MCHC, iron, ferritin, TIBC, creatinine, BUN and electrolytes at baseline as well as at the end of trial. Adverse events were not serious and occurred with the same frequency in the study groups. Conclusion: Pastopoitin showed comparable efficacy and safety profile with Eprex in anemic patients on hemodialysis. Hence, Pastopoitin may be considered as a rHuEPO with a lower cost and wider availability compared with the innovator product Eprex.

Influence of Chronic Hepatitis B and C Infections on Anemia in Hemodialysis Patients

Influence of Chronic Hepatitis B and C Infections on Anemia in Hemodialysis Patients

Hemoglobin Level Stability after a Switch from Darbepoetin Alfa to Epoetin Beta Pegol for the Treatment of Renal Anemia in Hemodialysis Patients

Background: New erythropoiesis-stimulating agents (ESAs) with a longer half-life have been developed for the treatment of anemia as a complication of patients with end-stage renal disease. Objectives: The objective of the present study was to assess the hemoglobin (Hb) stability of a Japanese cohort of hemodialysis (HD) patients who were simultaneously switched from darbepoetin alfa (DA) to epoetin beta pegol (CERA). Methods: This was an observational, prospective study of HD patients 20 years of age or more who were switched from intravenous (IV) DA to IV CERA and continued on HD for at least 3 months. The dose was adjusted to maintain the Hb level to within 1.0 g/dl of the baseline value. Results: A total of 68 HD patients (75.0% male, median age 63.0 years) were enrolled. The patients’ mean Hb levels were 10.8 ± (0.6) g/dl at Month 0, 10.9 ± 0.7 at Month 1, 10.8 ± 0.7 at Month 2, and 10.9 ± 0.8 at Month 3, and the differences from the level at Month 0 were not significant. After the switch, the ESA dose decreased significantly (P P < 0.0001). Conclusion: Switching from DA to CERA was associated with approximate 89% reduction of the required dose in Japanese HD patients being treated with an ESA and showed a favorable impact on the treatment of renal anemia, including the need for less frequent injections and a reduction of the ESA dose.

Efficacy and Safety of Intravenous Iron Therapy for Functional Iron Deficiency Anemia in Hemodialysis Patients: A Meta-Analysis

Background: Studies on benefits of intravenous iron therapy among hemodialysis patients with functional iron deficiency anemia have shown conflicting results. We conducted a meta-analysis to assess the efficacy and safety of intravenous iron in this subset of patients. Methods: We searched MEDLINE (through December 2012), the Cochrane Central Register of Controlled Trials and ClinicalTrials.gov for single-arm studies and randomized controlled trials (RCT) that examined the effect of intravenous iron for functional iron deficiency anemia in hemodialysis patients on anemia parameters and markers of oxidative stress and inflammation. Studies of absolute iron deficiency were excluded. Random-effect model meta-analyses were used to compute changes in outcomes of interest. Results: We identified 34 studies (2,658 patients), representing 24 single-arm studies, and 10 parallel-arm RCT. In the analyses of the study arms, intravenous iron therapy resulted in a significant increase in hemoglobin, serum ferritin, transferrin saturation rate, serum iron, reticulocyte hemoglobin content as well as a significant decrease in the percentage of hypochromic erythrocytes and erythropoietin dose. There were significant increases in plasma malonyldialdehyde level and thiobarbituric acid-reactive substances, and a decrease in neutrophil respiratory burst. The analyses of the RCT revealed less robust net changes in these parameters, and there was no increased risk of adverse events including infections, cardiac events and mortality. Conclusions: Intravenous iron therapy for functional iron deficiency anemia in hemodialysis patients improves anemia parameters but exerts some effects on markers of oxidative stress that are of unclear clinical significance. The long-term safety and efficacy of this treatment strategy requires further study.

