Hemoglobin Levels In Hemodialysis Patients Research Articles

WCN24-2088 Increased eryptosis and inflammatory cytokines are associated with low hemoglobin levels in hemodialysis patients

WCN24-2088 Increased eryptosis and inflammatory cytokines are associated with low hemoglobin levels in hemodialysis patients

Association Between Hemoglobin Levels and Quality of Life in Patients Undergoing Chronic Hemodialysis

Introduction: Anemia is a global problem that can be found almost all over the world. Anemia is the most common complication in patients undergoing chronic hemodialysis which can affect quality of life. Health-related quality of life is a factor that correlates with morbidity, mortality, and patient care costs. This study aimed to assess the correlation between hemoglobin levels and quality of life in patients undergoing chronic hemodialysis. Methods: This study was a cross-sectional study with consecutive sampling of 92 research subjects conducted in November-December 2022 at the hemodialysis installation at Dr. Soetomo General Academic Hospital. This study used the SF-36 questionnaire instrument which was divided into 8 quality of life domains.Results: Of the 92 samples that have been collected, 54 were male patients (58.7%) while 42 were female (41.3%). The average age of the subjects in this study was 47.55 years old. The highest level of education was senior high school graduates with a total of 40 people (43.5%). Hemoglobin levels in 92 research subjects were in the range of 7–3.9 g/dl with an average of 9.70±1.63. Fifty subjects (54.4%) had a poor quality of life and 42 subjects (45.6%) had a good quality of life. The range of total quality of life values was 22.98–89.75 with an average of 59.87±14.16. Conclusion: There was a significant relationship between hemoglobin levels with quality of life of the patients at Dr. Soetomo General Academic Hospital. The higher the hemoglobin level, the higher the total quality of life of the patients. It is recommended to the hemodialysis unit at Dr. Soetomo General Academic Hospital to increase hemoglobin level in hemodialysis patients.

Hand Grip Strength: A Tool of Nutritional Assessment in Prevalent Hemodialysis Patients

Abstract Background Malnutrition is a common problem in patients with end stage renal disease (ESRD) undergoing hemodialysis that is associated with increased morbidity and mortality. There are several clinical, nutritional, and biochemical parameters that may be indicative of PEW in patients using hemodialysis (HD). Handgrip strength is a simple, quick, non-invasive, inexpensive, rapid, and objective procedure. In addition, it has other advantages as a diagnostic/screening tool for nutritional assessment. However, HGS relies on the motivation of the subjects, and therefore it is imperative that researchers and clinicians are sufficiently trained in HGS assessment. L-Carnitine supplementation, levocarnitine is an amino acid derivative which is an essential cofactor of fatty acid metabolism, may improve several situations. Aim of the Work The aim of our study, a longitudinal observational study, is to assess HGS as an independent tool for assessment of the nutritional status in hemodialysis patients. This study can also show the significance of the commitment to high protein diet (1.2-1.4 g/ kg/ d) and receiving L-carnitine (10-20 mg/kg intravenously after each dialysis session) and its effect on the handgrip strength and other studied nutritional tools. Patients and Methods In our study, a longitudinal observational study, study duration was 3 months after washout period; our population is all End Stage Renal Disease patients in Kasr AlAiny Hemodialysis Unit, Cairo University. The unit provides hemodialysis and medical service for 104 patients from whom 50 were excluded and 54 patients were enrolled. Results the study showed comparison between both studied groups regarding the studied laboratory parameters and different nutrition assessment tools showed no statistically significant differences. The study showed Comparison between the effect of high protein diet and L Carnitine (pre and post) in patients of group B on the studied nutritional tools and laboratory parameters. Again HGS was the only tool that showed statistical significance. %BF(body fat) assessed by anthropometry was negativelycorrelated with HGS. Also they found lower HGSvalues in patients on HD with higher estimates of abdominal fatdeposition. Thus, it seems that low muscle mass can occurdespite fat accumulation, and one possible explication for thiswould be the proinflammatory phenotype presented by individualswith abdominal fat deposition. This confirms that subjects can have normal or higher BMI and have a depletionprocess, thus increasing the need for screening proceduresrelated to functional status. Conclusion In this study, we concluded that HGS was the only significant (p value: <.001), while all other nutrition assessment tools didn’t show any significant difference.The correlation between nPCR and HGS was statistically significant (p value:.001, r:.616). L-carnitine supplementation has no role over commitment to high protein diet only regarding improving the nutritional status and hemoglobin level in hemodialysis patients.

