Anemia In Hemodialysis Patients Research Articles

The clinical efficacy of combined ESA and Roxadustat treatment for renal anemia in hemodialysis patients with secondary hyperparathyroidism: A case series.

Pharmacological mechanism of Roxadustat in the treatment of renal anemia. To investigate the efficacy and safety of combined Roxadustat and erythropoiesis stimulator (ESA) treatment of renal anemia in hemodialysis patients with secondary hyperparathyroidism. A retrospective analysis was conducted on hemodialysis patients with renal anemia and secondary hyperparathyroidism treated with ESAs alone, who were admitted to our hospital from March 2022 to December 2022. The patients were treated with Roxadustat combined with ESAs for 3 months, during which oral iron supplementation was given, and the changes in Hb levels and laboratory-related indicators before and after the combined treatment were analyzed. The results showed that a total of 13 patients received combination therapy, with a significant increase in Hb compared to ESAs alone (t = -3.955, P = .002). The Hb qualification rate was 38.46%, and the ∆Hb response rate was 76.92%. The parathyroid hormone significantly decreased with a statistically significant difference (Z = -2.062b, P = .039). Hemoglobin (RBC), total iron binding capacity, and serum ferritin (male) were significantly increased compared to ESAs alone. Total cholesterol and low-density lipoprotein were significantly lower than ESAs alone. The differences in the changes in the above indicators were statistically significant (P < .05). There was no statistically significant difference in changes in other laboratory-related indicators (P > .05). No adverse reactions were observed during the combined treatment of 13 patients. The combination of Roxadustat and ESAs can effectively improve renal anemia in hemodialysis patients with secondary hyperparathyroidism, as well as improve indicators of hyperparathyroidism and blood lipid levels with high levels of safety. This combined treatment thus provides a new and safe treatment method for these patients.

Exploring The Prevalence And Underlying Causes Of Anemia In Hemodialysis Patients. A Cross-Sectional Study

Background: Anemia is a common complication among patients with chronic kidney disease (CKD), especially those who are on hemodialysis. It also has a marked effect on their Quality of Life and with it, the morbidity-morbility. This research aimed to evaluate the frequency and incidence of anemia in hemodialysis patients at MMC. Objectives: to find out the incidence and etiological factors responsible for anemia in hemodialysis patients at MMC. Study design: a cross-sectional study Duration and place of study. From June 2023 to Aug 2023 department of nephrology mmc mardan Methods This study was designed as a cross-sectional analysis on 200 hemodialysis patients of MMC. Demographics, clinical parameters and laboratory values were collected. Anemia was characterized by an hemoglobin &lt;13 g/dL in men and &lt;12 g/dL for women. Statistical Analysis: Descriptive statistics, including mean and standard deviation assisted by the p-value for determining significance. Results Out of 200 Patients had a mean age of 58.4 years (SD =12.6). 85% of patients had anemia, with a mean hemoglobin 10.2 g/dL (SD 1.4) in anaemic patient's. The main causes of anemia were iron deficiency (60%), inflammatory states (40%) and erythropoietin resistance(alone or in combinations) for 25%, respectively. Anemia prevalence was significantly associated with all the comorbidities and with increased duration of hemodialysis. Conclusion Anemia is highly prevalent among hemodialysis patients at MMC, most often attributed to iron deficiency and inflammation. Treatments are effective as long the condition can be caught early and so, regular monitoring is vital for a more positive prognosis. Additional investigation is necessary to improve anemia care in this population. Keywords: Anemia, Hemodialysis, Prevalence, Causes

Efficacy of sutimlimab for cold agglutinin disease in a patient on chronic hemodialysis.

