Relationship between Hemoglobin Level Variability and Effect of Repeated Blood Transfusion Therapeutic in Patients with Renal Anemia / 中国实验血液学杂志

OBJECTIVE@#To observe the variability of hemoglobin (HB) level in patients with renal anemia, and to analyze its relationship with effect of repeated blood transfusion therapeutic in patients.@*METHODS@#A retrospective cohort study and propensity score matching method were used, 60 patients with renal anemia who had effective treatment with repeated blood transfusion in Changzhou No.2 People's Hospital from May 2018 to May 2021 were retrospectively analyzed and set as the effective group; 153 patients with renal anemia who had ineffective treatment with repeated blood transfusion in the hospital in the same period were collected and set as the ineffective group, the propensity score matching method was used, the patients who were effective and ineffective in repeated blood transfusion were matched 1∶1 for analysis; the medical records and laboratory indexes of the two groups were checked; the Hb level of patients within 6 months (1/month) were recorded, the residual standard deviation (Res-SD) of Hb of patients was calculated according to the Hb level and evaluated the variability of Hb level; the relationship between HB variability level and therapeutic effect of repeated blood transfusion in patients with renal anemia was analyzed.@*RESULTS@#After propensity score matching, there was no statistical significant difference between the two groups in terms of baseline data such as age, sex, dialysis age and BMI (P>0.05). The levels of serum albumin and transferrin of patients in the ineffective group were significantly lower than those of patients in the effective group (P<0.05); at 1 and 2 months of the observation period, there was no statistical significant difference in Hb levels of patients in both groups (P>0.05); the Hb level of patients in the ineffective group was significantly lower than that of patients in the effective group at 3, 5 and 6 months, and significantly higher than that of patients in the effective group at 4 months (P<0.05); the Res-SD of male patients and female patients in the ineffective group were respectively significantly higher than that of male patients and female patients in the effective group (P<0.05). Logistic regression analysis results showed that high variability of Hb level (Res-SD) was a risk factor for the ineffective treatment of repeated blood transfusion in patients with renal anemia (OR>1, P<0.05); the decision curve results showed that, when the high-risk threshold was 0.0-1.0, Res-SD predicted the net benefit rates of male and female patients with renal anemia were greater than 0, which was clinically significant, the smaller the high-risk threshold in the above range, the greater the net benefit rate.@*CONCLUSION@#The therapeutic effect of repeated blood transfusion in patients with renal anemia may be related to the variability of Hb level.

Analysis of medication rules of traditional Chinese medicine in treatment of renal anemia based on data mining / 中国药房

OBJECTIVE To carry out data mining on the prescriptions of traditional Chinese medicine （TCM） for the treatment of renal anemia， and to explore the medication rules of TCM in the treatment of renal anemia. METHODS The Chinese and English databases including PubMed， the Cochrane Library， Web of Science， CNKI， Wanfang， VIP and CBM were searched by computer to screen the related literature about TCM in the treatment of renal anemia. Excel software was used to extract prescription information， including frequency of use， property and flavor， meridian tropism and efficacy of single TCM. Association rule analysis and hierarchical clustering analysis were performed for each ingredient of TCM with R language. RESULTS A total of 268 literature were included， involving 169 ingredients with a total use frequency of 3 919 times. Among them， Astragalus memeranaceus， Angelica sinensis， Atractylodes macrocephala， Rheum officinale， Poria cocos， Radix Rehmanniae Praeparata， Radix Codonopsis， Salvia miltiorrhiza and Ligusticum chuanxiong were used more than 100 times. The properties and flavors of the drugs were mainly warm and sweet； meridian tropism mainly targeted spleen， liver and kidney； the function was mainly in replenishing qi， nourishing blood， promoting blood circulation and removing blood stasis， and clearing damp and promoting diuresis， purgation. The result of association rule analysis showed that the core ingredients were A. memeranaceus， A. sinensis， A. macrocephala， P. cocos and S. miltiorrhiza. Hierarchical cluster analysis showed that the clustering results were divided into grade 1， 2 and 3， and the cluster classification of A. memeranaceus and A. sinensis was always the same. CONCLUSIONS The core prescription for treating renal anemia includes A. memeranaceus， A. sinensis， A. macrocephala， P. cocos and S. miltiorrhiza； among them， A. memeranaceus and A. sinensis are at the center of the core prescription and indispensable. The medication rule is mainly guided by drugs for invigorating qi， nourishing blood， strengthening spleen， and removing dampness. According to the characteristics of different symptoms of patients， dialectical treatment is made， and other TCM is added or subtracted on the basis of the core prescription.