48. Correlation of Hypertension and Hemoglobin Level in Hemodialysis Patients

Background: The Indonesian Kidney Registry in 2016 reported that 50% of Chronic Kidney Disease (CKD) patients had hypertension. Controlled blood pressure in CKD patient can minimize the risk of further complications, including anemia. Objective: To determine the relationship between hypertension and hemoglobin levels in CKD patients undergoing routine hemodialysis. Method: This research is retrospective cohort study with purposive sampling method. The subject of this study is CKD patient who underwent routine hemodialysis and met the inclusion and exclusion criteria. The subjects were categorised into two groups, which is subject with controlled hypertension and uncontrolled hypertension. The subjects in this study were still given erythropoietin-stimulating agents. After one month of therapy, hemoglobin level of both groups was classified into three subgroups: increased hemoglobin level, constant hemoglobin level, and decreased hemoglobin level. The data obtained was analyzed with Somers’d test. Result: Of the 129 patients underwent hemodialysis, we got 87 subjects which met all the study criteria. Of the 87 patients, 19 (22%) subjects have controlled hypertension with 5(26%) decrease of hamoglobin and 14 (74%) increase of hemoglobin 68 (78%) subjects uncontrolled hypertension with 33 (48%) decrase of hemoglobin, 3 (4%) no changes of hemoglobin, and 32 (47%) with increase hemoglobin. From the analysis, the p value = 0.044. Conclusion: There is significant relationship between hypertension and hemoglobin level in CKD patients undergoing routine hemodialysis.

The effect of subclinic thyroid pathologies on erythropoietine dose in hemodialysis patients.

The effect of subclinical thyroid pathologies on erythropoietin (EPO) treatment has not been well defined. The aim of the study is to compare the frequency and dose of EPO administration in patients with subclinical thyroid pathology and euthyroid hemodialysis patients. A cross-sectional and retrospective study was conducted with 210 patients. Special conditions were excluded, a total of 191 patients were included. Patients were divided into three groups. The incidences of subclinical hypothyroidism, subclinical hyperthyroidism and euthyroidism were 10.5%, 3.1%, and 86.4%, respectively. Statistically significant difference was found between subclinical hypothyroid and euthyroid patients in terms of the number of patients using EPO (p=0.0207), monthly total EPO doses (p=0.003), and total monthly EPO doses per weight (p=0.001). The EPO dose required to achieve similar hemoglobin levels in hemodialysis patients was significantly higher in subclinical hypothyroid patients than in euthyroid patients.

The Effect of Vitamin D Deficiency Treatment on Hemoglobin Levels in Hemodialysis Patients: A Double-blind, Randomized Controlled Trial

Background: The role of vitamin D deficiency and hemoglobin levels in renal anemia is well established. However, few studies with inconsistent findings have examined the relationship between vitamin D supplementation and the prevalence and severity of anemia in the chronic kidney disease. Objectives: The present study aimed to evaluate the effect of vitamin D deficiency treatment on hemoglobin levels in hemodialysis patients. Methods: The present study was a double-blind, randomized controlled trial on 60 hemodialysis patients aged 18 - 83 years, who were undergoing maintenance dialysis and receiving erythropoietin. All patients with vitamin D (< 30 ng/mL) referred to the dialysis wards of Imam Khomeini, Razi, and Sina hospitals in Ahvaz in 2019, were assigned into two groups. One group was treated with 500 mg oral calcium-D tablets three times a day, and another group was treated with 50,000 units of D-Pearls weekly. The two groups were treated for 12 weeks. Then they were re-evaluated in terms of response to treatment and the rate of improvement in hemoglobin levels and erythropoietin dose. Results: In each intervention group, vitamin D levels increased significantly (P < 0.001). D-Pearls improved vitamin D deficiency; however, the difference was not statistically significant. This study also showed a significant increase in hemoglobin (> 1 unit) in the calcium-D group; however, such a change was not observed in the D-Pearls group (P = 0.3824). Moreover, there was no difference between the two groups in terms of erythropoietin dose (P = 0.98), blood calcium level (P = 0.57), parathyroid level (P = 0.20), and phosphorus (P = 0.99). Conclusions: Despite its significant limitations,this study revealed vitamin D supplements improved vitamin D deficincy, and calcium-D tablets could improve hemoglobin levels in patient.

