Correction Of Anemia In Patients Research Articles

Efficacy and cost-effectiveness of darbepoetin alfa once every 4 weeks versus continuous erythropoietin receptor activator once every 4 weeks for anemia correction in patients with chronic kidney disease not on dialysis.

For anemia management in patients with chronic kidney disease not on dialysis, darbepoetin alfa (DA), which has a shorter half-life but is more inexpensive than continuous erythropoietin receptor activator (CERA), is preferred in Korea. This study evaluated the efficacy, safety, and cost-effectiveness of once-in-4-weeks DA compared with once-in-4-weeks CERA in patients with chronic kidney disease not on dialysis. In this randomized, prospective, non-inferiority study, 40 erythropoiesis-stimulating agent-naïve patients with chronic kidney disease not on dialysis were randomized 1:1 to the DA group and CERA group. They received the study drug once in 4 weeks during 10- or 12-week correction period and 24-week efficacy evaluation period. The primary outcomes were the mean difference in the changes in hemoglobin levels between baseline and efficacy evaluation period and hemoglobin response rates during the correction period. The secondary outcomes included differences in adverse events and costs. DA was non-inferior to CERA for anemia correction; the mean difference in the change in hemoglobin levels between the groups was -0.070 g/dL (95% confidence interval, -0.730 to 0.590 g/dL). Hemoglobin response rates were 100% with DA and 94.1% with CERA. Adverse events were comparable. The mean cost of DA was approximately one-third that of CERA (34,100 ± 7,600 Korean won/4 weeks vs. 115,500 ± 23,600 Korean won/4 weeks; p < 0.001). Once-in-4-weeks DA safely corrects anemia in erythropoiesis-stimulating agent-naïve patients with chronic kidney disease not on dialysis and is more cost-effective than once-in-4-weeks CERA.

Anemia correction in patients with gastric cancer during the preoperative period, the short-term results of surgical treatment

INTRODUCTION. In the Russian Federation, among all malignant diseases in the male population, gastric cancer ranks the 4th, in women – 5th place, and in terms of mortality in both sexes from malignant diseases – 2nd place. During surgical treatment of patients with gastric cancer, anemia is detected in more than 1/4 of patients, who significantly worsens the prognosis due to postoperative complications. Timely correction of anemia can reduce the risk of complications during surgical treatment and improve the course of the postoperative period.OBJECTIVE is to evaluate the effectiveness of correction of anemia in the preoperative period and the results of radical surgical treatment in patients with gastric cancerMETHODS AND MATERIALS. The article presents the analysis of medical records of 30 patients aged 56–75 years with a diagnosis of gastric cancer complicated by anemia (hemoglobin level &lt; 80 g/l). All patients in the preoperative period for the correction of anemia were prescribed iron (III) hydroxide oligoisomaltose intravenously at the dose of 20 mg/kg 21 days before surgery, due to the detection of iron deficiency in them.RESULTS. The target blood hemoglobin level was more than 95 g/l. In the absence of the desired effect, erythrocyte transfusion was performed. The use of iron preparations made it possible to correct anemia in 14 (46.7 %) patients without resorting to transfusions, in 16 (53.3 %) patients, it was required to additionally transfuse 1 dose of erythrocytes, while earlier in the preoperative anemia was corrected using transfusions of 2–3 doses of erythrocytes. All patients underwent radical surgery with D2 lymph node dissection. Operations were accompanied by blood loss of 201.0±94.4 ml (120–475 ml). It was revealed that radical surgeries for gastric cancer in patients who received anemia correction in the preoperative period are accompanied by a low number of purulent-inflammatory (in 27.3 % of patients) and cardiovascular complications (in 20 % of patients).CONCLUSION. Correction of anemia is a mandatory part of therapy in the preoperative period and allows to perform a full range of radical surgical intervention, improve the safety of surgical treatment and improve the course of the postoperative period.

