Increase In Hb Levels Research Articles

Treatment of iron deficiency in patients scheduled for pancreatic surgery: implications for daily prehabilitation practice in pancreatic surgery

BackgroundPreoperative anemia is a frequent complication in pancreatic surgical patients, and it adversely affects morbidity, mortality, and postoperative red blood cell (RBC) transfusion rates. Iron deficiency (ID) is often the underlying cause of anemia and constitutes a modifiable risk factor.MethodsSingle-center, longitudinal prospective cohort study conducted between May 2019 and August 2022 at the University Medical Center Groningen in the Netherlands. Patients scheduled for pancreatic surgery were referred to the outpatient prehabilitation clinic for preoperative optimization of patient-related risk factors. Patients were screened for anemia (< 12.0 g/dL in women and < 13.0 g/dL in men) and ID (either absolute [ferritin < 30 µg/L] or functional [ferritin ≥ 30 µg/L + transferrin saturation < 20% + C-reactive protein > 5 mg/L]). Intravenous iron supplementation (IVIS) (1,000 mg ferric carboxymaltose) was administered to patients with ID at the discretion of the consulting internist. Pre- and postoperative hemoglobin (Hb) levels were assessed, and perioperative outcomes were compared between patients receiving IVIS (IVIS-group) or standard care (SC-group).ResultsFrom 164 screened patients, preoperative anemia was observed in 55 (33.5%) patients, and in 23 (41.8%) of these patients, ID was the underlying cause. In 21 patients, ID was present without concomitant anemia. Preoperative IVIS was administered to 25 patients, out of 44 patients with ID. Initial differences in mean Hb levels (g/dL) between the IVIS-group and SC-group at the outpatient clinic and one day prior to surgery (10.8 versus 13.2, p < 0.001, and 11.8 versus 13.4, p < 0.001, respectively) did not exist at discharge (10.6 versus 11.1, p = 0.13). Preoperative IVIS led to a significant increase in mean Hb levels (from 10.8 to 11.8, p = 0.03). Fewer SSI were observed in the IVIS-group (4% versus 25.9% in the SC-group, p = 0.02), which remained significant in multivariable regression analysis (OR 7.01 (1.68 – 49.75), p = 0.02).ConclusionID is prevalent in patients scheduled for pancreatic surgery and is amendable to preoperative correction. Preoperative IVIS increased Hb levels effectively and reduced postoperative SSI. Screening and correction of ID is an important element of preoperative care and should be a standard item in daily prehabilitation practice.

Iron- and protein rich diets may boost hemoglobin levels among informal electronic waste recyclers exposed to metals at Agbogbloshie, Ghana

While human exposure to metals may play a role in the pathogenesis of anemia, consumption of balanced diets may boost blood hemoglobin (Hb) levels in humans. Although informal electronic waste (e-waste) recycling processes have recently drawn attention as an important source of pollution, there is almost no empirical evidence on the relationship between diet, metals exposure and anemia among e-waste recyclers. Therefore, we evaluated possible ameliorating effects of diet on metal exposure related anemia, as measured by Hb levels of e-waste recyclers and a reference population in Ghana.This repeated measure study used data collected from e-waste recyclers (n=142) and a reference population (n=65) between March 2017 and October 2018. Stored whole blood samples were analyzed for the following metals; Cd, Pb, Rb, Tb, Tl, and Eu. Next, Hb levels were analysed using the URIT-810® semiautomatic biochemistry analyzer. Furthermore, a 48-hour dietary recall questionnaire was administered to assess dietary intake parameters such as protein, folate, carbohydrates, Fe, Ca, Mg, Se, Zn, and Cu. Ordinary regression models were used to estimate joint effects of metals and nutrients on Hb levels.At baseline, the mean Hb was lower among recyclers (12.99 ± 3.17 g/dL) than the reference group (13.02±2.37 g/dL). Blood Pb, Cd, Rb, Eu and Tb were associated with significant decreases in Hb levels of e-waste recyclers. Dietary intake of proteins and Fe was associated with concomitant increase in Hb levels of both groups as well as when analysis was restricted to recyclers. Despite the high exposure of e-waste recyclers to a myriad of metals, consumption of Fe-rich diets appears to ameliorate anemia and improved Hb levels (β=0.229; 95% CI: 0.013, 0.445; p=0.04). Therefore, the consumption of Fe and protein-rich foods may boost blood Hb levels in e-waste recyclers, even though exposure to high levels of metals is a predictor of anemia among this worker-group.

IL-6 inhibitors and JAK inhibitors as favourable treatment options for patients with anaemia and rheumatoid arthritis: ANSWER cohort study.