Reports of cold agglutinin disease (CAD), an autoimmune hemolytic anemia, in dialysis patients are limited. Recently, sutimlimab for CAD was covered by insurance. Herein, we report a case in which sutimlimab was effective in the treatment of CAD in a patient undergoing hemodialysis (HD). The patient was a 73year-old Japanese man with an 11year history of HD for diabetic nephropathy. He was admitted to our hospital for examination and treatment of erythropoiesis-stimulating agent (ESA)-induced hyporesponsive anemia and fatigue, which was present in the previous year October to March when temperatures were cooler. The patient was diagnosed with hemolytic anemia based on decreased hemoglobin levels, elevated reticulocyte count, elevated lactate dehydrogenase levels, and decreased haptoglobin levels. Furthermore, he was diagnosed with CAD based on a positive direct antiglobulin test for C3 and cold agglutinin tests. The patient did not respond well to an elevated dialysate temperature or rituximab therapy. After initiating sutimlimab treatment, an increase in the hemoglobin level was observed despite a decrease in temperature, and his fatigue disappeared. Anemia in hemodialysis patients is generally renal; however, some ESA resistance exists, which may be due to hemolytic anemia. In this case, the use of sutimlimab was effective in controlling hemolytic anemia due to CAD.

Study of the Efficacy and Safety of Darbepoetin Alfa versus Epoetin Alfa in the Treatment of Anemia in Pediatric Patients on Regular Hemodialysis

Abstract Background Anemia is a common comorbidity in patients with chronic kidney disease (CKD). That affects the vast majority and can have a significant impact on patient morbidity and mortality. Erythropoiesis-stimulating agents (ESAs) are the main lines in management of anemia in hemodialysis patients. Replacement therapy with recombinant human erythropoietin (r- HuEPO) has provided an effective treatment for patients with renal “Epoetin alfa” is a recombinant erythropoietin with the same amino acid sequence as human erythropoietin (EPO). In comparison to epoetin alfa, darbepoetin alfa (DPO) contains an increased amount of sialic acid-containing carbohydrate chains. It shows a much longer elimination half-life than epoetin alfa, with prolonged erythropoietic effect. Aim of the Work to evaluate whether darbpoetin and epopoetin alpha can be used interchangeably on the same patient, achieving the same desired effect and to detect any difference in the occurrence of side effects between both ESAs. Patient and Methods This was a crossover study that took place in the Pediatrics Dialysis unit, Children’s Hospital, Ain Shams University. The study was conducted on 40 children with end stage renal disease on regular hemodialysis over a period of 6 months. The patients were randomly put into two groups A and B, each group contained 20 patients. Each group received one type of ESA either ( darbpoetin alpha or epopoetin alpha )for 3 months and then shifted to the other type of ESA for another 3 months. The dosage of epoetin alfa used was (200 IU/kg/week) and a conversion rate of EPO: DPO, 300:1. A period of 6 weeks was agreed as a washout period after the first drug given in both groups in which no results were recorded but ESA was not stopped due to its essentiality. Blood tests (hemoglobin (Hb), serum urea, serum creatinine and iron profile; (S. iron, S. ferritin, TIBC, and transferrin saturation)) were withdrawn at the start and the end of the 3 months’ period of each drug. Results We found no difference on the Hb level with both drugs. The interchange between them did not yield any significant drop in the Hb levels. Hb target in both EPO and DPO was reached in 22.5% of total cases, and was not reached in 62.5%. This proved that both drugs give the same effect with nearly negligible difference. No serious Sside effect as convulsions, hypertension, and thrombosis were noticed in both groups. Conclusion The target Hb was not reached in most patients of both groups of ESRD on regular hemodialysis at the unit and none of both drugs showed superior results or less side effects than the other.

#2895 Erythropoietin Resistance Index (ERI) between mortality and metabolic changes in a cohort of hemodialysis patients. What acts below the surface?