Clinical Observation of Roxadustat in the Treatment of Chronic Kidney Disease Combined with Renal Anemia / 中国药房

OBJECTIVE：To observe the efficacy and safet y of roxadustat in the treatment of chronic kidney disease （CKD） combined with renal anemia. METHODS ：The data of 80 inpatients with CKD combined with renal anemia treated in the nephrology department of the First Affiliated Hospital of Anhui University of Science and Technology during Nov. 2019 to Dec. 2020 were analyzed retrospectively. They were divided into observation group （40 case）and control group （40 case）according to different treatment methods. Control group was given Human erythropoieti n for injection subcutaneously ，100-150 IU/kg every week，3 times a week. Observation group were given Roxadu- stat capsules orally ，100 mg each time for dialysis patients with a bodyweight of 45-＜60 kg，70 mg each time for non- 717060193@qq.com dialysis patients ，3 times a week ；120 mg each time for dialysis patients with bodyweight ≥60 kg and 100 mg each time for non-dialysis patients ，3 times a week. After 4 weeks of treatment ，the dosage of the two groups w as adjusted according to the level of hemoglobin （Hb）. Treatment course of 2 groups were 12 weeks. The levels of anemia indexes （Hb，red blood cell count （RBC），hematocrit（Hct）），iron metabolism indexes （serum iron （Fe），ferritin（Fer），total iron-binding capacity （TIBC），tranfeerrin saturation （TSAT）），lipid metabolism indexes （total cholesterol （TC），triglycerides（TG），high-density lipoprotein （HDL），low-density lipoprotein （LDL））and inflammation index（C-reactive protein （CRP））were detected in 2 groups before treatment and after 12 weeks of treatment. The levels of Hb were observed in high-level CRP subgroup and low-level CRP subgroup ；the occurrence of ADR was recorded in 2 groups during treatment. RESULTS ：Before treatment ，there was no statistical significance in the anemia indexes ，iron metabolism indexes ，lipid metabolism indexes or inflammation index between 2 groups（P＞0.05）. After treatment ，the levels of Hb ，RBC and Hct in 2 groups and the levels of TIBC and HDL in observation group were significantly higher than before treatment. The levels of Fe ，Fer and TSAT in 2 groups and the levels of TC and LDL in observation group were significantly lower than before treatment ；the levels of Hb ，RBC，Hct，TIBC and HDL in observation group were significantly higher than before control group ，while the level of TC was significantly lower than control group （P＜0.05）. The incidence of high reactivity in observation group was significantly higher than control group ，while the incidence of low reactivity was significantly lower than control group （P＜0.05）. There was no statistical significance in the levels of CRP between 2 groups before and after treatment （P＞0.05）. Subgroup comparison results showed that there was no statistical significance in the level of Hb between high-level CRP subgroup and low-level CRP subgroup of 2 groups before treatment （P＞0.05）. After treatment ，the level of Hb in high-level CRP subgroup of observation group was significantly higher than that of high-level CRP subgroup of control group （P＜0.05）. The total incidence of ADR in observation group was significantly lower than control group （P＜0.05），and no severe ADR was observed in 2 groups. CONCLUSIONS ： Roxadustat can effectively improve anemia in CKD patients with renal anemia ，and curative effect is less affected by inflammatory state，and it has good short-term safety.