Anaemia, a common comorbidity of RA, is related to high disease activity and poor prognosis. It is unknown which biologic/targeted synthetic (b/ts)-DMARDs are optimal for patients with anaemia and RA in regulating anaemia and controlling disease activity. We investigated the change in haemoglobin (Hb) levels, drug retention rates and disease activities after the administration of b/ts-DMARDs with different modes of action [TNF inhibitors (TNFis), immunoglobulin fused with cytotoxic T-lymphocyte antigen (CTLA-4-Ig), IL-6 receptor inhibitors (IL-6Ris) and Janus kinase inhibitors (JAKis)] in patients with RA stratified by baseline Hb levels using the multicentre observational registry for patients with RA in Japan (ANSWER cohort). A total of 2093 patients with RA were classified into three groups based on tertiles of the baseline Hb levels (Hblow, anaemic; Hbint, intermediate; Hbhigh, non-anaemic). IL-6Ri increased Hb levels in all groups (the mean change at 12 months in Hblow was +1.5 g/dl, Hbint +0.7 g/dl and Hbhigh +0.1 g/dl). JAKis increased the Hb level in patients with anaemia and RA and retained or decreased the Hb level in non-anaemic patients (the mean change at 12 months in Hblow was +0.6 g/dl, Hbint 0 g/dl and Hbhigh -0.3 g/dl). In patients with anaemia and RA, overall adjusted 3-year drug retention rates were higher in JAKi followed by IL-6Ri, CTLA4-Ig and TNFi (78.6%, 67.9%, 61.8% and 50.8%, respectively). Change of disease activity at 12 months was not different among different b/ts-DMARDs treatments. IL-6Ri and JAKi can effectively treat patients with anaemia and RA in a real-world setting.

COMPARISON OF SAFETY AND EFFICACY OF ORAL PROGESTERONE WITH LEVONORGESTREL INTRAUTERINE SYSTEM IN MANAGEMENT OF DYSFUNCTIONAL UTERINE BLEEDING

The retrospective study was conducted in the Department of Obstetrics and Gynaecology, Nishtar Medical Hospital, Multan, to compare the safety and efficacy of oral progesterone and levonorgestrel-releasing intrauterine system (LNG-IUS) for the management of DUB. The study was conducted on 90 patients who fulfilled the inclusion criteria. Participants were randomly divided into groups A (LNG-IUS) and B (oral progesterone). The primary outcomes were Pictorial blood loss assessment chart (PBAC) scores. Secondary outcomes were the evaluation of adverse effects and Hb levels. A comparison of the mean PBAC score showed that LNG-IUS significantly reduced PBAC scores (P&lt; 0.0001). Comparison of post-treatment HB levels showed that LNG-IUS significantly increased Hb level, and the difference between both groups was statistically significant (P&lt; 0.0001). After 6 months, the incidence of adverse effects in group B was 60%, while in group A was 40%. However, hypomenorrhea was more prevalent in group A. It can be concluded that LNG-IUS is a more effective and safe treatment choice for Dub compared to oral progesterone.

#5814 SGLT2 INHIBITORS IN IGA NEPHROPATHY: REAL-WORLD CLINICAL PRACTICE

Abstract Background and Aims Immunoglobulin A nephropathy (IgAn) is a common type glomerulonephritis that often progresses to advanced CKD despite the use of ACEi/ARBs and immunosuppression. DAPA CKD has demonstrated that dapagliflozin reduced the risk of CKD progression in patients with IgAn at high risk of progression (mean eGFR, 43.8 mL/min/1.73 m2, and median urinary albumin-to-creatinine ratio, 900 mg/g) for a median follow up of 2.1 years. EMPA KIDNEY demonstrated that empagliflozin was associated to a lower risk of progression of CKD than placebo in a pool of 853 patients with glomerular diseases also at higher risk of progression at 2 years of follow up. Based on both RCT, SGLT2i have been proposed as new therapeutic tools for management of IgAn. However, there is a lack of studies in real-world clinical practice. Thus, we aimed to evaluate the renal effect of SGTL2i at 12 months in a cohort of patients with biopsy proven IgAn. Method Multicenter retrospective observational study including all patients with biopsy proven IgAn who received SGLT2i in 2 hospitals in Spain. Results 19 patients were included, followed up for 12 months. 73,7% were men with a mean age of 48,37±16,74 and a mean evolution of IgAn of 3,5 years before SGLT2i initiation. 21% presented type 2 DM. Oxford scores were: M0 68,42%, M1 26,31%; E0 78,95%, E1 5,79%; S0 68,42%, S1 26,31%; T0 84,21%, T15,26%, T2 5,26%. No patient presented with crescents, and 63-42% presented IF and TA. Before SGLT2i, 21% have received immunosuppression, and 2 were on steroids at the time of SGLT2i initiation (one budesonide). 94,7% were on ACEi/ARBs. 57,9% received dapagliflozin, 15,8% empagliflozin and 26,3% canagliflozin. At baseline, patients showed creatinine 1,10 (0,91-1,49) mg/dL, eGFR 69,84±28,446 ml/min/1.73 m2, and UACR 315,00 (210,75-590,75) mg/g. As showed in Table 1, there is a transient decline in eGFR at month 1 after SLGT2i but then, there was a tendency to an improvement in eGFR (from 69,84±28,446 at baseline to 87,83±31,33), and a tendency to a decrease in UACR from 315,00 (210,75-590,75) at baseline to 152,00 (86,75-423,75) at month 12. From month 3 after SGLT2i, a significant decrease in uric acid was observed, and, at month 6, better systolic and diastolic BP control was achieved. A tendency to higher Hb levels was also observed, as well as a decrease in weight at the end of follow up. Interestingly, SGLT2i withdrawal was only necessary in 1 patient who presented acute pyelonephritis and AKI, requiring dialysis (baseline eGFR 20 ml7min.1.73 m2 and previously known episodes of urinary tract infection). No other adverse events were found. Conclusion In a cohort of patients with IgAn at high risk of progression, a stabilization of renal function was found at 12 months after SGLT2i initiation, with no decrease in eGFR and no increase in UACR. Treatment with SGLTi was associated to a decrease in uric acid levels, a better blood pressure control, and to an increase in Hb levels. Thus, in real-world clinical practice, SGLT2i seem to be a promising therapy for modifying the clinical course of IgAn with a favorable safety profile.