Effects of Oral L-carnitine Supplementation on Lipid Profiles and Anemia in Patients under Hemodialysis in Gonbadkavoos, Iran

Aims: L-carnitine is an amino acid derivative, produced endogenously in the kidneys and liver or derived from meat and dairy products in the diet. Impaired L-carnitine synthesis by the kidneys contributes to the L-carnitine deficiency in dialysis patients. The aim of this study was to evaluate the effect of oral L-carnitine supplementation on lipid profiles and anemia in hemodialysis patients. Study Design: Thirty and four eligible patients were assigned to either L-carnitine or placebo groups based on the random. The patients in the L-carnitine group received 1 vial 1g (10 ml) of L-carnitine oral supplement 3 day a week after dialysis, for 16 weeks and the patients in the placebo group received 10 ml distilled water as in the same manner and duration. Blood sample was collected at the onset and after 16 weeks intervention for laboratory evaluations of biochemical and hematological parameters. Place and Duration of Study: Hemodialysis patients were chosen in Motahary Hospital in Original Research Article Annual Research & Review in Biology, 4(7): 1092-1098, 2014 1093 Gonbadkavoos, Iran, between September 2012 and March 2013. Results: The concentration of very low density lipoprotein and triglyceride were significantly decreased in L-carnitine group, whereas, none of these differences were statistically significant in placebo group whereas other measured biochemical parameters were not shown significant changes in both group. Conclusion: It seems that further experimental investigations are needed to clarify the effects of LC on lipid profiles, anemia and other factors in hemodialysis patients.

血液透析患者の腎性貧血に対するレボカルニチンの有効性

血液透析患者の腎性貧血に対するレボカルニチンの有効性

Evaluation of the effect of pentoxifylline on erythropoietin-resistant anemia in hemodialysis patients

Use of recombinant human erythropoietin (rh-Epo) improves hemoglobin (Hgb) in 90-95% of the cases of anemia of chronic kidney disease (CKD). However, it is known that pro-inflammatory cytokines such as interferon-gamma (IFN-γ), tumor necrosis factor-alfa (TNF-α) and interleukin-1 (IL-1) suppress erythropoiesis, resulting in inadequate response to rh-Epo. Pentoxifylline has been shown to have modulatory effects on the immune system. This prospective study to evaluate the effect of pentoxyphylline on erythropoeisis was performed on 15 (eight males, seven females) clinically stable patients who had been on hemodialysis for at least six months with anemia (Hgb of <10.7 g/dL) unresponsive to rh-Epo despite high doses. They were treated with 400 mg pentoxifylline tablets once daily for 12 weeks. Hgb increased after one and two months of drug administration, but significant changes were observed in eight (53%) patients after three months (P <0.05). Our study illustrates a probable new use for an old medicine. Three months treatment with pentoxifylline was seen to increase Hgb significantly in rh-Epo-resistant patients. More prospective studies with a larger sample size are needed to determine the inhibitory role of cytokines on hematopoiesis and exploring new drugs or new drug indications to overcome anemia in advanced renal failure.

Targeting the Hypoxia-Sensing Pathway in Clinical Hematology

Hypoxia-inducible factors (HIFs) are oxygen-sensitive transcription factors regulated by oxygen-dependent prolyl hydroxylase domain (PHD) enzymes and are key to cell adaptation to low oxygen. The hematopoietic stem cell (HSC) niche in the bone marrow is highly heterogeneous in terms of microvasculature and thus oxygen concentration. The importance of hypoxia and HIFs in the hematopoietic environment is becoming increasingly recognized. Many small compounds that inhibit PHDs have been developed, enabling HIFs to be pharmacologically stabilized in an oxygen-independent manner. The use of PHD inhibitors for therapeutic intervention in hematopoiesis is being increasingly investigated. PHD inhibitors are well established to increase erythropoietin production to correct anemia in hemodialysis patients. Pharmacological stabilization of HIF-1α protein with PHD inhibitors is also emerging as an important regulator of HSC proliferation and self-renewal. Administration of PHD inhibitors increases quiescence and decreases proliferation of HSCs in the bone marrow in vivo, thereby protecting them from high doses of irradiation and accelerating hematological recovery. Recent findings also show that stabilization of HIF-1α increases mobilization of HSCs in response to granulocyte colony-stimulating factor and plerixafor, suggesting that PHD inhibitors could be useful agents to increase mobilization success in patients requiring transplantation. These findings highlight the importance of the hypoxia-sensing pathway and HIFs in clinical hematology.