Dapagliflozin and Anemia in Patients with Chronic Kidney Disease

BackgroundIn the DAPA-CKD (Dapagliflozin in Patients with Chronic Kidney Disease) trial, dapagliflozin improved kidney and cardiovascular outcomes in patients with chronic kidney disease (CKD) with or without type 2 diabetes (T2D). In this post hoc analysis of DAPA-CKD, we assessed the effects of dapagliflozin on the correction and prevention of anemia.MethodsThe DAPA-CKD trial randomized patients (1:1) with an estimated glomerular filtration rate of 25 to 75 ml/min/1.73 m2 and a urinary albumin-to-creatinine ratio of 200 to 5000 mg/g to receive dapagliflozin 10 mg or placebo daily. Hematocrit was measured at baseline, 2 weeks, 2 and 4 months, and every 4 months thereafter. Anemia was defined as hematocrit less than 39% in men and less than 36% in women. Correction and incidence of anemia were defined as two consecutive measurements above or below these thresholds relative to baseline, respectively, during follow-up. We classified anemia-related adverse events using data from site investigator reports.ResultsMean age of the 4304 participants was 61.8 years, and 67.5% had T2D. Among the 4292 (99.7%) participants with baseline hematocrit data, 1716 (40.0%) had anemia. Over the 2.4-year median follow-up, patients assigned to dapagliflozin had an increase in hematocrit of 2.3 percentage points (95% confidence interval [CI], 2.1 to 2.5) greater than those assigned to placebo. Among patients with anemia at baseline, anemia was corrected in 443 (53.3%) patients randomized to receive dapagliflozin and 247 (29.4%) patients randomized to receive placebo (hazard ratio, 2.29; 95% CI, 1.96 to 2.68). Among patients without anemia at baseline, 10.4% of patients assigned to dapagliflozin developed incident anemia compared with 23.7% in the placebo group (hazard ratio, 0.39; 95% CI, 0.31 to 0.48). Anemia-related adverse events occurred in 2.2% of patients assigned to dapagliflozin compared with 3.8% assigned to placebo. Effects of dapagliflozin on the correction and prevention of anemia were consistent in patients with and without T2D. The adverse event profile was similar to that known for dapagliflozin.ConclusionsThis exploratory analysis suggests that dapagliflozin is associated with the prevention or correction of anemia in patients with CKD with and without T2D. (Funded by AstraZeneca; ClinicalTrials.gov number, NCT03036150.)

A prospective randomized controlled trial evaluating the safety and efficacy of patient blood management program in patients with gynecologic cancer (KGOG 4011/PBM)

BackgroundGynecologic cancer has a high frequency of anemia, which is associated with increased morbidity and mortality. Blood transfusion is used to correct anemia, but carries its own side effects and...

Features of pathogenesis and ways of anemia correction in patients with diseases of the upper gastrointestinal tract

Anemia is a frequently diagnosed complication in patients with various diseases of the esophagus and stomach, which negatively affects the quality of life and aggravates the course of the prior disease. There are three main mechanisms for reducing hemoglobin in the pathology of the upper gastrointestinal tract: bleeding, malabsorption, chronic inflammation. A combination of pathogenetic factors often leads to anemia associated with a deficiency of both iron and vitamin B complex. Anemia of chronic diseases is less common.Material and methods. 38 people with diseases of the esophagus and stomach were examined: 20 women and18 men. The average age was 70 years old. All patients were divided into groups according to the diagnosed variant of anemia: iron deficiency anemia (IDA), anemia of chronic diseases (ACD) and a combination of IDA and ACD, as well as by the type of therapy performed (therapy with iron preparations, B vitamins and treatment of the prior disease).Results. A comparative analysis of the hematopoietic lineage indices before and after the treatment was performed. A clinically significant increase in hemoglobin, erythrocytes and erythrocyte indices was observed in patients with IDA who received parenteral therapy with iron preparations, as well as combined treatment with iron preparations and B vitamins. In the ACD and ACD + IDA groups, there were no significant changes in the parameters of the hematopoietic lineage in any of the therapy variants.Conclusion. The effect of the treatment was found only in patients with IDA who received parenteral therapy with iron preparations. The rest treatment options did not show a positive effect on the dynamics of blood indices in any of the groups. Perhaps a longer follow-up and an increase in the sample of patients will allow creating an effective individualized algorithm for anemia therapy.