Direct Supervision of Daily Consumption of Blood Supplement Tablets During Menstruation Can Increase Adolescent Hemoglobin Levels

Consumption of blood supplement tablets (TTD) during menstruation is one effort to prevent anemia. The Ministry of Health recommends taking one tablet supplements weekly and one tablet daily during menstruation. However, adherence of TTD consumption still low among adolescence. The purpose of this study was to determine the effect of direct supervision of tablets consumption on hemoglobin level of adolescent girls. This research is a quasi-experimental with pretest-post-test with control group. Samples are female students of Islamic Boarding School at Bengkulu City. A total sample of 56 female students consisting of 28 intervention group and 28 control group was taken by systematic random sampling. Data were analyzed using t-test. TTD were given every day during menstruation until 2 months. Hemoglobin levels baseline were measured at the first day after menstruation and post HB level were measured at the third month of menstruation. The results showed that the baseline of mean HB in intervention group was 12.2 gr and control group was 12.74 gr and after intervention, the mean of HB increases in intervention group by 1.13 gr and in control group by 0.4 gr. There was a difference in average of hemoglobin levels before and after intervention between the two groups, the difference was 0.79 gr (p 0.000 &lt; α 0.005). Supervision of TTD consumption by the closest person like teacher was important for students, it can promote adherence of TTD consumption, which can increase HB levels and lower anemia among adolescent.

#2959 EFFICACY AND SAFETY OF ROXADUSTAT IN PATIENTS WITH ANEMIA OF DIALYSIS-DEPENDENT CKD WITH OR WITHOUT INFLAMMATION: A POOLED ANALYSIS OF 4 PHASE 3 STUDIES

Abstract Background and Aims Erythropoiesis-stimulating agents (ESAs) are commonly used to treat anemia of chronic kidney disease (CKD). ESA hyporesponsiveness is prevalent in a significant portion of patients with CKD, especially those with end-stage renal disease on dialysis. Inflammation has been reported to contribute to ESA hyporesponsiveness and is associated with poor outcomes in patients with CKD. Roxadustat, an oral medication, is a hypoxia-inducible factor prolyl hydroxylase inhibitor that has previously demonstrated efficacy in patients with anemia of CKD. This pooled analysis evaluated the efficacy and safety of roxadustat in correcting hemoglobin (Hb) levels in subgroups of patients with dialysis-dependent (DD) CKD with or without inflammation at baseline. Method Data for this analysis were pooled from four phase 3, randomized, open-label, active comparator−controlled studies (HIMALAYAS [NCT02052310], ROCKIES [NCT02174731], PYRENEES [NCT02278341], SIERRAS [NCT02273726]) in patients with DD CKD. Outcomes evaluated were mean Hb change from baseline to Weeks 28−52 and mean weekly roxadustat dose (mg/kg) at Week 24 in patients with or without baseline inflammation (as determined by high-sensitivity C-reactive protein [hsCRP] level, divided into quintiles). Data were analyzed with an analysis of covariance model with baseline Hb as a covariate. Adjusted least-squares means, their difference, and corresponding confidence intervals were generated from datasets where missing data were imputed using missing at random-based multiple imputation, by treatment group, with baseline Hb, cardiovascular/cerebrovascular/thromboembolic history, geographical region (United States vs non-United States) and incident vs stable dialysis (≤4 vs &amp;gt;4 months) as predictor variables. Safety data were summarized descriptively. Results In total, 4072 patients with DD CKD (roxadustat N = 2022; ESA N = 2050) were evaluated. At baseline, mean Hb levels (g/dL [SD]) were similar in the roxadustat (9.80 [1.29]) and ESA (9.83 [1.29]) groups, regardless of baseline hsCRP levels (roxadustat hsCRP quintiles 1−5: 9.72 [1.43], 9.78 [1.27], 9.80 [1.32], 9.90 [1.18], and 9.79 [1.23], respectively; ESA hsCRP quintiles 1−5: 9.75 [1.34], 9.92 [1.23], 9.90 [1.23], 9.96 [1.23], and 9.62 [1.38], respectively). Hb change from baseline was greater in patients treated with roxadustat compared with ESA, regardless of baseline hsCRP levels (Fig. 1). At Week 24, patients with higher baseline hsCRP levels did not require higher doses of roxadustat compared to patients with lower baseline hsCRP levels (Fig. 2). The overall percentages of patients with at least one treatment-emergent adverse event were similar for patients treated with roxadustat (hsCRP quintiles 1−5: 86.7, 88.1, 86.6, 88.7, and 90.0, respectively) or ESA (hsCRP quintiles 1−5: 83.5, 84.6, 90.5, 88.2, and 87.9, respectively) across hsCRP quintiles. Conclusion In patients with anemia of DD CKD, roxadustat increased Hb levels without requiring increased doses of roxadustat in patients with or without baseline inflammation. Results from the current analysis suggest that roxadustat is effective, with a comparable safety profile to ESA, regardless of inflammation status.