Abstract Background and Aims The management of anemia in hemodialysis patients (HD-ps) is influenced by many factors, including inflammation, martial balance (MB) and mineral metabolism (MM). Recent data would identify the Erythropoietin Resistance Index (ERI) as an indicator of mortality risk in HD-ps. The objective of the present study was to evaluate the relationship of ERI with inflammation, MB and MM, as well as all-cause mortality in a cohort of HD-ps. Method An observational-retrospective study was performed on 100 HD-ps, excluding those with acute or chronic infections (3 months), neoplasia, or immunosuppressive therapy. Mortality was considered primary outcome along a 2-year follow-up (FU). Results HD-ps, predominantly males, had advanced mean age, good Hb values and fair biochemical control. ERI showed significant correlations with some elements of inflammation, MM and BM (Table 1), including c-terminal fragment of Fibroblast Growth Factor 23 (cFGF23). At multivariate, ERI remained influenced by cFGF23 (p = 0.009), iron (p = 0.002) and transferrin (p = 0.007). Furthermore, after 2 years of FU, 42% of HD-ps died. As shown in Table 2, HD-ps that faced the primary outcome (death) were older, had lower levels of albumin, hemoglobin and transferrin, and higher levels of IL6, parathormone (PTH), reactive C protein (PCR), and ERI (p &amp;lt; 0.035). In multivariate, ERI (p = 0.011), age (p = 0.001) and albumin (p = 0.010) remained significant for the outcome studied. Conclusion Our data, albeit on few HD-ps, show a possible association between ERI and mortality. ERI was found to be related to several factors, including cFGF23, itself a factor implicated in maintaining a baseline inflammatory state. The results suggest the possible presence of some pathological mechanisms that can act silently with a negative impact on survival. Certainly, increased numbers and a prospective design could better clarify the explored relationships in the future.

Reticulocyte hemoglobin is an excellent biomarker for detecting and diagnosing absolute and functional iron deficiency anemia in hemodialysis patients

Reticulocyte hemoglobin is an excellent biomarker for detecting and diagnosing absolute and functional iron deficiency anemia in hemodialysis patients

The Administration of Intradialytic Parenteral Nutrition Does Not Affect the Anemia Status of Chronic Kidney Disease Patients Undergoing Hemodialysis

Background: Hemodialysis (HD) patients are susceptible to malnutrition, and there is a close relationship between malnutrition and the incidence of anemia. Parenteral nutrition plays a role in treating malnutrition. Objective: This study aims to determine the effect of parenteral nutrition on anemia in HD patients. Methods: Quasi-experimental research which is part of the nutritional research tree at the Hemodialysis Unit of RSUP Dr. Soetomo Surabaya for 3 months. A total of 45 malnourished CKD patients (SGA B &amp; C) undergoing routine HD were included in this study (n=26 received regular diet &amp; education, n=17 received regular diet, education and intradialytic parenteral nutrition, and n=2 dropped out of school due to blood transfusion). Measurements of body mass index (BMI), hemoglobin (Hb), serum iron (SI), and total iron binding capacity (TIBC) were carried out before and 8 weeks after therapy. Between groups used the Mann-Whitney test, while pre and post used the Wilcoxon matched-pairs sign rank test. Results: The treatment group was older than the control group. There was no difference in duration of HD between groups. Intradialytic parenteral nutrition had no effect on BMI (24.71±3.939 vs 24.71±4.026; p=0.3802), Hb (9.746±1.309 vs 9.162±1.960; p= 0.3525), SI (62.33±34.74 vs. 53.78±24.89; p=0.3594), and TIBC (242.8±119.0 vs. 197.3±43, 65; p=0.4258). Conclusion: In HD patients, intradialytic parenteral nutrition for 8 weeks did not affect Hb, SI and TIBC levels. Long-term observations with larger samples are needed to confirm these findings.

Possible role of cardiovascular stress induced by the volume load as a cause of anemia in hemodialysis patients: a case of a maintenance hemodialysis patient with a literature review

BackgroundAlthough a deficiency in erythropoietin relative to decreased hemoglobin levels is presumed to be the predominant cause of renal anemia, other factors may also exist that are not fully understood.Case presentationA 58-year-old man with pyelonephritis who had been on hemodialysis for 18 years presented a gradually decreasing serum creatinine level, possibly due to voluntary dietary restrictions, accompanied by a gradual increase in the cardiothoracic ratio from 48% to 56%. Concomitantly, his hemoglobin level decreased gradually from 14.5 to 8.7 g/dL by 6 months. Although he had no symptoms of heart failure and his left ventricular ejection fraction was 66.3%, which was almost identical to his condition 2 years prior, a drastic reduction in posthemodialysis body weight from 71.0 to 68.6 kg in 9 days was performed without apparent intrahemodialysis hypotension. His cardiothoracic ratio and serum prehemodialysis N-terminal pro-brain natriuretic peptide level decreased steeply, from 56% to 49% by 2 weeks and from 6139 to 647 pg/mL by 8 weeks, followed by a gradual increase in his hemoglobin level from 8.7 to 15.1 g/dL by 3 months. The patient was administered 50 mg/day sodium ferrous citrate but no erythropoietin-stimulating agents or hypoxia-inducible factor prolyl hydroxylase inhibitors. Although a modest increase in the serum protein level was observed immediately after the rapid reduction in posthemodialysis body weight, the patient’s hemoglobin level increased markedly and gradually, suggesting an improvement in anemia rather than hemoconcentration.ConclusionsCardiovascular stress induced by the volume load is one of the causes of anemia in hemodialysis patients.