Research progress on the relationship between erythropoietin-producing cells and anemia and fibrosis in chronic kidney disease / 解放军医学杂志

The basic features of chronic kidney disease are persistent decline in renal function, accumulation of extracellular matrix, and progressive tissue fibrosis. Renal interstitial fibrosis and renal anemia are common complications of chronic kidney disease. Renal interstitial fibrosis is a chronic and progressive process. Its severity is closely related to renal dysfunction. Renal anemia may increase the incidence of cardiovascular complications and mortality in patients with chronic kidney disease. Therefore, it will be important to note the diagnosis and treatment of these two complications in the early stage of chronic kidney disease. The key cells mediating renal interstitial fibrosis are activated myofibroblasts, which are a major matrix-secreting cell type, and reactive cells mostly present under injury or pathological conditions; while the important factor mediating renal anemia is the reduction of erythropoietin-producing cells, which resulting in decreased secretion of erythropoietin (which is a glycoprotein hormone that promotes erythropoiesis). In addition, the transformation of erythropoietin-producing cells into myofibroblasts underlies the link between anemia and fibrosis in chronic kidney disease, and the transformation is reversible. Targeting this may open a new way for the treatment of renal anemia and renal interstitial fibrosis. In recent years, researchers have tried to find alternative therapies for the treatment of anemia and fibrosis in chronic kidney disease, and traditional Chinese medicine has been increasingly used to treat chronic kidney disease because of its unique advantages. The relationship has been mainly discussed in present paper between erythropoietin-producing cells and anemia and fibrosis in chronic kidney disease, and the current research status of traditional Chinese medicine is then analyzed and summarized.

Application of Vitamin D level in nutritional status evaluation of patients with chronic kidney disease and its significance / 吉林大学学报(医学版)

Objective: To study the Vitamin D levels and deficiency rates in the patients with chronic kidney disease (CKD) in different stages, and to clarify the value of serum Vitamin D levels in the evaluation on nutritional status of the patients with CKD. Methods: The patients diagnosed as CKD in the Department of Nephrology and volunteered to participate in the survey were selected as the subjects. According to the different renal function stages, the patients were divided into early stage (CKD1-2 stage) group (n=115), middle and late stage (CKD3-5 stage) group (n=131) and dialysis group (n=38); the serum 25 (OH) D levels and Vitamin D deficiency rates of the patients in various groups were compared. According to K/DOQI guidelines, the patients were divided into Vitamin D deficiency group (n=196), Vitamin D insufficiency group (n=76), and Vitamin D sufficiency group (n=12); the red blood cell (RBC) count, hemoglobin (Hb), hematocrit (Hct), mean red blood cell volume (MCV), mean red blood cell hemoglobin (MCH), mean red blood cell hemoglobin concentration (MCHC), serum albumin (Alb), prealbumin (PA), total protein (TP), creatinine (Cr), blood urea nitrogen (BUN), 25 hydroxy Vitamin D [25 (OH) D] and urea protein (Up) of the patients in various groups were compared. The serum 25 (OH) D-related factors were analyzed by Spearman correlation analysis method; the influencing factors of serum 25 (OH) D level were analyzed by multiple linear regression analysis. Results: The Vitamin D deficiency rates of the patients in early stage group, middle and late stage group, and dialysis group were 77. 4%, 66. 4%, and 52. 6%, respectively; the serum 25 (OH) D level of the patients in early stage group was significantly lower than those of the patients in middle and late group and dialysis group (P<0. 05); the Vitamin D deficiency rate of the patients in early stage group was significantly higher than that of the patients in dialysis group (P<0. 05). The count of RBC, the level of Hb, and Hct of the patients in Vitamin D deficiency group were significantly lower than those of the patients in Vitamin D insufficiency group (P<0. 05). The Cr levels of the patients in Vitamin D deficiency group and Vitamin D insufficiency group were significantly lower than that in Vitamin D sufficiency group (P<0. 05). The levels of Alb and TP of the patients in Vitamin D deficiency group were significantly lower than those in other two groups (P<0. 05); the level of Up in Vitamin D deficiency group was significantly higher than that in Vitamin D deficiency group (P<0. 05). The Spearman correlation analysis results showed that the serum 25 (OH) D level was positively correlated with the RBC count, Hb level, Hct, MCV, Cr, PA, Alb, and TP levels (r=0. 199, P=0. 01; r=0.232, P<0.01; r=0. 232, P<0. 01; r=0. 131, P=0. 028; r= 0.147, P=0. 013; r=0. 277, P<0.01; r=0.696, P<0.01; r=0.677, P<0. 01); and it was negatively correlated with Up (r= -0. 603, P<0. 01). When 25 (OH) D was selected as the dependent variable, the RBC count, Hb, Hct, MCV, PA, Alb, TP, Cr, and Up as the independent variables, multiple linear regression analysis was performed; as Hb was positively correlated with Hct and the RBC count (r=0. 974, P<0. 01; r = 0.943, P<0. 01) and Alb was positively correlated with TP (r=0. 874, P<0. 01), Hb, MCV, PA, Alb, Cr, and Up were selected as the independent variables in order to avoid collinearity. The multiple linear regression analysis results showed that Alb and Up were the independent factors of 25 (OH) D level. Conclusion: Vitamin D deficiency is a serious problem in the patients with CKD in Dalian area, especially in the patients with early stage CKD. The too low serum 25 (OH) D levels are associated with anemia, hypoproteinemia, and urinary protein loss in the patients with CKD.