#5534 HIFS AND BUTS: A NETWORK META-ANALYSIS OF HIF-PH INHIBITORS AND ESAS IN NDD-CKD PATIENTS WITH ANEMIA COMPARING THEIR SAFETY AND EFFICACY

Abstract Background and Aims Hypoxia-inducible factor prolyl hydroxylase inhibitors (HIF-PHIs) are a new class of oral medicines for the management of anemia in CKD patients. These agents are found to be efficacious in the management of renal anemia, however safety is still under scrutiny. While, ESAs (Erythropoietin stimulating agents) are available since long with a well-established clinical profile. This network meta-analysis aimed to compare the safety and efficacy of HIF-PHI vs ESA in CKD patients with anemia not undergoing dialysis. Method An electronic database search was carried out in EBM (Evidence Based Medicine) Reviews, Cochrane Library and PubMed from inception to July 2022 for phase III clinical trials comparing six different HIF-PHIs and ESA for treating anemia in non-dialysis-dependent (NDD) CKD patients. The outcomes included the serious adverse events (SAEs) and change in hemoglobin (Hb) levels. Results Total 163 records were identified out of which 6 studies involving a total of 6847 patients were eligible for analysis. Compared to ESA, all HIF-PHIs increased risk for SAEs (daprodustat of RR, 1.21[95% CI, 0.825–1.77]; desidustat, 1.38[95% CI, 0.695–2.76]; enarodustat, 1.29[95% CI, 0.568–3.02]; molidustat, 1.02[95% CI, 0.585–1.74]; roxadustat, 1.29[95% CI, 0.674–2.57] and vadadustat, 1.01[95% CI, 0.693–1.47]) although these differences were statistically non-significant. When change in Hb was analyzed, there was no statistically significant difference between the two groups. The mean difference in change in HB with various HIFs as compared to ESA were: daprodustat (MD: 0.0796, 95% CI −0.676–0.838), desidustat (MD: 0.120, 95% CI: −0.626–0.883), enarodustat (MD: -0.600, 95% CI: −1.36–0.157), molidustat (MD: -0.309, 95% CI: −1.07–0.449), roxadustat (MD: -0.0702, 95% CI: −0.831–0.692) and vadadustat (MD: -0.0402, 95% CI: −0.802–0.720). Conclusion In terms of safety, HIF PHIs were associated with more SAEs compared to ESA although these differences are not statistically significant. Comparing efficacy, HIF-PHIs and ESA both effectively increase Hb level in NDD-CKD patients without any significant difference. Results of our network meta-analysis suggest the need for larger and long-term studies comparing HIF-PHIs with ESAs to have better understanding of their comparative efficacy and safety profiles.

#2962 EFFICACY AND SAFETY OF ROXADUSTAT IN NON-DIALYSIS-DEPENDENT CKD PATIENTS WITH OR WITHOUT INFLAMMATION: A POOLED ANALYSIS OF FOUR PHASE 3 STUDIES

Abstract Background and Aims Chronic kidney disease (CKD)-associated anemia is commonly treated with erythropoiesis-stimulating agents (ESAs); however, some patients respond inadequately to ESAs. Inflammation may be a cause of ESA hyporesponsiveness. Roxadustat, an oral medication, is a hypoxia-inducible factor prolyl hydroxylase inhibitor that has shown efficacy in patients with anemia of CKD. This pooled analysis examined the efficacy and safety of roxadustat in correcting hemoglobin (Hb) levels in subgroups of patients with non−dialysis-dependent (NDD) CKD with or without inflammation at baseline. Method Data from four phase 3, randomized, placebo-controlled (OLYMPUS [NCT02174627], ALPS [NCT01887600], ANDES [NCT01750190]) or erythropoiesis-stimulating agent−controlled (ESA; DOLOMITES [NCT02021318]) studies in patients with NDD CKD were pooled for this analysis. Mean Hb change from baseline to Weeks 28−52 and mean weekly total roxadustat dose (mg/kg body weight) at Week 24 in patients with or without inflammation at baseline (as determined by high-sensitivity C-reactive protein [hsCRP] levels divided into quintiles) were evaluated with an analysis of covariance model with baseline Hb and baseline estimated glomerular filtration rate as covariates. Safety data were summarized descriptively. Results In total, 3573 patients with NDD-CKD (roxadustat N = 2068; placebo = 1212; ESA N = 293) were evaluated. At baseline, the mean [SD] Hb levels (g/dL) for roxadustat (hsCRP quintiles 1−5: 9.17 [0.82], 9.26 [0.68], 9.18 [0.75], 9.15 [0.74], 9.08 [0.82]), placebo (hsCRP quintiles 1−5: 9.09 [0.74], 9.20 [0.71], 9.15 [0.69], 9.09 [0.71], 9.01 [0.76]), and ESA (hsCRP quintiles 1−5: 9.53 [0.69], 9.53 [0.64], 9.54 [0.73], 9.60 [0.66], 9.53 [0.71]) were similar across hsCRP quintiles. The mean Hb change from baseline to Weeks 28–52 was greater with roxadustat than with placebo, and comparable between roxadustat and ESA, regardless of inflammation at baseline (Fig. 1). At Week 24, roxadustat dose was not increased in patients across hsCRP quintiles (hsCRP quintiles 1−5: 3.3, 3.0, 2.7, 3.1, 3.1 mg/kg, respectively). Roxadustat dose was not significantly higher at Week 24 for patients with moderate-to-high baseline hsCRP levels (quintile 4, &amp;gt;3.48 to ≤8.67 mg/L; least squares mean [LSM], 3.05; 95% CI, 2.80−3.30; quintile 5, &amp;gt;8.67 mg/L; LSM, 3.10; 95% CI, 2.83−3.36) compared with patients with low baseline hsCRP levels (quintile 1, ≤0.71 mg/L; LSM, 3.30; 95% CI, 3.04−3.56; treatment comparison between quintile 1 and quintile 4: LSM difference, 0.25; 95% CI, −0.11 to 0.61; treatment comparison between quintile 1 and quintile 5: LSM difference, 0.20; 95% CI, −0.17 to 0.57; Fig. 2), indicating that patients with increased inflammation at baseline did not consistently require a higher roxadustat dose. The overall percentages of patients with at least one treatment-emergent adverse event were similar across hsCRP quintiles for patients treated with roxadustat (hsCRP quintiles 1−5: 88.7, 91.4, 90.3, 90.7, 90.5), placebo (hsCRP quintiles 1−5: 88.2, 84.5, 89.4, 88.5, 87.9), and ESA (hsCRP quintiles 1−5: 89.1, 90.9, 91.4, 94.1, 94.8). The most common treatment-emergent adverse events were hypertension (hsCRP quintiles 1−5 [%]; roxadustat: 16.8, 16.5, 17.4, 22.2, 18.9; placebo: 7.9, 9.5, 11.8, 9.3, 8.5; ESA: 45.7, 36.4, 39.7, 22.1, 31.2), end-stage renal disease (hsCRP quintiles 1−5 [%]; roxadustat: 21.3, 22.7, 21.1, 24.6, 23.1; placebo: 13.8, 15.9, 15.3, 18.1, 16.5; ESA: 32.6, 36.4, 34.5, 39.7, 36.4), and decreased glomerular filtration rate (hsCRP quintiles 1−5 [%]; roxadustat: 4.6, 5.0, 4.5, 5.3, 5.1; placebo: 2.0, 2.0, 2.4, 1.3, 3.1; ESA: 13.0, 22.7, 19.0, 13.2, 16.9). Conclusion Independent of baseline inflammation status, roxadustat increased Hb levels greater than placebo and comparable to ESA with a similar safety profile. Patients with high baseline hsCRP did not require increased roxadustat doses to maintain Hb levels up to Week 24. These data suggest that roxadustat is effective in patients with anemia of NDD CKD regardless of inflammation status.