Investigation of Lipid Peroxidation Products and Antioxidant Enzyme Activities in End-Stage Renal Disease Patients

Background: Intravenous application of iron preparations which is a routine treatment of anemia in hemodialysis patients with end-stage renal disease can lead to iron overload in the body. Redox-active iron can catalyze the formation of hydroxyl radicals and initiation of lipid peroxidation, increase oxidative stress and speed up the development of complications in these patients. Objective: In this study, we determined the markers of lipid peroxidation, protein oxidation and antioxidant enzyme activities (superoxide dismutase, glutathione peroxidase, glutathione S-transferase) in serum of patients with end-stage renal disease on hemodialysis, who had received repeated treatment of iron supplementation. Patients and Methods: The study included 29 patients undergoing regular hemodialysis treatment. These patients were divided into three groups according to the serum ferritin levels: group I (serum ferritin between 100 and 300 mg/L); group II (serum ferritin between 301 and 600 mg/L), and group III (serum ferritin above 601 mg/L). Results: The serum of patients with the highest concentration of serum ferritin and iron contained significantly higher level of lipid peroxidation products, total hydroperoxides and malondialdehyde and advanced oxidation protein products and the lowest concentration of sulfhydryl groups, reduced glutathione and total antioxidant capacity. Conclusion: Based on the obtained results, it can be concluded that iron supplementation in hemodialysis patients and consequently body iron overload of exacerbated oxidative stress have already been present in these patients.

Impact of inflammation on anemia of hemodialysis patients who were under treatment of recombinant human erythropoietin.

The aim of this study was to investigate the association between serum C-reactive protein (CRP) as the marker of inflammation with serum ferritin level and its role in the severity of anemia of hemodialysis (HD) patients. A cross-sectional study was conducted on a group of stable hemodialysis patients. There were 36 patients overall, 25 of which were non-diabetic and 11 were diabetic mean patients’ age was 53 (±15.8) years. In this study, there was a significant inverse correlation between serum ferritin and hematocrit level (r=-0.34, p=0.044) (adjusted for age). Also a significant positive correlation between serum CRP and serum iron (r=0.44, p=0.008) (adjusted for age too) was observed. Moreover, in male HD patients, a significant positive correlation between serum CRP and serum ferritin (r=0.56, p=0.009) was found. Malnutrition and inflammation in hemodialysis may increase serum ferritin concentration apart from iron status, and needs more attention during iron therapy for the treatment of anemia in HD patients.

KDOQI US Commentary on the 2012 KDIGO Clinical Practice Guideline for Anemia in CKD

The 2012 KDIGO (Kidney Disease: Improving Global Outcomes) Clinical Practice Guideline for Anemia in Chronic Kidney Disease provides clinicians with comprehensive evidence-based recommendations to improve patient care. In this commentary, we review these recommendations and the underlying evidence. Most recommendations are well reasoned. For some, the evidence is unclear and recommendations require some qualification. While the KDIGO guideline stresses the potential risks of intravenous iron therapy, withholding iron might have its own risks. The recommendation to avoid hemoglobin levels falling below 9 g/dL sets a lower bound of "acceptability" that may increase blood transfusion. Given the lack of research supporting the optimal transfusion strategy for end-stage renal disease patients, it is difficult to weigh the risks and benefits of red blood cell transfusion. We find a paucity of evidence that hemoglobin concentration targeted between 11 and 11.5 g/dL is associated with a safety risk. Although the evidence that erythropoiesis-stimulating agent use improves patient quality of life is poor, it is possible that the instruments used to measure quality of life may not be well attuned to the needs of chronic kidney disease or dialysis patients. Our last section focuses specifically on the recommendations to treat anemia in children.