Low-dose ferrous bisglycinate chelate supplementation in chronic kidney disease and hemodialysis patients

Provision of parenteral or oral iron supplementation can restore iron stores and maintain stable hemoglobin levels in chronic kidney disease (CKD) and hemodialysis (HD) patients. The route for oral or intravenous (IV) administration of iron depends on the acuity of anemia, costs, and patient tolerance. IV iron can restore iron stores rapidly but also carries higher risks for allergy and infection. Oral iron supplementation is limited by high gastrointestinal adverse effects. We conducted an open-label trial to study the efficiency of a film-coated iron supplementation tablet, which contains ferrous bisglycinate chelate, vitamin C, and folic acid, in CKD stage 3b to 4 and HD patients. Twenty-seven HD patients and 20 CKD patients participated this study. After a 16-week intervention, low-dose ferrous bisglycinate chelate improved serum iron concentration (67.8 vs 87.2 mg/dL, p = 0.04) and transferrin saturation (24.7% vs 31.3%, p = 0.03) in stage 3 to 4 CKD patients, restored iron loss, and maintained stable hemoglobin levels in HD patients. No GI upset events were reported. Ferrous bisglycinate chelate is a well-tolerated oral iron supplementation for CKD and HD patients.

The relationship between FGF23 and anemia in HD and renal transplant patients.

Recent studies claim that FGF23 is also associated with anemia and inflammation. In this study, the relationship between FGF23 and anemia in hemodialysis (HD) and renal transplantation patients (RTx patients) patients was investigated. This was a cross-sectional study involving 40 RTx patients (13 females, 27 males; mean age, 45.93 ± 12.49years) who had transplantation at least 6months before, 25 HD patients (12 females, 13 males; mean age, 54.72 ± 15.5years), and 20 healthy control subjects (13 females, 7 males; mean age, 36.7 ± 9.38years). FGF23 was studied using Elisa method. Parameters such as iron, ferritin, total iron binding capacity, and transferrin saturation were assessed. FGF23 level was significantly higher in HD patients when compared with the RTx patients and control groups. In the bivariate correlation analysis, hemoglobin was positively correlated with albumin (r = 0.681, p = 0.000), ferritin (r = 0.446, p = 0.043), and negatively correlated with CRP (r = - 0.476, p = 0.016) and FGF23 (r = 0.493, p = 0.043). FGF23 was found to be an independent predictor of decreased hemoglobin in HD patients. In addition, this association was observed to disappear after transplantation. While FGF23 is closely related to hemoglobin levels in HD patients, we have shown that this relationship disappears after transplantation.

The Change of Haemoglobin Levels in Hemodialysis Patient with The Provision of Nutritional Support

Background : Hemodialysis patients are at risk of anemia, malnutrition, and gastrointestinal disorders. Because of those many nutritional problems, hemodialysis patients need to obtain nutritional support of protein sources, which can be filled with catfish (Clarias sp.) abon. Objectives : This study aimed to determine the change of hemoglobin level in hemodialysis patients with the provision of nutritional support. Method : This was a quasi-experimental with the pre-post test design. The study was conducted at Panembahan Senopati General Hospital in Bantul during January–December 2017. Catfish abon was given to the eligible patients approximately 0.36 g/kgBW/day for 21 days. Subjects were 32 routine hemodialysis patients whose age are >18 years. The dependent variable was hemoglobin level, while the independent variable was the provision of catfish abon. Data were analyzed using univariate and bivariate with paired T-test. Results : The average of pre and post intervention hemoglobin level were 9.24±SD g/dl and 9.50±SD g/dl respectively. There were no differences on average hemoglobin level of hemodialysis patient (p=0.208). Conclusion: provision of nutritional support increases the average of hemoglobin level during the intervention, although it does not statistically affect the hemoglobin level of hemodialysis patients.