Effect of parathyroidectomy on renal anemia in maintenance hemodialysis patients with secondary hyperparathyroidism of uremia / 中国实用内科杂志

OBJECTIVE: To investigate the effect of parathyroidectomy(PTX)on the progression of renal anemia and erythropoietin dose in maintenance hemodialysis(MHD)patients with secondary hyperparathyroidism(SHPT)of uremia. METHODS: A total of 58 MHD patients with SHPT treated with PTX were retrospectively analyzed. The changes of serum intact parathyroid hormone(iPTH), calcium(Ca), phosphorus(P), alkaline phosphatsae(AKP), hemoglobulin(Hb), hematocrit(Hct), serum ferritin(SF), transferrin saturation(TS), c-reactive protein(CRP), albumin(Alb)and Kt/V at 3 months and6 months after PTX treatment were evaluated. The Hb level at 3 and 6 months after surgery and the doses of recombinant human erythropoietin(EPO)were recorded. RESULTS: Serum iPTH decreased dramatically(before PTX 1828.88±811.2 ng/L,three months after PTX 56.75±158.4 ng/L,six months after PTX 64.52±178.5 ng/L, P<0.05); Ca, P and AKP levels also decreased significantly after PTX(P<0.05). Hb increased after PTX(before PTX 99.92±14.26 g/L, six months after PTX123.2±13.65 g/L, P<0.05); meanwhile, the dose of EPO decreased after the operation[before PTX 235.18±62.65 U/（kg·W), three months after PTX 158.78±34.24 U/（kg·W),six months after PTX 112.53±25.37 U/（kg·W), P<0.05]. CONCLUSION: PTX can effectively control secondary hyperparathyroidism, significantly improve the renal anemia, and decrease dose of erythropoietin in MHD patients with SHPT.

Effect of Qingshen Granules on inflammation/hepcidin axis and iron metabolism in patients with renal anemia: a single-center, randomized controlled trial / 南方医科大学学报