Exploring the effect of erythropoietin on mortality using USRDS data

Erythropoietin (EPO) improves measures of quality of life and reduces transfusions. Clinical trials have reported higher mortality associated with higher hemoglobin targets in varied clinical settings, making difficult the selection of erythropoiesis stimulation strategies in end-stage kidney disease. Observational studies distinguishing an effect of EPO from underlying conditions are challenging, but promise insights relevant to real-world settings. Using data from the United States Renal Data System, we performed a retrospective cohort study of hemodialysis patients treated between 2000 and 2004. 409 364 Medicare insured patients receiving hemodialysis therapy as of January 2000 or who began dialysis after January 2000 and survived >6 months were studied. We examined the association of EPO dose in any given month with death over subsequent follow-up. Within each hematocrit group (<30%, 30%–< 33%, 33%–< 36%, 36%–< 39% and >39%), the hazard ratios comparing the 80th percentile to the median EPO dose were 0.88 (95% CI: [0.87–0.90]), 0.94 ([0.93–0.94]), 0.98 ([0.98–0.99]), 1.06 ([1.05–1.06]) and 1.08 ([1.07–1.09]), respectively. Within the highest hematocrit group, the association of a high EPO dose with elevated mortality was attenuated over time. Among patients with malignancy or indications of EPO resistance, the association of higher EPO dose with lower mortality was attenuated when hematocrit was low, while its association with higher mortality was stronger when hematocrit was high. These analyses demonstrate a complex relationship between EPO dosing and mortality, suggesting a possible beneficial effect among severely anemic hemodialysis patients, but possible harm when administered to individuals with higher hematocrit levels.

Association of Secondary Hyperparathyroidism with Hemoglobin Level in Patients with Chronic Kidney Disease

Purpose:Secondary hyperparathyroidism (SHPT) is one of the less recognized reasons of anemia in chronic kidney disease (CKD). In this study, we evaluated the role of SHPT as a cause of anemia and correlation of intact parathyroid hormone (iPTH) and hemoglobin (Hb) level in hemodialysis (HD) patients.Methods:This cross-sectional study was carried out in 63 individuals admitted in HD unit of the institute. Serum samples were collected and urea, creatinine, Hb, ferritin and iPTH levels were measured. Statistical analysis was carried out using the SPSS software (IBM, NY, USA).Results:Mean ± standard deviation for serum urea, creatinine, Hb, ferritin and intact PTH were 177 ± 15.52, 15.16 ± 2.28 mg/dl, 7.03 ± 2.26 g/dl, 654.7 ± 563.4 ng/ml, 539.18 ± 493.59 pg/ml respectively. A reverse correlation was found between intact PTH and Hb level.Conclusions:A variety of postulated pathophysiological mechanisms linking SHPT and anemia in CKD are discussed. An efficient control of parathyroid hormone hypersecretion may be required to achieve a better management of anemia in HD patients.

Does the extracorporeal circulation worsen anemia in hemodialysis patients? Investigation with advanced microscopes of red blood cells drawn at the beginning and end of dialysis