Evaluating Rates of Preoperative Medical Optimization to Correct Anemia in Patients Undergoing Myomectomy

Objective: The aims of this retrospective cohort study were to determine the proportion of women on medical therapy to correct anemia, defined as hemoglobin <12.0g/dL prior to myomectomy and to det...

A small-molecule inhibitor of hypoxia-inducible factor prolyl hydroxylase improves obesity, nephropathy and cardiomyopathy in obese ZSF1 rats.

Prolyl hydroxylase (PH) enzymes control the degradation of hypoxia-inducible factor (HIF), a transcription factor known to regulate erythropoiesis, angiogenesis, glucose metabolism, cell proliferation, and apoptosis. HIF-PH inhibitors (HIF-PHIs) correct anemia in patients with renal disease and in animal models of anemia and kidney disease. However, the effects of HIF-PHIs on comorbidities associated with kidney disease remain largely unknown. We evaluated the effects of the HIF-PHI FG-2216 in obese ZSF1 (Ob-ZSF1) rats, an established model of kidney failure with metabolic syndrome. Following unilateral nephrectomy (Nx) at 8 weeks of age, rats were treated with 40 mg/kg FG-2216 or vehicle by oral gavage three times per week for up to 18 weeks. FG-2216 corrected blood hemoglobin levels and improved kidney function and histopathology in Nx-Ob-ZSF1 rats by increasing the glomerular filtration rate, decreasing proteinuria, and reducing peritubular fibrosis, tubular damage, glomerulosclerosis and mesangial expansion. FG-2216 increased renal glucose excretion and decreased body weight, fat pad weight, and serum cholesterol in Nx-Ob-ZSF1 rats. Additionally, FG-2216 corrected hypertension, improved diastolic and systolic heart function, and reduced cardiac hypertrophy and fibrosis. In conclusion, the HIF-PHI FG-2216 improved renal and cardiovascular outcomes, and reduced obesity in a rat model of kidney disease with metabolic syndrome. Thus, in addition to correcting anemia, HIF-PHIs may provide renal and cardiac protection to patients suffering from kidney disease with metabolic syndrome.

Analysis of economic efficiency of iron deficiency anemia therapy in patients with malignant tumors

Introduction. Correction of iron deficiency anemia in patients with malignant neoplasms is an important aspect affecting the quality of life and the effectiveness of special treatments. At the same time, the therapy of comorbid conditions significantly increases the cost of treating cancer patients.The aim of the study was to conduct a comparative pharmacoeconomic analysis of the two most common methods for correcting iron deficiency anemia in cancer patients: transfusion of erythrocyte suspension and intravenous iron preparations using iron carboxymaltose as an example.Materials and methods. An observational, analytical, cohort study was carried out, which included 120 cancer patients. The patients underwent laboratory examination. The tests were assessed: a general blood test with an assessment of the morphological characteristics of erythrocytes, serum iron, ferritin, CRP, total protein. An analysis of the costs of iron deficiency anemia therapy was carried out, taking into account the procurement cost of drugs.Results. It is economically more profitable to use intravenous iron preparations in comparison with transfusion of erythrocyte suspension for the treatment of iron deficiency anemia in patients with malignant neoplasms. The cost of correcting iron deficiency anemia per patient was: when treated with carboxymaltosate iron (Ferinject): 7943.96 rubles, with transfusion of erythrocyte suspension: 16856.40 rubles.Conclusion. In the treatment of anemia in patients with malignant neoplasms with blood preparations (erythrocyte suspension), an improvement in hematological parameters is noted earlier and to a greater extent than with the use of iron preparation carboxymaltozate («Ferinject»). Nevertheless, the duration of the clinical effect when using erythrocyte suspension is lower than that of a parenteral iron preparation.