The Switch from Ferric Gluconate to Ferric Carboxymaltose in Hemodialysis Patients Acts on Iron Metabolism, Erythropoietin, and Costs: A Retrospective Analysis.

Background and Objectives: Iron deficiency and anemia characterize patients on chronic hemodialysis (HD). Available intravenous iron agents, such as ferric gluconate (FG) and ferric carboxymaltose (FCM), vary in dosing regimens and safety profiles. The aim of the present study was to analyze the modification of the iron status, the correction of anemia, and the economic implications after the shift from FG to FCM therapy in chronic HD patients. We evaluated, during the study, the variations in iron metabolism, assessing ferritin and transferrin saturation, erythropoietin-stimulating agent (ESA) doses and the number of administrations, the effects on anemic status, and consequent costs. Materials and Methods: A retrospective study was performed with a follow-up period of 24 months, enrolling forty-two HD patients. The enrolment phase started in January 2015, when patients were treated with iv FG, and continued until December 2015, when FG was discontinued, and, after a wash-out period, the same patients were treated with FCM. Results: The iron switch reduced the administered dose of ESA by 1610.500 UI (31% of reduction; p < 0.001) during the entire study period and reduced the erythropoietin resistance index (ERI) (10.1 ± 0.4 vs. 14.8 ± 0.5; p < 0.0001). The FCM group had the highest percentage of patients who did not require ESA treatment during the study period. The FCM patients were characterized by higher levels of iron (p = 0.04), ferritin (p < 0.001), and TSAT levels (p < 0.001) compared to the FG patients. The annual cost during FG infusion was estimated at EUR 105,390.2, while one year of treatment with FCM had a total cost of EUR 84,180.7 (a difference of EUR 21,209.51 (20%), saving EUR 42.1 per patient/month (p < 0.0001). Conclusions: FCM was a more effective treatment option than FG, reducing ESA dose requirements, increasing Hb levels, and improving iron status. The reduced ESA doses and the decreased number of patients needing ESA were the main factors for reducing overall costs.

A nonlinear relationship between the hemoglobin level and prognosis of elderly patients with sepsis: an analysis based on MIMIC-IV