BackgroundIn hemodialysis (HD) patients, anemia relates to three main factors: insufficient production of erythropoietin; impaired management of iron; and decreased lifespan of red blood cells (RBCs). The third factor can relate to structural deterioration of RBCs due to extrinsic (extracorporeal circuit; biochemical activation and/or mechanical stress during dialysis) and intrinsic (uremic milieu; biochemical interference of the RBC membrane constituents with toxins) mechanisms. Herein, we evaluate information accessed with advanced imaging techniques at the cellular level.MethodsAtomic force and scanning electron microscopes were employed to survey intact RBCs (iRBCs) of seven HD patients in comparison to seven healthy donors. The extrinsic factor was investigated by contrasting pre- and post-HD samples. The intrinsic environment was investigated by comparing the microscopy data with the clinical ones.ResultsThe iRBC membranes of the enrolled HD patients were overpopulated with orifice-like (high incidence; typical size within 100–1,000 nm) and crevice-like (low incidence; typical size within 500–4,000 nm) defects that exhibited a statistically significant (P < 0.05) relative increase (+55% and +350%, respectively) in respect to healthy donors. The relative variation of the orifice and crevice indices (mean population of orifices and crevices per top membrane surface) between pre- and post-HD was not statistically significant (−3.3% and +4.5%, respectively). The orifice index correlates with the concentrations of urea, calcium, and phosphorus, but not, however, with that of creatinine.ConclusionExtracorporeal circulation is not detrimental to the structural integrity of RBC membranes. Uremic milieu is a candidate cause of RBC membrane deterioration, which possibly worsens anemia.

L-Carnitine for Anemia in Hemodialysis Patients

In this issue of the Clinical Journal of the American Society of Nephrology , Mercadal and colleagues address whether the biologically active form of carnitine, L - carnitine (LC), offers an adjuvant erythropoietic effect to patients with newly diagnosed ESRD undergoing maintenance hemodialysis ([1

Vitamin E–coated polysulfone membrane improved red blood cell antioxidant status in hemodialysis patients

Oxidative stress has emerged as a strong pathogenic cofactor implicated in the development of long-term complications in hemodialysis (HD) patients, such as anemia, and as a major component of the malnutrition inflammation complex syndrome. This prospective multicenter study aimed at evaluating the short-term effects of the new vitamin E (vitE)-coated polysulfone (PS) membrane (VitabranE) on biocompatibility performances and anemia in HD patients. After a 3-month washout period with a high-flux synthetic dialyzer, 43 HD patients were switched to a vitE-PS dialyzer. Sampling was performed at baseline (corresponding to the end of the washout period) and after 1, 2 and 3 months of treatment. Oxidative stress status, as well as inflammatory parameters, was investigated at the end of each study period. Hemoglobin levels and administered doses of recombinant human erythropoietin or epoetin (EPO) were available in each center. The use of vitE-coated membranes for 3 months was not associated with any change in inflammatory parameters. By contrast, vitE-PS dialyzer resulted in a progressive increase in red blood cell (RBC) vitE concentration and in RBC superoxide dismutase activity. A concomitant progressive significant decrease in advanced oxidation protein product concentration at 2 months was observed, suggesting a preventive effect on oxidative stress. Finally, a significant decrease of the erythropoietin resistance index was obtained after 3 months of treatment. Use of the vitE-PS membrane during a short period improves erythrocyte antioxidant defense mechanisms and seems to lead to a reduction in EPO requirements in HD patients.