P350 SAFIIR: Study of Anemia Following Intravenous Iron Repletion

Abstract Background The main objective of this study was to assess the prevalence of anemia and the secondary objectives aimed to evaluate the real-life impact of intravenous iron therapy on anemia correction in patients living with Inflammatory Bowel Disease (IBD). Methods We performed a retrospective cohort study of adult patients (18 to 80 years old) with a Crohn’s Disease or Ulcerative Colitis diagnosis who were followed at our clinic between January 2018 and March 2020. Clinical data were obtained from the patients’ electronic medical records. Iron-deficiency anemia was defined as hemoglobin (Hb) &amp;lt; 12,0 g/dL and/or transferrin saturation (TSAT)&amp;lt; 20 % and/or low serum iron (≤ 10 μmol/L). Intravenous (IV) iron treatment was defined as at least one infusion of iron isomaltoside, iron sucrose, or sodium ferric gluconate. The secondary analyses were performed in terms of IV iron treatments. Results Of the cohort of 556 IBD patients, 223 (40.1%) had an anemia diagnosis. Among the latter, 39 patients received an intravenous iron treatment and had laboratory results in the 8 weeks preceding and in the 8 weeks following the treatment. Table 1 shows the response to intravenous iron treatment in patients with baseline Hb &amp;lt; 12,0 g/dL (n=28 patients, 47 IV iron infusions). Table 2 shows the changes in anemia-related laboratory values in the 8 weeks preceding and in the 8 weeks following intravenous iron treatment. Conclusion This was the first study to evaluate the prevalence of iron-deficiency anemia and the real-life impact of intravenous iron treatment among patients living with IBD in Quebec, Canada. The findings will serve as a baseline for subsequent interventions to improve the wellbeing and the quality of life of IBD patients with anemia.

Effect of dapagliflozin on anaemia in DAPA-HF.

Anaemia is common in heart failure and associated with worse outcomes. We examined the effect of dapagliflozin on correction of anaemia in patients with heart failure (HF) and reduced ejection fraction in DAPA-HF. We also analysed the effect of dapagliflozin on outcomes, according to anaemia status at baseline. Anaemia was defined at baseline as a haematocrit <39% in men and <36% in women. Resolution of anaemia was defined as two consecutive haematocrit measurements above these thresholds at any time during follow-up. The primary outcome was a composite of worsening HF (hospitalization or urgent visit requiring intravenous therapy) or cardiovascular death. Of the 4744 patients randomized in DAPA-HF, 4691 had a haematocrit available at baseline, of which 1032 were anaemic (22.0%). The rate of the primary outcome was higher in patients with anaemia (16.1 per 100 person-years) compared with those without (12.9 per 100 person-years). Anaemia was corrected in 62.2% of patients in the dapagliflozin group, compared with 41.1% of patients in the placebo group. The effect of dapagliflozin on the primary outcome was consistent in anaemic compared with non-anaemic patients [hazard ratio (HR) 0.68, 95% confidence interval (CI) 0.52-0.88 vs. HR 0.76, 95% CI 0.65-0.89; interaction P= 0.44]. Similar findings were observed for cardiovascular death, HF hospitalization, and all-cause mortality. Patients with resolution of anaemia had better outcomes than those in which anaemia persisted. Patients with anaemia had worse outcomes in DAPA-HF. Dapagliflozin corrected anaemia more often than placebo and improved outcomes, irrespective of anaemia status at baseline.

Pathogenetic and substitution correction of anemia in patients with malignant neoplasms

Anemia in patients with malignant neoplasms affects the quality of life of the patient and sometimes limits the timely implementation of antitumor treatment. In the pathogenesis of anemia of the malignant neoplasms the largest role play infiltration of the bone marrow by tumor cells, suppression of hematopoiesis by inflammation cytokines, development of functional iron deficiency, reduction of sensitivity of receptors to erythropoietin or its synthesis. The doctor can prescribe effective pathogenetic therapy after evaluating the mechanisms of anemia development in this category of patients. In the article are described in detail the methods of pathogenetic correction of anemic syndrome using parenteral iron preparations, recombinant erythropoietin, indications for their appointment, effectiveness in patients with cancer, as well as possible side effects and complications of therapy. The mechanisms of action, pharmacokinetics, and features of the use of different erythropoietin adents are described. It is shown the effectiveness of erythropoietin preparations in patients with lymphoproliferative disorders based on the results of our own study. A positive response was observed in 77.3 % of patients with non-Hodgkin’s lymphomas, in 61.8 % – with multiple myeloma and 60.9 % with chronic lymphocytic leukemia. It is presented the prognostic factors for the response to erythropoietin therapy and showed own datum in patients with myelodysplastic syndrome (in case of the serum erythropoietin &lt;500 mMU / ml a positive response was found in 35.6 %, with higher level – no response) and with lymphoproliferative disorders (in case of erythropoietin was &lt;130 mMU / ml, the positive response was 80 %, at 130–499 mMU / ml – 63.6 %, and at ≥500 mMU / ml – 25 %). In the article are described the principles of anemia correction using red blood cells transfusions and features of their use in patients with cancer. Special attention is paid to the study of blood saturation as one of the indicators that allow us to assess the adequacy of the gas transport function of blood during red blood cells transfusions. The algorithm for correcting anemia in malignant neoplasms using red blood cells transfusions and erythropoietin agents are presented. It is shown low blood saturation (&lt;60 %) in 32 % hematological malignancie’s patients with a hemoglobin 8.0 g / dL. This datum suggests presence of tissue hypoxia and gives approval to expand the threshold for red blood cells transfusions