A pharmacist-managed dosing algorithm for darbepoetin alfa and iron sucrose in hemodialysis patients: A randomized, controlled trial.

The attainment of target hemoglobin levels in hemodialysis patients is low. Several factors play a role, such as hyporesponsiveness to erythropoiesis‐stimulating agents (ESA), but also suboptimal prescribing of ESA and iron. The goal of this study was to investigate if a pharmacist‐managed dosing algorithm for darbepoetin alfa (DA) and iron sucrose improves the attainment of target hemoglobin levels. In this randomized controlled trial, 200 hemodialysis patients from a Dutch teaching hospital were included. In the intervention group (n = 100), a pharmacist monthly provided dose recommendations for DA and iron sucrose based on dosing algorithms. The control group (n = 100) received usual care. In the intervention group, the percentage per patient within the target range (PTR) for hemoglobin (target range 6.8‐7.4 mmol/L) and iron status was higher than in the control group (for hemoglobin median 38.5% vs 23.1%, P = .001 and for iron status median 21.1% vs 8.3%, P = .003). The percentage of high hemoglobin levels (>8.1 mmol/L) was lower in the intervention group (median 0.0% vs 7.7%, P = .034). The weekly dose of DA was lower in the intervention group (median 34.0 vs 46.9 mcg, P = .020), whereas iron dose was higher (median 75 vs 0 mg). No difference was found for the percentage of hemoglobin levels below the target range. In conclusion, a pharmacist‐managed dosing algorithm for DA and iron sucrose increased the attainment of target levels for hemoglobin and iron status, reduced the percentage of high hemoglobin levels, and was associated with a lower DA and a higher iron sucrose dose.

Different Effects of Iron Indices on Mortality in Patients With Autosomal Dominant Polycystic Kidney Disease After Long-Term Hemodialysis: A Nationwide Population-Based Study

Iron supplementation and erythropoietin stimulating agents (ESAs) are essential for maintaining hemoglobin levels in hemodialysis patients. However, patients with autosomal-dominant polycystic kidney disease (PKD) have higher endogenous erythropoietin levels, so their recommended iron indices for hemodialysis patients may differ. This study evaluated iron profiles, including ferritin levels and transferrin saturation (TSAT) to identify factors affecting mortality in patients on dialysis, and those associated with mortality in patients with and without PKD. This cohort study from the Taiwan Renal Registry Data System stratified mortality risk by the presence of PKD recorded as the underlying disease. We enrolled 1346 hemodialysis patients with PKD and 82,873 hemodialysis patients without PKD. The primary outcome was 3-year all-cause mortality. Predictors included time-averaged and baseline serum ferritin levels and TSAT. Multivariate Cox regression analysis adjusting for age, comorbidities, and relevant laboratory parameters was used to estimate the all-cause hazard ratios (HRs) for mortality. The mean ages of patients with and without PKD were 56.2±13.2 and 61.7±13.5 years and the median follow-up time was 37 (15-76) months. The adjusted mortality risks for time-averaged ferritin levels >800 ng/mL (HR=1.52; 95% confidence interval: 1.40-1.65) or TSAT levels >50% (HR=1.46; 95% confidence interval: 1.30-1.65) were significantly higher among patients without PKD than those for patients with normal iron indices. However, a U-shaped curve of mortality against ferritin/TSAT levels was not observed in patients with PKD. In the sensitivity test, there was no difference among PKD patients who underwent regular ESA therapy and those who did not. Iron indices have different effects on mortality among patients with and without PKD. Iron supplementation, recommended serum ferritin levels, or TSAT should be monitored in hemodialysis patients, especially those without PKD. Clinicians should consider treating anemia in hemodialysis patients individually, especially in PKD.

Long-term maintenance of hemoglobin levels in hemodialysis patients treated with bi-weekly epoetin beta pegol switched from darbepoetin alfa: a single-center, 12-month observational study in Japan.