Efficacy and factors influencing dosage of roxadustat for erythropoietin-resistant anemia in hemodialysis patients

Efficacy and factors influencing dosage of roxadustat for erythropoietin-resistant anemia in hemodialysis patients

Proton Pump Inhibitors and Hyporesponsiveness to Erythropoiesis-Stimulating Agents in Hemodialysis Patients: Results from the Japan Dialysis Outcomes and Practice Patterns Study.

Hyporesponsiveness to erythropoiesis stimulating agents (ESAs) is important problem in dialysis patients. While proton pump inhibitors (PPIs) may inhibit iron absorption, few studies have examined associations between PPIs and ESA-resistant anemia in hemodialysis patients. This study examined the associations between PPIs and ESA-resistant anemia in hemodialysis patients. The present study was a cross-sectional study using repeated 4-month observations, up to eight observations/patient, from the Japan Dialysis Outcomes and Practice Patterns Study (J-DOPPS). The primary outcome was erythropoietin resistance index (ERI). ESA dose, hemoglobin, proportion of erythropoietin-resistant anemia, transferrin saturation (TSAT), and ferritin were also examined. Linear or risk-difference regression models were used with generalized estimating equations to account for repeated measurements. Of 1,644 patients, 867 patients had PPI prescriptions (52.7%). Patients prescribed PPI had higher ERI, higher ESA dose, and lower TSAT levels. Multivariable analysis for 12,048 four-month observations showed significantly greater ERI in PPI users (adjusted difference 0.95 IU/week/kg/[g/dL] [95% CI: 0.40-1.50]). Significant differences were also found in ESA dose (336 IU/week [95% CI: 70-602]) and the prevalence of erythropoietin-resistant anemia (3.9% [2.0-5.8%]) even after adjusted for TSAT and ferritin. Among possible mediators between the association of PPIs and anemia, TSAT was significantly different between PPI users and non-users (adjusted difference, -0.82% [95% CI: -1.56 to -0.07]). This study showed the associations between PPI and ERI, ESA dose, and TSAT in hemodialysis patients; physicians should consider anemia's associations with PPIs in hemodialysis patients.

Soluble transferrin receptor concentration compared with reticulocyte hemoglobin content as a reliable marker of iron deficiency anemia in hemodialysis patients

Abstract Introduction Adequate iron stores are necessary for successful erythropoiesis-stimulating agents (ESAs) therapy in hemodialysis (HD) patients. However, iron status estimation in HD patients remains challenging, as most parameters are affected by inflammation. We aimed to compare the performance of soluble transferrin receptor concentration (sTfR) and reticulocyte hemoglobin content (CHr) as potential markers for iron status assessment. Methods This was a cross-sectional study that included 60 anemic patients with kidney failure on regular HD for a minimum of 3 months. Patients were in the maintenance phase of the ESAs with stable doses for at least 4 weeks and at least 3 weeks free of iron therapy. Patients were classified into two groups; group I: 18 patients with noniron deficiency anemia (NIDA); transferrin saturation (TSAT) greater than 20% and ferritin greater than 200 ng/ml and group II: 42 patients with iron deficiency anemia (IDA); transferrin saturation less than 20% and/or ferritin less than 200 ng/ml. CHr and sTfR were evaluated as reliable markers for diagnosing iron deficiency. Results CHr was significantly lower while sTfR was significantly higher in patients with IDA. Based on the receiver operating characteristic (ROC) curve, the area under the curve (AUC) of sTfR was significantly larger than the area under the curve of CHr; however, this had a borderline significance. Conclusion sTfR has a significantly higher diagnostic power for diagnosis of IDA than CHr.