Inhibition of HIF prolyl-hydroxylase domain to correct anemia in patients with chronic kidney disease

Since the introduction of recombinant human erythropoietin in the 1980s, the anemia of chronic kidney disease (CKD) can be effectively treated with erythropoiesis-stimulating agents (ESAs) and oral or intravenous iron supplementation. The majority of patients with CKD respond to such treatment; however, some patients do not respond adequately to recommended ESA or iron doses, with higher doses exposing them to an increased risk of adverse effects.1 Although on one hand complete correction of anemia paradoxically worsens patient outcomes, undertreatment of anemia is also associated with reduced quality of life, increased hospitalization rates, more blood transfusions, and higher mortality rate.

Is an Additional Dose of Intravenous Ferric Carboxymaltose Useful in the Treatment of Iron Deficiency Anemia?

Even though a single high dose administration of intravenous ferric carboxymaltose (FC) is supposed to be effective, it is unknown whether the second dose of FC given one week after the initial dose provides additional benefits. The aim of the present study was to investigate whether two doses of intravenous ferric carboxymaltose is more effective than a single dose of intravenous FC for replenishing iron stores and correction of anemia in patients with iron deficiency.

Preclinical Evaluation of ALS20, a New and Improved Lentiviral Vector for Beta-Globinopathies