To investigate the correlation of hemoglobin (Hb) level with prognosis of elderly patients diagnosed as sepsis. A retrospective cohort study was conducted. Information on the cases of elderly patients with sepsis in the Medical Information Mart for Intensive Care-IV (MIMIC-IV), including basic information, blood pressure, routine blood test results [the Hb level of a patient was defined as his/her maximum Hb level from 6 hours before admission to intensive care unit (ICU) and 24 hours after admission to ICU], blood biochemical indexes, coagulation function, vital signs, severity score and outcome indicators were extracted. The curves of Hb level vs. 28-day mortality risk were developed by using the restricted cubic spline model based on the Cox regression analysis. The patients were divided into four groups (Hb < 100 g/L, 100 g/L ≤ Hb < 130 g/L, 130 g/L ≤ Hb < 150 g/L, Hb ≥ 150 g/L groups) based on these curves. The outcome indicators of patients in each group were analyzed, and the 28-day Kaplan-Meier survival curve was drawn. Logistic regression model and Cox regression model were used to analyze the relationship between Hb level and 28-day mortality risk in different groups. A total of 7 473 elderly patients with sepsis were included. There was a "U" curve relationship between Hb levels within 24 hours after ICU admission and the risk of 28-day mortality in patients with sepsis. The patients with 100 g/L ≤ Hb < 130 g/L had a lower risk of 28-day mortality. When Hb level was less than 100 g/L, the risk of death decreased gradually with the increase of Hb level. When Hb level was ≥ 130 g/L, the risk of death gradually increased with the increase of Hb level. Multivariate Logistic regression analysis revealed that the mortality risks of patients with Hb < 100 g/L [odds ratio (OR) = 1.44, 95% confidence interval (95%CI) was 1.23-1.70, P < 0.001] and Hb ≥ 150 g/L (OR = 1.77, 95%CI was 1.26-2.49, P = 0.001) increased significantly in the model involving all confounding factors; the mortality risks of patients with 130 g/L ≤ Hb < 150 g/L increased, while the difference was not statistically significant (OR = 1.21, 95%CI was 0.99-1.48, P = 0.057). The multivariate Cox regression analysis suggested that the mortality risks of patients with Hb < 100 g/L [hazard ratio (HR) = 1.27, 95%CI was 1.12-1.44, P < 0.001] and Hb ≥ 150 g/L (HR = 1.49, 95%CI was 1.16-1.93, P = 0.002) increased significantly in the model involving all confounding factors; the mortality risks of patients with 130 g/L ≤ Hb < 150 g/L increased, while the difference was not statistically significant (HR = 1.17, 95%CI was 0.99-1.37, P = 0.053). Kaplan-Meier survival curve showed that the 28-day survival rate of elderly septic patients in 100 g/L ≤ Hb < 130 g/L group was significantly higher than that in Hb < 100 g/L, 130 g/L ≤ Hb < 150 g/L and Hb ≥ 150 g/L groups (85.26% vs. 77.33%, 79.81%, 74.33%; Log-Rank test: χ2 = 71.850, P < 0.001). Elderly patients with sepsis exhibited low mortality risk if their 100 g/L ≤ Hb < 130 g/L within 24 hours after admission to ICU, and both higher and lower Hb levels led to increased mortality risks.

The Effect of Red Beans on Increasing HB Levels of Pregnant Women

Hemoglobin level is a measure to find out whether a person has anemia or not. According to Basic Health Research (Riskesdas) (2021) 48.9% of pregnant women in East Java Province experience anemia with an average prevalence of anemia still below the national target of 28%. Low Hb in pregnant women can cause miscarriage, bleeding, birth defects and others. Red bean is one of the foods that contain minerals that are useful in increasing hemoglobin levels in pregnant women. The purpose of the study was to analyze the effect of red beans on increasing HB levels of pregnant women at the Bubakan Pacitan Health Center. The esearch method used is quantitative using the One Group Pretest-Postest Design. The subjects of this study were pregnant women in the first to third trimesters and met the criteria. The sample using Nonprobability Sampling obtained 32 respondents. Data analysis used univariate analysis and bivariate analysis with the Paired Sampel T-Test. The results of this research indicate that is a difference before and after consuming red beans on the increase in hemoglobin levels of pregnant women based on the results of the Paired sampel t-test, a significant probability value of 0.000 is obtained where the probability (Asymp.sig &lt;0.05) means the hypothesis is accepted. There is a difference before and after consuming red beans on the increase in hemoglobin levels of pregnant women at the Bubakan Pacitan Health Center.

Association of hemoglobin levels with radiographic progression in patients with rheumatoid arthritis: an analysis from the BRASS registry

BackgroundTo evaluate baseline hemoglobin (Hb) and radiographic progression over time in patients enrolled in the Brigham and Women’s Rheumatoid Arthritis Sequential Study (BRASS) registry.MethodsThe BRASS is a prospective observational registry of patients with rheumatoid arthritis. BRASS Hb data and total sharp score data were matched with the main BRASS patients. Hb at baseline was categorized per the World Health Organization guidelines. Mean Hb, mean total sharp score, and mean changes over time from baseline to month 120 were summarized (overall, by low/normal Hb, and by current medication at baseline). All analyses were descriptive.ResultsOut of the total (N = 1114) rheumatoid arthritis patients included in the analysis, patients with low Hb at baseline (n = 224 [20%]) had longer disease duration and higher disease activity and reported more pain compared with patients with normal Hb at baseline (n = 890 [80%]). Patients with low Hb at baseline continued to have lower Hb than patients with normal Hb throughout 10 years; although, on average, patients in the low Hb subgroup exhibited a steady increase in Hb levels. A larger increase in total sharp score over time was observed for patients with low Hb than for patients with normal Hb. No meaningful differences potentially attributable to medication at baseline were detected.ConclusionsPatients with low Hb levels at baseline tended to have increased radiographic progression as measured by total sharp score compared with patients with rheumatoid arthritis having normal Hb levels. Patients with low Hb experienced sustained improvements in Hb levels over time, regardless of the class of medication used.Trial registrationClinicalTrials.gov NCT01793103.