Impact of Dialysis Fluid Delivery System on Anemia in Hemodialysis Patients

Background Patients on standard dialysis, in particular those on high-flux and high-efficiency dialysis, are exposed to hundreds of liters of dialysis-water per week. The quality of dialysis-water is a factor responsible for inflammation which is a potent trigger of atherosclerosis and a pathogenic factor in anemia, increasing mortality and morbidity in these patients. Current systems for water treatment do not completely eliminate bacteria and endotoxins. Our study tests if improved dialysiswater purity by using Central dialysis Fluid Delivery System (CDDS) can reduce inflammation and ameliorate hemoglobin levels. Aim of the Work The aim of this work is to compare between the effect of using Central Dialysis Fluid Delivery System (CDDS) and Single Dialysis Fluid Delivery System (SDDS) on Anemia in prevalent Hemodialysis Patients Patients and Methods This prospective observational cohort study was conducted between May 2019 and July 2019 and was conducted on 100 prevalent Hemodialysis Patient divided into 2 groups, each group included 50 patients, one group receiving Hemodialysis treatment using the central dialysis fluid delivery system (CDDS), while the other group receiving Hemodialysis treatment using the single-patient dialysis fluid delivery system (SPPDS). Results Endotoxin level in the dialysate fluid was found to be markedly lower in the CDDS group (0.05 EU/ml) compared to the SPDDS group (0.11 EU/ml). Baseline CRP level didn’t differ significantly between both groups (P-value: 0.88), however throughout the follow up period patients who were on dialysis using the CDDS showed a sustained significant decrease in CRP level compared to those using the SPDDS (P-value: &amp;lt;0.001 for the 3m follow up period), denoting improvement of their chronic inflammatory status. Baseline hemoglobin level didn’t differ significantly between both groups (P-value: 0.52), however throughout the follow up period patients who received dialysis using CDDS showed a sustained significant increase in their hemoglobin level, while those receiving dialysis using SPDDS showed no significant change in their hemoglobin level, also hemoglobin level in the CDDS Group was higher than in the SPDDS group at 1st, 2nd and 3rd months. (P-value: 0.008, &amp;lt;0.001 and &amp;lt;0.001 for the follow up month 1, 2 and 3 respectively). Using URR as an indicator for efficiency of the HD session, there was no statistically significant difference between both groups among three months of follow-up. Conclusion Ultrapure dialysis fluid (UPD) produced by the Central dialysis

Effect of pentoxifylline on the dose of erythropoietin among hemodialysis patients: A double-blind randomized clinical trial

Introduction: It was suggested that pentoxifylline (PTX) might improve the response to recombinant human erythropoietin (rhEPO) in anemic hemodialysis (HD) patients. However, there is no considerable evidence for it. We aimed to evaluate the effect of PTX on anemia and prescription of rhEPO dose in HD patients. Methods: This double-blind randomized clinical trial study was conducted on 57 HD patients (54.1 ± 13.8 years old and 52.6% of them were women). Patients were randomly categorized into 2 groups (27 PTX cases and control group with 30 cases). Hemoglobin (Hb), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and albumin (Alb) were measured before and after the study. Data were analyzed using SPSS, and p-value &lt;0.05 was considered significant. Results: Hb levels increased significantly after treatment in both groups (p&lt;0.002). Although the mean Hb change in the PTX group was more but not significant (p=0.195). rhEPO dose decreased significantly after treatment in the PTX groups (11000.0 ± 3140.0 IU vs. 9100.0 ± 3400.0 IU, p=0.018) compared to the control (11130.0 ± 3180.0 IU vs. 10870.0 ± 3900.0 IU, p= 0.690). CRP levels significantly reduced only in the PTX group (22.8 ± 15.3 vs. 16.5 ± 9.5, p=0.005). Also, a significant increase in Alb was observed only in the PTX (3.9 ± 0.4 vs. 4.1 ± 0.3, p=0.031). Conclusion: Using the PTX may reduce the required rhEPO dose, so it could be used in the anemia treatment in HD patients. Although, as a therapeutic strategy in HD patients with anemia it is controversial. Due to the limitations of the studies in this field, further studies with more sample size are recommended.

