A prospective observational study on the effect of Erythropoiesis stimulating agents in chronic kidney disease Anemia patients

Background and Objectives: Anemia is a frequent complication, and significant morbidity and mortality in patient with chronic kidney disease (CKD). Erythropoiesis Stimulating Agents (ESAs) have become the standard care for anemia t erapy and reduces need for blood transfusions. The bjective of the study was to evaluate the safety and effect of ESAs and to create the awareness among patients regarding the Erythropoiesis stimulating agents through patient i formation leaflets.Methods: The prospective observational study of 6-month duration was conducted in a tertiary care hospital. A total of 162 patients on ESAs were enrolled in the study. Patients were followed for continuously and the mean difference is assessed by monitoring the primary and secondary hematological parameters before and after ESAs administration. Patient information leaflet was given t the patients for education and awareness about ESAs.Results: Out of 162 patients, after the administration of ESAs mean value increase in hemoglobin level was found from base line 6.9g/dL to 11.6g/dL. Significant improvement was noted in CKD anemia patient indicating impact of patient counseli g.Conclusion: It can be concluded that Erythropoiesis Stimulating Agents in treatment of anemia along with effective counseling from clinical pharmacist benefits CKD patients and improves the health outcomes.

Obesity may be erythropoietin dose-saving in hemodialysis patients

BACKGROUND: In dialysis patients, the obesity-survival paradox still requires an explanation. Anemia and high doses of erythropoiesis-stimulating agents (ESAs) are associated with worse outcomes in the hemodialysis (HD) population. In the present study, we explored the relation between obesity and anemia control in a sample of maintenance HD patients in Egypt. METHODS: This multicenter observational study included 733 patients on maintenance HD from 9 hemodialysis centers in Egypt. Clinical and laboratory data as well as average doses of ESAs and parenteral iron were recorded. The erythropoietin resistance index (ERI) was calculated. RESULTS: Obesity, defined as a body mass index (BMI) ≥ 30 kg/m2, was present in 22.6% of the studied population. The target hemoglobin level (10.0–11.5 g/dL) was achieved in 27.3% of non-obese and 25.3% of obese patients, with no significant difference. The median serum ferritin and the values of transferrin saturation index did not differ significantly between these two groups. The weekly ESA dose was significantly lower in obese than in non-obese patients (P = 0.0001). A trend toward higher ESA doses and ERI values was observed in patients with lower BMIs (P < 0.0001). Multiple linear regression revealed that the BMI and urea reduction ratio were the strongest predictors of the ERI. CONCLUSION: Our study adds more evidence to obesity-associated advantages in HD patients. BMI may determine ESA response, with better responses observed in patients with higher BMIs.

Chronic kidney disease-associated anemia: Progress in treatment / 第二军医大学学报

Chronic kidney disease(CKD)-associated anemia is developed during CKD; it is one of the important clinical manifestations and complications of CKD. Presently some novel reagents to ameliorate anemia such as erythropoiesis-stimulating agents and erythropoietin receptor excitomotors, are in the process of clinical trials. In this paper we reviewed the novel remedies for correcting anemia and stimulating erythropoiesis; we also discussed the primary mechanisms and adverse effects of the treatment. The clinical treatment should be chosen according to the advantages and risks of each individual patients, so as to correct anemia, reduce risk of cardiovascular events, and eventually improve the life quality of patients with end-stage renal disease.

Anemia Management Practice in French Hemodialysis Centers.

Objective: Evaluate the hemoglobin (Hb) target values in hemodialysis (HD) patients treated with erythropoiesis-stimulating agents (ESA). Methods: Records of anemia parameters of HD patients treated during year 2012 in 5 French dialysis centers were retrospectively analyzed. Patients were stratified into “annual Hb categories” according to their monthly mean Hb: Low Hb (< 10 g/dL), Ideal Hb (from 10 to ≤ 12 g/dL), High Hb (> 12 g/dL) if they spent ≥ 75% of time in the respective category; otherwise patients were classified as Fluctuating Hb. Results: Out of 636 evaluable patients (mean age 66.6 [SD 14.9] years; male 59.4%), 91.4% received ESA treatment and 74.2% received intravenous iron. Most patients (68.9%) belonged to the Fluctuating Hb category (Ideal 18.7%; High 9.6%; Low 2.8%). Patients in the Fluctuating category experienced more frequently ESA dose changes, transfusions, hospitalizations and comorbidities compared with patients in other Hb categories. Multinomial logistic regression identified presence of at least one comorbidity (odds-ratio [OR]=7.6), hospitalization (OR=2.2), transfusion (OR=2.9), male gender (OR=0.6) and serum ferritin ≥500 vs. <200 μg/L (OR = 0.4) as predictors of Fluctuating vs. Ideal annual Hb category. Conclusions: Only 18.7% of patients had stable Hb levels within the target range according to French and international guidelines; most had fluctuating Hb levels and few patients had a consistently low annual Hb. These findings suggest that development and implementation of improved hematologic assessment and anemia treatment strategies are needed to minimize fluctuating Hb values in HD patients.