The ongoing clinical trials, based on the use of lenti-globin vectors for beta-globinopathies, indicate that current vectors require high number of integrations (~3-4 copies per genome) in a pancellular fashion to make a patient transfusion independent, regardless of the genotype. This increased VCN requirement could increase the risk of genome toxicity, limiting the application of these vectors and preventing their use in a reduced myeloablative regimen. To overcome this limitation we designed new vectors, using modification or inclusion of a variety of regulatory genomic elements aiming to increase expression of the beta-globin gene. We performed in vitro and in vivo studies to compare the ability of these constructs to express the therapeutic gene with a low number of integrations and reduced chimerism. We screened new constructs using a CRISPR-Cas9 modified clonal cell line, HUDEPM#13, which derives from the previously described erythroid HUDEP-2 cell line (Kurita, 2013). Upon differentiation, HUDEPM#13 cells produce a hemoglobin variant (HbMut) that can be discriminated by liquid chromatography from the adult hemoglobin (HbA) produced by the transgene in the lentiviruses. Among our candidates we identified a construct, indicated as ALS20, that synthesizes HbA at high level at a single integration (VCN). Moreover, ALS20 produced significantly more HbA per copy than constructs currently utilized in clinical trials, which were reproduced based on the literature (Negre, 2015; Miccio, 2008; and Boulad, 2014) and designated CV-1, CV-2, and CV-3, respectively. In erythroblasts differentiated in vitro from patients with SCD ALS20 produces, on average, 21% HbA at VCN=1(P&lt;0.001). CV1, which proved to be the most powerful among the clinical vectors tested in HUDEP#M13, produces, on average, 14.9% HbA at VCN=1 (P&lt;0.001). Overall, ALS20 expresses 40% more HbA per VCN in patients' cells, confirming results observed in the mutant HUDEP cell line. In a parallel potency assay, we tested ALS20 using beta0/beta0 thalassemic specimens, which represent the most severe phenotype to correct, due to complete absence of HbA production. Statistical analyses indicate that ALS20 produces, on average, 32.5% HbA at VCN=1 (P&lt;0.001). All results were obtained targeting a range between 0 and 3 integrations, using dilutions of the viral product. Our ongoing bone marrow transplantation studies, using a semi-myeloablative conditioning based on busulfan administration on the beta thalassemia Hbbth3/+mouse model, indicate that ALS20 is curative at VCN lower than 1. In fact, mice with an average of 0.8 copies per genome and 65% transgenic chimerism, present Hb levels of 13.6g/dL, reiterating the potential of this new lentivirus in vivo. In immunocompromised NSG mice, injection of human CD34+cells transduced with ALS20 did not trigger tumor formation or meaningful pathological changes. The safety of our vector has been further assessed using an in vitro immortalization assay on primary mouse BM cells, in which no clonal survival has been observed. Finally, genome integration analyses on human CD34+cells infected with ALS20 showed that none of the examined samples had clones that exceeded the 20% abundance threshold, in accordance with the expected level of safety for gene therapy-based approaches. In summary, we have identified a powerful new lentiviral vector with an enhanced ability to synthesize hemoglobin with a low number of integrations. ALS20's performance has been demonstrated in specimens from patients with hemoglobinopathies as well as in mice affected by thalassemia. Treatment of thalassemia and SCD with ALS20 could reduce the risk of cytotoxic events due to high levels of integration, and also lessen the intensity of the myeloablative regimen to correct anemia in patients. This, in addition with its confirmed safety features, makes this construct an outstanding candidate for clinical trial. Disclosures Kwiatkowski: Imara: Consultancy; Apopharma: Research Funding; Terumo: Research Funding; Novartis: Research Funding; bluebird bio, Inc.: Consultancy, Research Funding; Agios: Consultancy; Celgene: Consultancy. Rivella:Meira GTx, Ionis Pharmaceutical: Membership on an entity's Board of Directors or advisory committees; Disc medicine, Protagonist, LIPC, Meira GTx: Consultancy.

ВЛИЯНИЕ МАГНИТНОЙ ОБРАБОТКИ КРОВИ НА НЕКОТОРЫЕ МЕХАНИЗМЫ КОРРЕКЦИИ АНЕМИИ У ПАЦИЕНТОВ С СЕПСИСОМ ПРИ ПРОВЕДЕНИИ ЭКСТРАКОРПОРАЛЬНОГО ОЧИЩЕНИЯ КРОВИ

Background. Anemia is rather common in patients with sepsis and is associated with depression of erythropoiesis&nbsp;by septic mediators.Aim. To study the effect of magnetic treatment of blood on the mechanisms of anemia correction in patients with&nbsp;sepsis.Material and methods. Laboratory parameters of 232 patients with sepsis were under analysis. Magnetic treatment&nbsp;of blood was carried out using the apparatus «HemoSPOK» (Magnomed, Belarus).Results. The use of magnetic blood treatment did not lead to the decrease in the number of erythrocytes (before&nbsp;treatment – 3.63 (3.0; 4.42)×1012/l, after – 3.47 (3.18; 3.62)×1012/l, p=0.916512) and hemoglobin level (before&nbsp;treatment – 109.5 (92.0; 129.0) g/l, after – 106.9 (91.0; 113.0) g/l, p=0.776105). The concentration of iron in blood&nbsp;increased from 5.83 (4.21; 7.13) to 10.0 (6.03; 13.80) μmol/l (p=0.027993). There was a simultaneous rise in ferritin&nbsp;from 210.3 ( 20.5; 311.6) to 545.1 (250.2; 813.2) ng/ml (p=0.027709).Conclusion: Magnetic treatment of blood prevents the development of anemia in patients with sepsis.