Prevalence of Anemia and Variations of Hematological Parameters among Anemic Hemodialysis Patients in the Tripoli Region

Background: Prolonged decline in the ability of the kidney to regulate acid–base balance, eliminate waste products, and manage water homeostasis and entered chronic phase, toxic metabolic accumulates and erythropoietin secretion by the kidney is decreasing and causes hematological changes including decrease of HCT, MCV, RBCs and platelet counts. Hemodialysis became a practical treatment for kidney failure and is the most common method used to treat advanced and permanent kidney failure. Anemia is one of the most common complications in hemodialysis patients. Objectives: The study aimed to evaluate the prevalence of anemia among hemodialysis patients and investigate the variations of hematological parameters among anemic hemodialysis patients in the Tripoli region. Materials and Methods: The present study was conducted on 250 renal failure patients, attending Tripoli Center for dialysis and 100 normal healthy subjects. The study Ethical Committee of the medical centers and the Libyan Academy of graduate studies reviewed and approved the study design and patient consent statements were taken from each patient. Information's about the patients were recorded in a questionnaire. A blood sample of 5 ml was drawn by venous puncture from each normal healthy individual and hemodialysis patient. 2.5 ml of the blood sample was collected in K-EDTA tubes for the hematological examinations and another 2.5 ml of the blood sample was collected in a plain tubes for biochemical tests (serum urea, creatinine, and uric acid concentrations). The hematological parameters (RBCs count, Hb, HCT, MCV, MCH, MCHC, WBCs count, differential count of WBCs, and Platelets count) were determined using an automated hematology analyzer Sysmex (K- 4500) machine. The data were compared using GraphPad Prism version.9. The statistical significance of differences between groups was evaluated with the independent t-test. A P-value of &lt;0.05 was considered significant for all statistical tests. Results: The results showed that the prevalence of anemia among hemodialysis patients was 89.8%. The degrees of anemia were 17% severe, 71.66% moderate, and 11.34% mild anemia. The types of anemia were 13.36% microcytic hypochromic, 82.59% normocytic hypochromic, and 4.05% macrocytic hypochromic anemia. RBCs, WBCs &amp; platelets counts, Hct, MCHC, and Lymphocytes % showed a significant (P&lt;0.01) decrease, and MCV was a significant (P&lt;0.01) increase in the anemic hemodialysis patients compared with the healthy individuals. But, a significant (P&lt;0.05) decrease in MCH was observed in the anemic hemodialysis patients when compared with the healthy individuals. A significant correlation was observed between RBCs and their indices with most of the hematological parameters. A significant (P&lt;0.01) negative correlation was observed between serum urea with Hb, and RBCs count and Hct. While, a significant (P&lt;0.01) positive correlation was recorded between uric acid with platelets count. A significant (P&lt;0.05) positive correlation was observed between gender with platelets count, while, a significant negative correlation was recorded between gender with serum urea (P&lt;0.01), creatinine, and uric acid, and Hb (P&lt;0.05). A significant (P&lt;0.01) negative correlation was observed between blood groups with serum uric acid. A significant (P&lt;0.01) positive correlation was observed between durations of hemodialysis with RBCs count and Hb, while, a significant (P&lt;0.05) negative correlation was recorded between durations of hemodialysis with body weight, and MCHC. Conclusion: It can be concluded that a higher prevalence of moderate, normocytic hypochromic anemia among hemodialysis patients. Also, results showed a significant variation in hematological parameters among the anemic hemodialysis patients. So, hemodialysis patients advice to examine the hematological parameters and treated from anemia if detected.

Impact of Water Treatment on Anemia in Hemodialysis Patients.