OBJECTIVE@#To evaluate the therapeutic effect of Qingshen Granules on renal anemia in patients with damp-heat syndrome and explore the mechanisms in light of inflammation/hepcidin axis and iron metabolism.@*METHODS@#Sixty patients with renal anemia and dampness-heat syndrome were randomized into control group (=30) and treatment group (=30). All the patients were given routine treatment, and the patients in the treatment group received additional treatment with Qingshen Granules (3 times a day). After 12 weeks of treatments, the patients were examined for changes in the integral value of TCM syndrome, serum creatinine (Scr), glomerular filtration rate (eGFR), hemoglobin (HGB), hematocrit (HCT), red blood cell (RBC) count, interleukin-6 (IL-6), hypersensitive C-reactive protein (hs-CRP), ferritin, growth differentiation factor-15 (GDF-15), serum iron (SI), total iron binding capacity (TIBC), transferrin saturation (TAST), soluble transferrin receptor (sTfR) and ferritin levels.@*RESULTS@#After the treatment, the scores of TCM syndrome were significantly improved in the treatment group and were better than those in the control group (=0.000). Scr and eGFR were improved in both groups after the treatment. The levels of HGB, HCT and RBC were all improved in the two groups after treatment, and the improvements were more obvious in the treatment group (=0.002, 0.002, and 0.017, respectively). The levels of IL-6, hs-CRP, hepcidine and GDF-15 were all lowered in the two groups after the treatment, and they were all significantly lower in the treatment group than in the control group (all =0.000). The treatments increased the levels of SI and TAST in both of the groups, and compared with those in control group, the levels of TIBC, sTfR and ferritin were significantly lowered in the treatment group after the 12-week treatment (=0.000).@*CONCLUSIONS@#Qingshen granules can effectively improve renal anemia in patients with damp-heat syndrome possibly by improving iron metabolism through alleviation of inflammation and reduction of hepcidine level.

Therapeutic effect of L-carnitine combined with erythropoietin and iron on renal anemia in rats / 中国比较医学杂志

Objective To investigate the therapeutic effect of L-carnitine combined with erythropoietin (EPO) and iron on renal anemia in rats. Methods The renal anemia rat model was established using adenine. All rats were randomly divided into three groups: control group (group A), EPO combined with iron group (group B), and L-carnitine combined with EPO and iron treatment group (group C). The levels of red blood cells (RBC), hemoglobin (Hgb), hematocrit (Hct), C-reactive protein (CRP), Fe in peripheral blood (Fe), serum ferritin (SF) and transferrin saturation (TS) were measured. Pathological changes in the kidney, liver and small intestine tissues were examined using HE staining. Results Compared with the group A, the levels of RBC, Hgb, Hct, Fe, SF, and TS were significantly increased, however, the level of CRP significantly decreased in the groups B and C (P＜ 0. 05). In the group C, the levels of RBC, Hgb, and CRP was higher than the group B (P＜ 0. 05). Furthermore, the pathological changes in the kidney, liver and small intestine tissues were improved in the groups B and C. Conclusions L-carnitine combined with EPO and iron has a therapeutic effect on renal anemia in rats, thus, it deserves further studies and application.

Comparison of Therapeutic Efficacy and Safety of Jianpi Shengxue Tablets and Iron Polysaccharide Complex Capsules in the Treatment of Nondialysis Renal Anemia / 中国药房

OBJECTIVE:To compare the clinical efficacy and safety of Jianpi shengxue tablets and Iron polysaccharide complex capsules in the treatment of nondialysis renal anemia. METHODS:A total of 60 nondialysis renal anemia patients in our hospital during Mar. 2016 to Mar. 2017 were divided into control group(30 cases)and observation group(30 cases)with random allocation concealment method according to random number and admission order. Both groups received routine treatment as rhEPO injection,Folic acid tablets,Vitamin B12 tablets. Based on it,control group was given Iron polysaccharide complex capsules 0.15 g orally,once a day;observation group was given Jianpi shengxue tablets 1.8 g orally,3 times a day. Both groups were treated for 12 weeks. Clinical efficacies were compared between 2 groups. The levels of Hb,RBC,HCT and Ret％ were observed before treatment and 2,4,8,12 weeks after treatment;the levels of SI,SF and TS were also observed before treatment and 8,12 weeks after treatment. The occurrence of ADR was recorded. RESULTS:Both groups completed the treatment. The total effective rate of observation group(86.67％)was significantly higher than control group(63.33％),with statistical significance(P<0.05). Before treatment,there was no statistical significance in the levels of Hb,RBC,HCT,Ret％,SI,SF or TS between 2 groups (P<0.05). After treatment,the levels of above indexes in 2 groups were significantly higher than before treatment,and observation group was significantly higher than control group(except for Ret％ at 8th week),with statistical significance(P<0.05). The case number of black stool and rust colored stool in observation group were significantly lower than control group,while the incidence of black-dyed teeth in observation group was significantly higher than control group, with statistical significance (P<0.05). CONCLUSIONS:Therapeutic efficacy of Jianpi shengxue tablets are significantly better than Polysaccharide iron complex capsules in the treatment of nondialysis renal anemia,and can significantly improve iron reserve and anaemia. But Jianpi shengxue tablets causes high incidence of black-dyed teeth.