Recent evidence on maintenance administration of epoetin beta pegol, a continuous erythropoiesis receptor activator (CERA), in dialysis patients shows the clinical benefit of bi-weekly administration (Q2W) in improving hematopoiesis and iron use efficiency. We undertook a single-center observational study of 33 Japanese maintenance dialysis patients, whose anemia had been kept stable through weekly administration (Q1W) of darbepoetin (DA), to evaluate the effectiveness of CERA Q2W switched from DA in maintaining hemoglobin (Hb) levels over a 12-month period. The target Hb level was 10.0-12.0g/dL. Throughout the 12-month period, the mean Hb was stably maintained at 10.5-10.8g/dL, 69.7-87.9% of the patients achieving the target Hb level. The mean CERA dose was within the range of 62.9-78.8µg/2weeks. The average CERA dose adjustment frequency after switching was low at 0.42-0.67 times/3months. In both subgroups stratified by the DA dose prior to the switch, Hb levels were kept stable during CERA administration; however, in the low-dose group (10-20µg/week of DA), the CERA and iron doses decreased over time, whereas in the high-dose group (30-60µg/week of DA) they remained unchanged. CERA Q2W achieved long-term successful anemia management in Japanese maintenance dialysis patients after switching from DA Q1W. CERA dose was adjusted based on an overall consideration of past changes in Hb levels, erythropoiesis-stimulating agent and iron doses. Subgroup analysis showed the CERA dose in the low-dose group decreased continuously, due possibly to a long-term improvement in iron use efficiency.

TCT-842 Correlation between VerifyNow P2Y12 Reaction Unit, Light transmission aggregometry and Hemoglobin level in Hemodialysis Patients

P2Y12 inhibitors are the mainly prescribed antiplatelet drug for patients with coronary artery disease along with aspirin. Because the response of the drug was highly variable among patients, for individualized treatment VerifyNow P2Y12 assay is widely used as a point of care testing. But several

Variability in hemoglobin levels in hemodialysis patients in the current era: a retrospective cohort study.

Background: Given regulatory and reimbursement changes in anemia management, we examined hemoglobin variability in a contemporary cohort of maintenance hemodialysis patients. Materials and methods: The study population included > 200,000 hemodialysis patients with Medicare parts A and B as primary payer on October 1, 2012. Based on 25th and 75th percentiles, monthly hemoglobin values were categorized as low, intermediate, or high. Six variability categories were created by patterns during the 6-month observation period. Stable categories were: always-low, always-intermediate, always-high; variable patterns were: varying between low and intermediate, intermediate and high, low and high (most-variable). Cox proportional hazard models were used to assess the association between hemoglobin variability and all-cause mortality or major adverse cardiac events (MACE). Results: The 25th and 75th hemoglobin percentiles were 10.2 and 11.5 g/dL, respectively, in 2012, vs. 11 and 12.5 g/dL in 2004. ESA doses were lower in all categories in 2012 and transfusion rates higher, particularly for always-low patients. Hemoglobin variability decreased modestly: in 2004, 6.0% were always-intermediate, vs. 9.5% in 2012. In 2012, more patients were always-high and fewer were most-variable. Mortality hazard ratios (HRs) were higher for patients with any low hemoglobin: always-low (HR, 95% CI: 2.07, 1.84 – 2.31), varying between low and intermediate (1.37, 1.29 – 1.45), and most-variable (1.23, 1.16 – 1.31); the pattern was similar for MACE. Conclusions: In 2012 vs. 2004, hemoglobin levels decreased, the range of levels narrowed, and variability decreased modestly; transfusions increased. The highest risk of mortality and MACE appeared to occur in patients with persistently low, rather than highly variable, hemoglobin levels.

Low levels of serum ferritin and moderate transferrin saturation lead to adequate hemoglobin levels in hemodialysis patients, retrospective observational study.