Perbandingan Konsumsi Buah Naga dan Sari Kacang Hijau terhadap Peningkatan Kadar Hb pada Ibu Hamil Anemia di Wilayah Puskesmas Mranggen II Kecamatan Mranggen Kabupaten Demak

ABSTRACT &#x0D; Background: Anemia is still a complex health problem in Indonesian women. The most common cause of anemia in pregnancy is lack of nutrients in the body. Pharmacological treatment has side effects faster than non-pharmacological treatment. Natural products that are traditionally used as an additional intake in the prevention of anemia, for example there are dragon fruit, green beans, and so on. &#x0D; Purpose: The purpose of this study was to determine the effectiveness comparison between consumption of dragon fruit and mung bean juice on increasing Hb levels in anemia pregnant women in the Mranggen II Public Health Center, Demak Regency. &#x0D; This type of research is quantitative research with a research design using Two Group Pretest Posttest Design. The population in this study were pregnant women with anemia. Sampling using the entire population of as many as 40 respondents. Giving dragon fruit in the form of pieces shows 100% of the ingredients used and green beans are made by boiling to get the juice from the green beans. The research instrument was the Easy Touch Hb test as a measuring tool for Hb levels. Data analysis used Paired T-Test / T-dependent test. &#x0D; Result: The results showed that the average hemoglobin level of pregnant women with anemia in the intervention group before being given Dragon Fruit had a Mean value of 10.241 g/dl, while after the intervention the Mean value became 11.125 g/dl. The Hb level in the control group before being given Mung Bean Extract had a Mean value of 10.825 g/dl while after being given Mung Bean Extract the Mean value became 11.266 g/dl. The results of the statistical test using the Independent T-Test between the two intervention groups and the control group showed p-values 0.539 which means there is no difference in the effectiveness of giving Dragon Fruit and Green Bean Extract to increase Hb levels in pregnant women with anemia. &#x0D; Keywords: Dragon fruit, Green Beans, Increased Hb levels, pregnancy

PENGARUH KONSUMSI JAMBU BIJI MERAH TERHADAP PERUBAHAN KADAR HEMOGLOBIN PADA IBU HAMIL

Guava (Psidium guajava L) is a fruit that can be used as a functional food ingredient because it has a function for health. The functional properties of guava are caused by the presence of high enough vitamin C. The research objective was to determine the effectiveness of giving guava to increase Hb level in pregnant women. The design of this study is on experimental study with one group pre-test post test design apporoach with populastion 15 pregnant women whe have anemia and sampel get to total sampling. Variabel Independent is of red guava and variabel dependent is increase pregnant women Hb level, the research t-test. The result showed that mother’s Hb level before consume of red guava Mean Mean 1,40 gr/dl, Maximum 2 gr/dl, Minimum 1gr/dl dan Std. Deviation 0,507 gr/dl. Mother’s Hb consent after consuming of guava of read is Mean 1,20 gr/dl, Maximum 2 gr/dl, Minimum 1 gr/dl dan Std Deviation 0,414 gr/dl with p = 0,005.

A Comparative Study to Assess the Safety and Efficacy between Intravenous Iron Sucrose and Ferric Carboxymaltose in the Treatment of Iron Deficiency Anemia in Pregnancy – A Single Center Prospective Observational Study from a Tertiary Care Center.

Abstract Objective: To Compare the safety and efficacy between intravenous iron sucrose and ferric carboxy maltose in the treatment of iron deficiency anemia in pregnancy. Methodology: A Prospective study was conducted on 100 antenatal women with iron deficiency anemia in department of Obstetrics and Gynecology of a tertiary care center in northern India from June 2021 to May 2022. Results: The mean age in group A (Iron Sucrose group) was 25+ 2.83 years and in group B (FCM group) was 24.08+4.45 years. In group A (IS group) the average increase in Hb level was about 1.24 ± 0.29 gm/dl at 3 weeks and 2.62 ± 0.2 gm/dl at 6 weeks. In group B (FCM group) the average increase was about 1.74 ± 0.42 gm/dl at 3 weeks and 4.15 ± 1.94 gm/dl at 6 weeks. In IS group the average increase in ferritin was about 18.83 ± 18.18 ng/dl at 3 weeks and 43.54 ± 31.71 ng/dl at 6 weeks. In FCM group the average increase was about 34 ± 19.83 ng/dl at 3 weeks and 96.62 ± 50.7 ng/dl at 6 weeks. P value at both time periods was 0.0001, which is highly significant. 43 patients (86%) in Group B as compared to 19 patients (38%) in group A showed improvement in anaemia in PBS findings over 3 week and 6 week period, which was statistically significant with a P value of 0.024. In Group A (IS group ) only two patients complained of diarrhoea, two complained of headache, 1 patient complained of nausea ,vomiting, one complained of nausea only, In Group B (FCM group) total 3 patients (6%) complained of minor reactions like nausea, vomiting and itching. There were mild side effects only in both the groups. Conclusion: Intravenous FCM is more efficient and better alternative than iron sucrose in the treatment of iron deficiency anaemia in pregnancy. Key Words: IDA, FCM, IS, Ferritin, Haemoglobin.