Application Value of Multi Parameter Analysis of Net and Red Blood Cells in the Treatment of Renal Anemia / 现代检验医学杂志

Objective The dynamic changes of hematopoietic function of bone marrow in patients with renal anemiabefore and after treatment and the curative effect of drug treatment were discussed through the detection of the related parameters of the red blood cell.Methods Reticulated red cells using Mindray-6900 automatic blood cell analyzer,54 cases of renal anemia patients were divided into three groups,respectively for renal function of compensatory group,renal function insufficiency decompensation group and renal failure group,and 45 cases of normal healthy group for comparison analysis were used to detect the reticulocyte percentage (RET),immature red blood cell index (IRF),red blood cell (RBC) count,hemoglobin (HB),serum creatinine (CR) and blood urea nitrogen (BUN) were detected before and after treatment of red blood cell hematocrit (HCT) and RET,and through the correction formula to calculatethe net knits red blood cell production index (RPI).The results were compared and analyzed.Results RET in renal failure compensatory group and renal failure group was significantly higher than that of the control group (P＜0.05);IRF％ in renal insufficiency compensatory group was significantly lower than that of control group (P＜0.05).and renal failure compensatory group and renal failure group were significantly higher than those of the control group (P＜0.05);RBC,Hb levels with the levels of bun and Cr increased significantly reduced,in kidney function not full decompensated group was significantly lower than that of control group (P＜0.05).and with the severity of the kidney was decreased gradually.Renal insufficiency compensatory group before and after treatment with HCT(％),Ret(％),HFR(％),MFR(％),RPI the difference was statistically significant (t=2.103,2.062,2.079,2.354,2.368;all P＜0.05),LFR (％) showed no significant difference (t=1.812,P＞ 0.05);renal insufficiency decompensation group before and after treatment with HCT(％),Ret(％),HFR(％),MFR(％),LFR(％),HFR showed significant differences (t =2.228,2.172,2.894,2.185,2.023,2.455;all P＜ 0.05);renal failure group HCT (％),Ret (％),HFR(％),MFR(％) HFR was statistically significant differences before and after the treatment (t=2.148,2.351,2.642,2.086,2.686;all P＜0.05),LFR(％) showed no significant difference (t=1.921,P＞0.05).The ROC area of IRF％ waslarger than other hematological indexes,and its diagnostic sensitivity and specificity were 88.4 ％ and 80.2 ％,respectively,when the critical value was 22.3 ％.Conclusion Reticulocyte erythrocyte parameters can effectively assist physicians in renal anemia patients for diagnosis and treatment,especially the IRF％ and RPI is net woven red cells more sensitive,and the index can more accurately reflect the growth of hematopoietic function of bone marrow and erythroid,worthy of clinical application.

Effect of L-carnitine on renal anemia anemia in maintenance hemodialysis patients and its effects on endothelin and left ventricular remodeling / 药物评价研究