The microbiological quality of water in the dialysate used in hemodialysis has been suggested as a contributor to inflammation, and a link between dialysate purity, inflammation, and responsiveness to erythropoietin therapy has been suggested in many studies. The level of endotoxin might induce inflammation and resistance to erythropoietin therapy in dialysis patients. We aimed to compare the effect of using the central dialysis fluid delivery system (CDDS) versus the single-patient dialysis fluid delivery system (SPDDS) on anemia in prevalent hemodialysis patients. In a prospective cohort study, 100 adult prevalent hemodialysis patients with T-SAT ≥20% were divided into two equal groups: CDDS and SPDDS. Endotoxin in water sample and routine investigations (hemoglobin, serum Ca+, serum Po4-, PTH, and urea level) were done. CRP, erythropoietin resistivity index (ERI), and erythropoietin stimulating agents (ESAs) doses were assessed repeatedly to assess inflammatory and anemia states. Endotoxin level in the dialysis fluid of the CDDS group was significantly lower compared to the SPDDS group (0.05 vs. 0.11 EU/ml, P = 0.001). CRP level decreased significantly after 3 months in the CDDS group (P < 0.001) compared to the SPDDS group (P = 0.54), with significant improvement in the hemoglobin level and ERI at 3 months in the CDDS group and decrease in ESA requirements. Improvement in dialysis liquid purity reduces inflammatory markers in prevalent hemodialysis patients, improves ERI, and decreases ESA requirements in renal anemia.

Lactoferrin: A Promising New Player in Treatment of Iron Deficiency Anemia in Patients on Regular Hemodialysis: A Randomized Controlled Trial.

Hepcidin is secreted in inflammatory states as in patients on regular hemodialysis (HD). Therefore, novel agents modulating hepcidin secretion may have the potential to effectively reverse anemia in HD patients. Bovine milk derivative lactoferrin (BLF) is a glycoprotein that was found to decrease serum interleukin-6, therefore, having anti-inflammatory properties. Thus, it can downregulate hepcidin secretion in various inflammatory states including patients on regular HD, so improving iron absorption and utilization in those patients. In addition, BLF is a source of iron as each BLF molecule chelates two ferric ions. We started an interventional study. Seventy patients on regular HD with iron deficiency anemia received 100 mg of 20%-30% iron-saturated BLF (corresponding to 70-84 μg of elemental iron) orally b.i.d for 6 months. We compared those patients with another 70 patients on regular HD with iron deficiency anemia who were given 576 mg of ferrous glycine sulfate (corresponding to 100 mg of elemental iron) orally b.i.d for 6 months. BLF significantly decreased serum hepcidin level (from 340-350 ng/mL to 101-112 ng/mL), P <0.0001 and significantly increased hemoglobin (Hb) concentration (from 7.5-8.1 g/dL to 9.3-10 g/dL), P <0.0001, and transferrin saturation (TSAT) (from 5%-9% to 26%-31%), P <0.0001. Furthermore, ferrous glycine sulfate significantly decreased serum hepcidin level (from 335-350 ng/mL to 330--341 ng/mL), P <0.0001, and significantly increased Hb (from 7.5-8.1 to 7.6-8.5 g/dL), P <0.0001, and TSAT (from 5%-9% to 7%-12%), P <0.0001. However, the magnitude of decrease in serum hepcidin level and rise in Hb and TSAT in the BLF group was significantly higher than in the ferrous glycine sulfate group, P <0.0001. Oral BLF can be considered a promising novel agent in treatment of iron deficiency anemia in patients on regular HD.

Methods of diagnosis and treatment of anemia in hemodialysis patients

Methods of diagnosis and treatment of anemia in hemodialysis patients

Efficacy, Safety and Pharmacoeconomic Analysis of Intravenous Ferric Carboxymaltose in Anemic Hemodialysis Patients Unresponsive to Ferric Gluconate Treatment: A Multicenter Retrospective Study.