Effect of Ascorbic acid on EPO-hyporesponsive anemia in Hemodialysis patients

We performed the present study to evaluate the efficacy of intravenous and oral ascorbic acid in improving anemia and iron availability on EPO-hyporesponsive anemia in hemodialysis patients with hyperferritinemia. This study of three months duration was conducted in 49 patients with Hb <11 g/dL and ferritin levels greater than 300 ng/ml. Blood samples for measurement of Hb, Hct, serum iron, ferritin, TIBC, transferrin saturation, EPO dose were obtained after baseline and at the end of study after three months. Patients were randomly divided into three groups. 16 patients had received standard care(group 1), 17 patients had received standard care and daily oral ascorbic acid at a dose of 500 mg/day(group 2), and 16 patients had received standard care and 300mg of intravenous vitamin C with each dialysis session(group 3). Forty-seven patients completed the study. All of patients dialyzed 4 hours, 3 times a week with similar kt/V. Hb, serum iron, serum ferritin, transferrin saturation and EPO dose was similar in the three groups at baseline. After 3 month, Hemoglobin and hematocrit and transferrin saturation significantly increased in group 2,3. but not changed in group 1. EPO dose and ferritin level decreased in group 2,3. but not changed in group 1. There was no difference between group 2 and 3. In conclusion, intravenous or oral ascorbic acid therapy can improve hyperferritinemia and EPO hyporesponsive anemia in hemodialysis patients. And The effect of intravenous and oral ascorbic acid are similar.Table 1. Baseline and 3 month DataGroup1(n=16)Group2(n=17)Group3(n=14)baselineAfter3monthbaselineAfter3monthbaselineAfter3monthHb(g/dl8.9+1.48.8+1.38.8+1.39.5+1.29.0+1.29.6+1.2Fe(u/L)55.84+2358.6+1958.57+2563.7+2261.12+216729+19EPOdose(unit/week)147291453815584123691498611345Ferritin(ug/l)764+217781+192783+191646+189754+220634+231Transferrin saturation(%)18+6.418+5.820.6+5.526.4+4.419.8+4.924.5+3.2*is p<0.5 Table 1. Baseline and 3 month Data *is p<0.5

The relationship between anemia, liver disease, and hepcidin levels in hemodialysis patients with hepatitis

We investigated the role of hepcidin in ameliorating anemia in hemodialysis patients with hepatitis. A total of 72 hemodialysis patients with hepatitis were classified according to their requirement of erythropoietin (EPO). Anemia parameters, C-reactive protein (CRP), and biochemical measurements were recorded along with the hepcidin. The number of patients receiving no EPO was higher among patients with liver disease when compared with those without liver disease (P = 0.002). The mean hepcidin levels of the patients who did not receive EPO did not differ statistically from those of the patients who received the maximum dose (P = 0.5). The hepcidin levels of patients with liver disease who received no EPO were lower compared to those patients without liver disease who received the maximum dose (P = 0.04). There was a positive correlation between hepcidin and mean platelet levels (r = 0.26, P = 0.027) and annual intravenous iron dose (r = 0.31, P = 0.007). In hemodialysis patients with hepatitis, liver disease may be one of the factors affecting erythropiesis, related with decreased hepcidin levels and iron hemostasis. Further studies are needed to verify these associations.

Abnormalities of the Small Intestine Detected by Capsule Endoscopy in Hemodialysis Patients

Many patients on hemodialysis for chronic renal failure suffer from progressive anemia. In hemodialysis patients with gastrointestinal bleeding, endoscopic examination often fails to identify hemorrhagic lesions. We surveyed hemodialysis patients with obscure gastrointestinal bleeding (OGIB) for the presence of intestinal lesions by capsule endoscopy (CE). Among 90 patients who underwent CE, 13 had hemodialysis-related anemia (8 men and 5 women, age 66.5 ± 7.9 years, Hb 8.8 ± 1.9 g/dL, mean ± SD) and 77 had non-hemodialysis anemia (47 men and 30 women, age 55.7 ± 19.9 years, Hb of 11.9 ± 3.1 g/dL). The types and distribution of hemorrhagic lesions were investigated by CE. All patients had signs or symptoms of gastrointestinal bleeding but no active bleeding site was detected by endoscopy. The CE-observed lesions were classified into reddening, erosions/ulcers, vascular lesions, and tumors. The characteristic features of each lesion and patient demographic data were compared. Vascular lesions were significantly more frequent in the hemodialysis group than in the controls (p<0.001). Reddening was observed in all patients of the hemodialysis group and mainly found in the ileum. Erosions/ulcers were observed in 4 patients (30.7%) and were more frequent in the jejunum. Vascular lesions were observed in 8 patients (61.5%) and they were more frequent in the ileum. A submucosal tumor was seen in one patient. There were no significant differences in demographic factors between patients with erosions/ulcers and those with a vascular lesion. Vascular lesions are common in anemic hemodialysis patients with OGIB and should be considered in the differential diagnosis of anemia in patients on hemodialysis with OGIB.