Objective To investigate the effect of L-carnifine on the anemia of renal anemia and its effect on endothelin and left ventricular remodeling in maintenance hemodialysis patients.Methods 206 patients with uremia who underwent hemodialysis for more than 6 months from November 2010 to November 2014 were randomly divided into study group and control group (n =103),control group (n =103).Patients in the study group were treated with intravenous injection of levocarnitine injection on the basis of the control group.After 6 months of treatment,the clinical curative effect of the two groups was observed.Results After treatment,the levels of Hb and HCT were significantly increased,ET levels were significantly reduced,in which the change of patients in the study group was significantly better than the control group (P ＜ 0.05);LAD,LVDs and LVDd of the two groups were different (P ＜ 0.05).The difference between the two groups was statistically significant (P ＜ 0.05).Conclusion L-carnitine combined with erythropoietin in the treatment of renal hemodialysis patients with renal anemia can improve the therapeutic effect,reduce plasma endothelin levels,effectively improve or inhibit the occurrence and development of left ventricular remodeling,effective prevention of heart failure,The effect is remarkable,can promote the use.

Clinical Observation of Ferrous Succinate versus Shengxuening in the Adjuvant Treatment of Renal Anemia in Patients with Diabetic Nephropathy Peritoneal Dialysis / 中国药房

OBJECTIVE:To compare the efficacy and safety of ferrous succinate or Shengxuening in the adjuvant treatment of renal anemia in patients with diabetic nephropathy peritoneal dialysis (CAPD). METHODS:64 diatetic nephropathy CAPD pa-tients with renal anemia were randomly divided into observation group (32 cases) and control group (32 cases). All patients re-ceived subcutaneous injection of insulin for blood glucose control (adjusted the insulin dosage based on fasting blood glucose lev-els),hypertension patients actively controlled blood pressure,corrected acid-base and electrolyte balance disorders,orally received fo-lic acid and vitamin B12,ambulant CAPD,then rhEPO was subcutaneously injected with initial dose of 100-150 U/(kg·week) for 2-3 times and other conventional treatment. Based on it,observation group received 1 g of Shengxuening tablet,3 times a day;control group received 0.2 g Ferrous succinate tablet,3 times a day. The treatment course for both groups was 16 weeks. The rhEPO dose was monthly adjusted to make Hb 100-120 g/L. Clinical efficacy,serum iron,serum ferritin,total iron binding capacity,transfer-rin saturation before and after treatment,Hb,Hct,hs-CRP,rhEPO dose before treatment and after 4,8,12 and 16 weeks of treat-ment,and the incidence of adverse reactions in 2 groups were observed. RESULTS:There was no significant difference in the total effective rate between 2 groups (P>0.05). After treatment,serumiron,total iron binding capacity,transferrin saturation,Hb and Hct in 2 groups were significantly higher than before,and it gradually increased by treatment time,serum ferritin,hs-CRP was sig-nificantly lower than before,and it gradually decreased by treatment time,the differences were statistically significant(P0.05). The rhRPO dose in observation group 8,16 and 16 weeks af-ter treatment and in control group 8 weeks after treatment were significantly lower than 4 weeks after treatment,and 12 and 16 weeks after treatment in observation group were lower than control group,the differences were statistically significant (P<0.05). The incidence of adverse reactions in observation group was significantly lower than control group,the difference was statistically significant(P<0.05). CONCLUSIONS:Based on conventional treatment,both ferrous succinate and Shengxuening show good ef-ficacy in the adjuvant treatment of renal anemia with diabetic nephropathy CAPD,both can improve anemia and iron metabolism, while Shengxuening is superior to ferrous succinate in terms of improving microinflammatory state and reducing rhEPO dose,with better safety.

Clinical Observation of Shengxuening Tablets Reducing the Risk of Microinflammation in Maintenance Ho-modialys with Renal Anemia / 中国药房