Safety and efficacy of intravenous iron isomaltoside for correction of anaemia in patients with inflammatory bowel disease in everyday clinical practice

Aims: Iron deficiency anaemia (IDA) is common in patients with inflammatory bowel disease (IBD), who are often treated with intravenous iron. This observational study aimed to investigate the effectiveness and safety of iron isomaltoside in routine practical care of IDA in IBD patients.Methods: The study included 197 IBD patients designated for treatment with iron isomaltoside. Treatment was administered according to routine practice. Data were recorded at baseline and after approximately 4, 8, and 16 weeks. Efficacy data included haemoglobin (Hb) levels and haematinics, while safety data included adverse drug reactions and safety laboratory variables.Results: Patients received a mean (range) cumulative dose of 1304 (100–3500) mg iron isomaltoside. Hb increased from 10.7(±1.6) g/dL at baseline to 13.1(±1.5) g/dL at the final visit. In addition, serum iron, ferritin and transferrin saturation increased and soluble transferrin receptor decreased. Calprotectin decreased, as did IBD symptom scores, Harvey–Bradshaw Index (Crohn’s disease) and partial Mayo score (Ulcerative colitis). About 8% of patients reported transient adverse reactions, most commonly skin reactions, nausea and vomiting, and 2% SAEs, most frequently tachycardia.Conclusion: Iron isomaltoside was demonstrated to be effective and had a good safety profile in IBD patients in everyday clinical practice in Germany.

The problem of anemia treatment in patients with chronic heart failure.

This article presents the literature review devoted to studying the problem of iron-deficient states in the event of chronic heart failure. The epidemiological indicators, various published data on the impact of anemia on the prognosis of chronic heart failure which show a particular urgency of this problem have been presented. All existing approaches to the treatment of iron deficiency anemia and anemia of chronic diseases in this category of patients have been described. The results of studies on the use of classical oral ferrocorrection, as well as the use of modern approaches – intravenous ferrotherapy, isolated and combined use of recombinant human erythropoietin have been demonstrated. The advantages and disadvantages of each of the methods of anemia correction in patients with chronic heart failure have been discussed. The possible reasons for failures in anemia treatment and the absence of a pronounced impact on the clinical manifestations of chronic heart failure with the use of standard approaches to treatment have been discussed as well.

Is there a difference in phenotype between males and females with non-transfusion-dependent thalassemia? A cross-sectional evaluation

ABSTRACTObjectives: Non-transfusion-dependent thalassemia includes a variety of phenotypes and genotypes that rarely require regular transfusions. However, these patients can experience a wide range of complications. The objective of this retrospective study was to verify whether there is a significant difference in non-transfusion-dependent thalassemia-related complications and treatment among males and females.Methods: We performed a re-analysis of samples evaluated in a previously published cross-sectional study, regarding 96 non-transfusion-dependent thalassemia patients followed at the ‘UOSD Malattie Rare del Globulo Rosso’ Centre of the Cardarelli Hospital in Naples, Italy.Results: We found that females were more anemic than males, but there was no significant difference in prevalence of common complications among genders, except for hypogonadism. Furthermore, the transitory regular transfusions regimen in women who had been pregnant does not seem to have a significant impact on overall prognosis.Discussion: In non-transfusion-dependent thalassemia patients, the lower levels of hemoglobin found in females do not seem to indicate a higher prevalence of complications.Conclusion: This data should be considered in studies with experimental treatments aiming to correct anemia in patients with non-transfusion-dependent thalassemia. It should probably also be taken into account in order to set up different transfusion regimens among genders in transfusion-dependent patients.

Therapeutic correction of anemia in patients with chronic heart failure of ischemic origin with iron’s drugs in combination with quercetin