BackgroundOptimal iron levels in patients on hemodialysis are currently unknown, and a higher level than that for the healthy population is usually set for such patients considering the use of erythropoiesis-stimulating agents or the occurrence of chronic inflammation. However, excessive iron causes oxidative stress and impairment of its utilization by cells. Therefore we investigated the relationship between hemoglobin (Hb) level and iron status in hemodialysis patients to identify the optimal iron levels for patients undergoing hemodialysis.MethodsA total of 208 outpatients on maintenance hemodialysis were followed up between July 2006 and June 2007. Men accounted for 64.9% cases [mean age, 59.3 ± 13.1 years and median dialysis history, 7.7 (3.6–13.2) years], and diabetic nephropathy accounted for 25.0% cases. Hemoglobin level was measured twice a month and serum ferritin, serum iron, and total iron-binding capacity were measured once a month. The doses of recombinant human erythropoietin and low-dose iron supplement were adjusted to maintain a hemoglobin level of 10–11 g/dL, according to the guidelines of the Japanese Society for Dialysis Therapy. Hepcidin was measured at baseline. Using the mean values for 1-year period, the relationships among hemoglobin, serum ferritin levels, and transferrin saturation levels were investigated based on a receiver operating characteristic curve and a logistic regression model. In addition, the correlations among serum ferritin, transferrin saturation, and hepcidin levels were analyzed by Pearson product—moment correlation coefficient and linear regression model.ResultsBy receiver operating characteristic curve, the cutoff point of serum ferritin and transferrin saturation levels with a hemoglobin ≥10 g/dL showed <90 ng/mL (sensitivity: 69.1%, specificity: 72.1%, p < 0.001) and ≥20% (sensitivity: 77.6%, specificity: 48.8%, p = 0.302).Upon logistic regression model analysis with a hemoglobin ≥10 g/dL as the endpoint, the analysis of odds ratios relative to a group with serum ferritin ≥90 ng/mL and transferrin saturation <20% revealed that the group with serum ferritin <90 ng/mL and transferrin saturation ≥20% had the highest ratio: 46.75 (95% confidence interval: 10.89–200.70, p < 0.001). In Pearson product—moment correlation coefficient, hepcidin showed a strong positive correlation with serum ferritin [r = 0.78 (95% confidence interval: 0.72–0.83, p < 0.001)] and a weak positive correlation with transferrin saturation [r = 0.18 (95% confidence interval: 0.04–0.31, p = 0.010)]. In the multivariable analyses of the linear regression model, a positive relationship was shown between hepcidin and serum ferritin [β-coefficient of 0.30 (95% confidence interval: 0.27–0.34, p < 0.001)]; however, no relationship was shown with transferrin saturation [β-coefficient of 0.09 (95% confidence interval: −0.31–0.49, p = 0.660)].ConclusionsIn this study, the iron status of serum ferritin <90 ng/mL and transferrin saturation ≥20% was optimal in hemodialysis patients receiving recombinant human erythropoietin for anemia therapy. This result indicates that the threshold values for the optimal iron status may be lower than those currently recommended in iron-level management guideline.

Effect of oral and intravenous iron therapy on hemoglobin levels in hemodialysis patients according to serum ferritin level

For iron therapy in hemodialysis patients, intravenous rather than oral administration is recommended. For hemodialysis patients with serum ferritin levels less than 200 ng/ml (less than 100 ng/ml: 67 patients, between 100 and 199 ng/ml: 20 patients) with no iron therapy for more than 3 months, iron was administered intravenously (40 mg of ferric oxide saccharate for ten times consecutively, N = 40) or orally (50 mg/day of sodium ferrous citrate N = 31, or 1500 mg/day of ferric citrate hydrate N = 16). We conducted the retrospective observational study to evaluate the changes in hemoglobin levels, the dose of erythropoietin-stimulating agents (ESAs), and the ratio of ESA dose/hemoglobin (Hb) levels for 28 weeks. During the first 8 weeks, hemoglobin levels increased and ESA/Hb ratio decreased uniformly with almost the same ESA dose. Subsequently, ESA/Hb ratio increased in patients with intravenous iron but decreased further in patients administered oral iron. ESA dose reduction at the end of the study in the patients receiving intravenous iron, sodium ferrous citrate, and ferric citrate hydrate were 12.2, 33.8, and 39.5 %, and ESA/Hb reduction ratios were 10.3, 34.5, and 37.4 %, respectively. In patients with serum ferritin levels less than 100 ng/ml at baseline, ESA/Hb ratio decreased especially in those receiving oral rather than intravenous iron (p < 0.05), while it did not change with either oral or intravenous iron in patients with serum ferritin levels between 100 and 199 ng/ml. In hemodialysis patients with serum ferritin levels less than 100 ng/ml, oral iron therapy is an effective method to treat anemia.