Patients undergoing hemodialysis with iron deficiency anemia (IDA) receiving treatment with erythropoiesis-stimulating agents (ESAs) who were intolerant or non-responsive to intravenous (i.v.) ferric gluconate (FG) (hemoglobin; Hb values < 10.5 g/dL or increase in <1 g/dL) or % transferrin saturation; TSAT of <20%) in the previous 6 months were switched to i.v. ferric carboxymaltose (FCM). Changes in iron status parameters, economic and safety measures were also assessed. Seventy-seven hemodialysis patients aged 68 ± 15 years were included. Erythropoietin resistance index decreased from 24.2 ± 14.6 at pre-switch to 20.4 ± 14.6 after 6 months of FCM treatment and Hb levels ≥10.5 g/dL improved from 61% to 75.3% patients (p = 0.042). A 1 g/dL increase in Hb levels was also seen in 26% of patients as well as a 37.7% increase in patients achieving >20% increase in TSAT after FCM. Levels of Hb, TSAT and ferritin parameters increased during FCM treatment with a concomitant decrease in ESA. A mixed-model analysis, which also considered gender, confirmed these trends. Safety variables remained stable, no hypersensitivity reaction was recorded and only one patient reported an adverse event after FCM. FCM treatment was associated with a cost saving of 11.11 EUR/patient/month. These results confirm the efficacy, safety and cost-effectiveness of FCM in correcting IDA in hemodialysis patients.

Relationship between oral cinacalcet therapy with CRP and anemia in hemodialysis patients with secondary hyperparathyroidism

Background: Cinacalcet is one of the newest calcium mimetic drugs in the treatment of patients with parathyroid cancer, secondary hyperparathyroidism in adults with chronic kidney disease. Due to the possible association between the effect of Cinacalcet on C-reactive protein and the pathophysiology of anemia in end-stage renal disease patients. The aim of this study was to evaluate the effect of oral Cinacalcet on rate of CRP and anemia in ESRD patients with secondary hyperparathyroidism. Methods: This descriptive cross-sectional study was done on all 40 hemodialysis patients over 18 years of age underwent hemodialysis for at least 6 months. The levels of C-reactive protein, phosphorus, calcium, parathyroid hormone, ferritin, Total iron binding capacity, iron, hemoglobin before the start of treatment and based on the routine dialysis ward were repeated once every three months and recorded in the, in the checklist. Also, age, sex, weight, underlying disease, duration of dialysis and duration of use and dose of Cinacalcet were entered. The results of these experiments were reviewed and analyzed before and after treatment with Cinacalcet.Results: In these patients, after treatment with Cinacalcet, the amount of hemoglobin increased and the amount of inflammation decreased and these changes were significant in hemoglobin rate but not significant in CRP rate. The relationship between patients' weight and inflammation was significant.Conclusions: Treatment with Cinacalcet in hemodialysis patients, at least in this study, could be increased hemoglobin and decreased CRP rate and can be a hypothesis for large analytical studies.

Predictors of iron versus erythropoietin responsiveness in anemic hemodialysis patients.

Anemia protocols for hemodialysis patients usually titrate erythropoietin (ESA) according to hemoglobin and iron according to a threshold of ferritin, with variable response seen. A universally optimum threshold for ferritin may be incorrect, and another view is that ESA and iron are alternative anemia treatments, which should be selected based on the likely response to each. Hemodialysis patients developing moderate anemia were randomised to treatment with either an increase in ESA or a course of intravenous iron. Over 2423 patient-months in 197 patients, there were 133 anemia episodes with randomized treatment. Treatment failure was seen in 20/66 patients treated with ESA and 20/67 patients treated with iron (30.3 vs. 29.9%, p=1.0). Successful ESA treatment was associated with lower C-reactive protein (13.5 vs. 28.6 mg/L, p=0.038) and lower previous ESA dose (6621 vs. 9273 μg/week, p=0.097). Successful iron treatment was associated with lower reticulocyte hemoglobin (33.8 vs. 35.5 pg, p=0.047), lower hepcidin (91.4 vs. 131.0 μg/ml, p=0.021), and higher C-reactive protein (29.5 vs. 12.6 mg/L, p=0.085). A four-variable iron preference score was developed to indicate the more favorable treatment, which in a retrospective analysis reduced treatment failure to 17%. Increased ESA and iron are equally effective, though treatment failure occurs in almost 30%. Baseline variables including hepcidin can predict treatment response, and a four-variable score shows promise in allowing directed treatment with improved response rates.