The aim of the study was to evaluate the effectiveness of anemia's correction in patients with chronic heart failure of ischemic genesis with iron's drugs in comparison with their combination with quercetin based clinical, cardiohemodynamic characteristic, indicators of erythropoiesis and cytokines. Materials and methods. Tere were examinated 120 patients with chronic heart failure due to iscemic heart disease and anemia. Chronic heart failure FC II diagnosed in 49 pations, III FK – 42 and FC IV – 29. Patients with CHF and anemia were divided in 2 groups. 1 group recieved standart therapy and iron’s drugs, the 2 group was additionally assigned quercetin. Hemoglobin, serum iron, erythropoetin and ferritin levels were evaluated. Results. After the therapy, the level of erythrocytes, hemoglobin, hematocrit, serum iron in the first group increased by 5.3, 20.3, 12.8, 40.2 %, respectively, in the II group – by 9.2, 25.6, 14.2 and 62.4 % respectively. The level of erythropoietin before the onset of therapy in both groups significantly exceeded the control indices. After treatment it significantly decreased in the I group by 20.4 %, in II – by 28.2 %. A significant increase of the level of tumor necrosis factor-α, interleukin-1β was determined in both groups of patients with chronic heart failure and anemia, In first group level of tumor necrosis factor -α significantly decreased by 14.2 %, interleukin-1β – on 6.5 %, in II group – by 26.6 % and 28.1 % respectively after the treatment. In the first group the end-diastolic diameter was significantly decreased by 7.7 %, the end-diastolic volume by 9.5 %, the end-systolic diameter by 7.9 %, the end systolic volume by 7.5 %, the ejection fraction increased by 14.4 % and indicators of a 6-minute walk test by 19.4 %, quality of life parameters by 24.2 %, in II group the end diastolic diameter decreased by 11.3 %, the end diastolic volume by 10.2 %, the end systolic diam, eter by 9.4 %, the end systolic volume by 13.6 %, the ejection fraction increased by 18.3 %, the distance of 6-minute walk test improved by 34.0 % the quality of life parameters by 32.9 %. Conclusions. It has been detected, that anemia’s correction in patients with CHF, who received combination of standart treatment with iron’s drugs accompanied by an increase in the level of erythrocytes, hemoglobin, iron, and decreased level in the initially increased levels of erythropoetin, ferritin, tumor necrosis factor-α, interleykin-1β. Favorable changes in erythropoiesis were accompanied by a positive dynamics of the morphofunctional parameters of the myocardium, the distance during the 6-minute walk test and the quality of life indicators. Quercetin, included in the scheme of therapy of patients with chronic heart faiulure and anemic syndrome, potentiated hematopoietic and hemodynamic effects of therapy.

ANEMIA OF CHRONIC KIDNEY DISEASE: NOVEL PHYSIOLOGICAL APPROACHES TO THERAPY BASED ON SIMULATION OF HYPOXIC RESPONSE

Anemia is a modifiable risk factor for the progression of chronic kidney disease (CKD) and is characterized by a decrease in the hemoglobin level, the hematocrit, and the number of circulating red blood cells. In the pre-erythropoietin era blood transfusion was a common practice for the adequate correction of anemia in patients with CKD. However, a recombinant human erythropoietin, that was developed and implemented into a clinical practice three decades ago, made a revolution in the renal anemia treatment. Today the management of anemia is based on the use of exogenous erythropoiesis-stimulating agents, such as erythropoietin and its analogues, as well as an oral or parenteral administration of iron. Nevertheless, despite of the high efficacy in the majority of patients this approach has a negative side. The hemoglobin excursions, increased risk of cardiovascular complications, as well as the development of iron deficiency and chronic inflammation become additional factors in the pathogenesis of anemia associated with the renal failure. In this regard, the development of effective and safe methods of anemia management in CKD is of immediate interest. New medications based mainly on physiological approach are developed. A pharmacological activation of hypoxia-inducible factor (HIF) response is one of them. HIF is the main hormonal regulator of erythropoiesis that stimulates the production of endogenous erythropoietin. It is known that in patients with renal failure, the activation of this factor in response to hypoxia is compromised, resulting in a lack of erythropoietin production. This review covers the new mechanistic views on the hypoxic regulation of erythropoiesis and the production of erythropoietin by the kidneys, and presents the newly discovered interactions between the synthesis of erythropoietin, iron metabolism, and the chronic inflammation. Besides that, ongoing clinical trials of pharmacological HIF activators, such as FG-4592, GSK1278863, AKB-6548, BAY85-3934 are also discussed as a new comprehensive and physiological approach for the treatment of anemia associated with CKD. Preliminary results of the clinical trials demonstrated a high efficiency of HIF activators in the treatment of renal anemia including a high tolerability, an increase in hemoglobin level and its maintenance in the target range, an increase in general capacity for iron binding and a reduction in the serum levels of both ferritin and hepcidin. However, there are some safety-related problems that include proangiogenic and adverse cardiovascular and metabolic complications, so the possibility of their development should be thoroughly studied in long-term clinical trials.