Twice-monthly administration of a lower dose of epoetin beta pegol can maintain adequate hemoglobin levels in hemodialysis patients.

Epoetin beta pegol is a continuous erythropoietin receptor activator (CERA) with a long half-life. Although CERA has been shown to maintain adequate hemoglobin (Hb) levels at prolonged dosing intervals, the optimal dosing schedule remains unclear. We therefore compared the efficacy of maintaining hemoglobin levels with administration of twice-monthly CERA (TWICE) versus once-monthly CERA (ONCE). Twenty hemodialysis patients receiving epoetin beta (EPO) were enrolled in this crossover study. Patients were assigned to either the TWICE or the ONCE group based on matching Hb levels and EPO doses. After 6 months of treatment, the CERA dosage was interchanged between the groups and the study was continued for an additional 6 months. The effect of the different regimens on iron metabolism was also assessed during the first 6 months of the study. Hb levels significantly increased in the TWICE group, allowing for a reduction in CERA dosage, while the dose of CERA required to maintain Hb levels in the ONCE group remained unchanged. After the interchange, a decrease in Hb levels with incremental increase in CERA dosage was observed in the TWICE→ONCE group, with the opposite effect observed in the ONCE→TWICE group. Although increases in ferritin and hepcidin-25 levels in the ONCE group were noted at one month, they disappeared at 6 months. Although Hb levels were maintained in both the ONCE and TWICE groups, a twice-monthly administration was advantageous, as it required a lower dose of CERA.

Prediction of the hemoglobin level in hemodialysis patients using machine learning techniques

Patients who suffer from chronic renal failure (CRF) tend to suffer from an associated anemia as well. Therefore, it is essential to know the hemoglobin (Hb) levels in these patients. The aim of this paper is to predict the hemoglobin (Hb) value using a database of European hemodialysis patients provided by Fresenius Medical Care (FMC) for improving the treatment of this kind of patients. For the prediction of Hb, both analytical measurements and medication dosage of patients suffering from chronic renal failure (CRF) are used. Two kinds of models were trained, global and local models. In the case of local models, clustering techniques based on hierarchical approaches and the adaptive resonance theory (ART) were used as a first step, and then, a different predictor was used for each obtained cluster. Different global models have been applied to the dataset such as Linear Models, Artificial Neural Networks (ANNs), Support Vector Machines (SVM) and Regression Trees among others. Also a relevance analysis has been carried out for each predictor model, thus finding those features that are most relevant for the given prediction.

Erythropoietin-stimulating agents in the management of anemia of end-stage renal disease patients on regular hemodialysis: a prospective randomized comparative study from Qatar.

Despite extensive use, to the best of our knowledge, no trial has simultaneously compared the three currently used erythropoietin-stimulating agents (ESAs) in a prospective manner in the treatment of anemia of end-stage renal disease patients. All hemodialysis patients in Qatar who were treated with short-acting epoetin alfa or beta have been screened. Eligible patients had been prospectively randomized, either to continue on the previous regimen of epoetin or to receive darbepoetin alfa or continuous erythropoietin receptor activator (CERA) for a total period of 40 weeks. All groups were assessed at the end of the study for safety and efficacy parameters. A total of 327 eligible patients were randomized. Mean hemoglobin concentration remained constant within the recommended target range (11-12 g/dL) throughout the study in the three studied groups. The percentage of patients who reached the target range was constantly above 50% in the second half of the study among CERA group patients who also had significantly lower mean number of dose adjustments as compared with the other two groups (P = 0.001). Similarly, the number of discontinuations of ESA among epoetin, darbepoetin, and CERA groups was 17, 19, and 9, respectively (P = 0.042). The frequencies of adverse events were similar in all groups. This study has specifically compared the effect of ESA type on the variability of serum hemoglobin levels in hemodialysis patients. Furthermore, it confirmed the efficacy and safety of once monthly CERA for maintaining tight hemoglobin control within recommended target ranges.

Comparison of the Effect of Various Products of Erythropoietin on Hemoglobin Level in Hemodialysis Patients

Comparison of the Effect of Various Products of Erythropoietin on Hemoglobin Level in Hemodialysis Patients