MANAGEMENT OF CHRONIC KIDNEY DISEASE THROUGH AYURVEDA– A CASE REPORT

Chronic kidney disease (CKD) affects over 10% of the population and is a signicant public health problem. CKD can lead to end-stage renal disease (ESRD), cardiovascular disease, and premature death. The most common causes of CKD are diabetic nephropathy and hypertensive nephropathy. Diabetic nephropathy is characterized by slowly progressive albuminuria, worsening hypertension, and renal insufciency. Hypertensive nephropathy is more common in elderly people. Diabetic nephropathy can be correlated to upadrava of vata pradhana sannipathika prameha with increase in the Kleda bhava of medodhatu and kapha, and sthanasamsraya in vasthi. Asingle case of diabetic nephropathy admitted in IPD of Ayurveda College Coimbatore was selected for the study. And the case was managed by adopting deepana pachana, samana and rasayana chikitsa. The changes in blood parameters and RFT was noted and systematically analyzed after each treatment. It was found increase in Hb level, and reduction of values of serum creatinine, blood urea, and urinary excretion of albumin. Marked symptomatic improvement was found in the patient. This management may bring some new hope to the patients of diabetic nephropathy which terminates to chronic renal failure and ultimately to death.

Pengaruh Pemberian Jus Buah Naga (Hylocereus Polyrhizus) dan Madu Dengan Kombinasi Tablet Fe Terhadap Peningkatan Kadar Hemoglobin Pada Ibu Hamil Dengan Anemia

&lt;p&gt;&lt;em&gt;According to the World Health Organization (WHO), 40% of pregnant women worldwide suffer from anemia. Anemia in pregnancy is a condition in which pregnant women have Hb levels &amp;lt; 11.00 g% in the I, II and III trimesters or Hb levels &amp;lt; 10.50 g% in the second trimester, because there are differences in hemodilution, especially in the second trimester. Efforts to overcome iron deficiency anemia in pregnant women can be done medically and non-medically (complementary). The purpose of this study was to determine the effect of dragon fruit juice (Hylocereus Polyrhizus) and forest honey combine with Fe tablets to increase Hb levels in pregnant women with anemia in the Working Area of Harapan Raya Community Health Center Pekanbaru in 2022. The type of this study was a Quasy Experiment, with a design a one-group pretest-posttest study, namely by conducting a pre-test study of Hemoglobin levels in research subjects and then giving treatment to research subjects, after that a post-test assessment of Hemoglobin levels was carried out on the research subjects. The results showed that the average Hb level of pregnant women before being given dragon fruit was 10,558 (SD .2107) and after being given dragon fruit, the average Hb level of pregnant women was 11,776 (SD .2716). Based on the results of statistical tests, it was found that there was an effect of giving dragon fruit to increase hemoglobin levels in pregnant women (p = 0.000 (&amp;lt;0.05)). The conclusion of this study is dragon fruit juice and honey have an effect in increasing Hb levels in pregnant women with anemia. It is recommended to Harapan Raya Community Health Center Pekanbaru to provide education to pregnant women that Dragon Fruit can be used as an alternative to Fe tablets to increase hemoglobin levels in pregnant women.&lt;/em&gt;&lt;/p&gt;

The Effectiveness Of The Administration Of Beet Juice And Honey Against Increased Hemoglobin Levels In Nursing Mothers

WHO in 2020, said some 295,000 women worldwide lost their lives during and after pregnancy and childbirth. Africa, sub-Saharan and South Asia account for around 86% of all maternal deaths worldwide. MMR in Indonesia in 2020 is 230 per 100,000 live births. Causes of maternal death are bleeding, hypertension, infection, prolonged labour, abortion, CED and anemia (Hb &lt;11gr). The prevalence of anemia in pregnant and lactating women in Indonesia is 48.9%. The impact of anemia on pregnant women will occur during pregnancy, childbirth and the postpartum period. Knowing the effectiveness of giving beetroot juice and honey to increase hemoglobin levels in nursing mothers. Quasy Experiment with Pretest Posttest With Control Group Design The sample in this study were lactating mothers with anemia who were registered at the KIA PMB Samsa Qomariyah register in May-October 2022 as many as 40 people, the sampling technique was total sampling. The average HB level in the intervention group was 10.175 gr/dl pretest and 10.865 gr/dl posttest. The average HB level in the control group was 11.250 gr/dl pretest and 11.275 gr/dl posttest. Beetroot juice and honey are effective in increasing hemoglobin levels in lactating mothers with a p.value of 0.000 (p &lt;0.005). Beetroot juice and honey are effective in increasing hemoglobin levels in nursing mothers. It is expected that breastfeeding mothers consume vegetables and fruit that contain lots of iron and vitamin C to increase HB levels and prevent anemia.

Black Garlic (Allium sativum L.) as Alternative Treatments for Increasing Hb and Decreasing Glucose Blood Level

Diabetes and anemia’s treatment with modern technology were still not affordable for some people. Therefore, cheaper and easily to get alternative treatments needs to be provided. Black garlic could be used as alternative treatments due to antioxidant activity from active compounds like flavonoids, tanin, saponin, and sterol. Compared to garlic, black garlic contains more active compounds so that it is expected to be able to work optimally for treatment. This study aims to determine the effect of black garlic extract on Hb and glucose levels. The method used in this study was experimental using a completely randomized design with the extract administered orally for 14 days at a dose of 150mg/Kg BW. The results showed that black garlic extract could increase hemoglobin levels up to 2.15% and reduce glucose levels up to 0.67%. From this experiment, we could know that black garlic extract can be used for increasing Hb levels and lowering glucose levels.