OBJECTIVE:To observe the clinical efficacy of Shengxuening tablets reducing the risk of microinflammation in maintenance hemodialysis(MHD)patients with renal anemia. METHODS:60 MHD patients were randomly divided into observa-tion group and control group with 30 cases in each group. The total dialysis times of all the patients were 12 h every week at blood flow of 200-250 ml/min and dialysis flow of 500 ml/min. Both groups received routine treatment;observation group was additional-ly given Shengxuening tablets orally 1.0 g,tid;control group was given ferrous succinate 0.2 g,tid,orally;both groups were giv-en subcutaneous injection of erythropoietin (EPO),10 000 IU/time,once a week;treatment for all of the patients lasted for 3 months. The fasting venous blood sample were collected at the beginning of treatment and in the morning every one months. The levels of hypersensitive C-reactive protein(hs-CRP),tumor necrosis factor α(TNF-α),IL-6,hemoglobin(Hb),and hematocrit (Hct)were detected. RESULTS:After 3 months of treatment,total effective rate of 2 groups were 90.00%,the levels of hs-CRP、TNF-α、IL-6 in observation group were much lower than that before treatment and control group after treatment,with statistical sig-nificance(P<0.05 or P<0.01). No severe ADR was found in 2 groups,and the incidence of ADR in observation group(6.67%) was significantly lower than in control group (13.33%),with statistical significance (P<0.05). CONCLUSIONS:Shengxuening tablets have good curative effect,and they can reduce the risk of microinflammation due to the long-term use of EPO and chalybeate.

Erythropoietin-β in chronical kidney diseases children non-responsive to EPO-α: A case report and review of the literature / 中国药学杂志

OBJECTIVE: To report a clinical case and review the therapy of renal anemia in children with EPO-α non-response to provide ideas on optimization of dosing regimens and new ways of clinical practice. METHODS: One case of renal anemia was described and analyzed, and relevant literature was accessed and reviewed. RESULTS: The level of hemoglobin increased to 100 g·L-1 and the clinical symptoms were alleviated after transfering to EPO-β from EPO-α. CONCLUSION: For pediatric patients with chronic renal anemia, EPO-β instead of EPO-α is effective.

Clinical effect of intravenous iron dextran on peritoneal dialysis patients with renal anemia / 中国综合临床

Objective To investigate the clinical effect of intravenous iron dextran peritoneal dialysis patients with renal anemia.Methods Fifty cases of peritoneal dialysis patients with renal anemia in the Shenzhen Hospital of Peking University from Jan.2010 to Jun.2014 were randomly divided into control group and the observation group,and 25 cases in each group.Patients in observation group were given intravenous iron dextran at dose of 100 mg/time,and 3 times/week.Patients in control group were given ferrous succinate at dose of 200 mg/times orally,and 3 times/day.Both treatment period was eight weeks.Changes in clinical symptoms and treatment of the two groups of patients were recorded.Results Ater eight weeks treatment,the levels of hemoglobin(Hb),red blood cell count (RBC),hematocrit (Hct),reticulocyte count (Ret),total iron binding capacity(TS) and serum iron(SF) in two groups were significantly better than before treatment (P＜0.05 or P ＜0.01).The levels of Hb,RBC,Hct,Ret,TS and SF in observation group after treatment were (91.6± 13.8) g/L,(3.4± 0.4) × 109/L,0.31 ± 0.04,(1.7 ± 0.6) ％,(38.9 ± 6.7) ％ and (525.9 ± 81.4) μg/L,significantly better than those of control group((79.6 ± 13.9) g/L,(3.0±0.7) × 109/L,0.27±0.06,(1.4 ±0.6) ％,(28.1 ±8.4)％ and (377.2 ± 107.2) μg/L),and the differences were statistically significant (P ＜0.05).Total effective rate of observation group were 80％(20/25) and 76％(19/25) in the control group.The difference was not statistically significant(x2 =4.364,P＞0.05).Adverse reactions in observed group was 4％ (1/25) and 8％ (2/25) in control group (x2 =4.895,P ＞ 0.05).Conclusion The therapy of intravenous iron dextran on peritoneal dialysis patients with renal anemia can effectively improve the clinical symptoms,and supply iron for the patient.

Treatment of renal anemia with six patients with Modified Decoction / 中国医师进修杂志

Objective To analyze the clinical effect of the treatment of renal anemia with six noble gentleman decoction.Methods From February 2012 to January 2014,80 patients with renal anemia were randomly divided into groups.The control group received western medicine routine treatment,the experimental group was treated with Ka Miroku' s gentleman decoction.Continuous treatment for 8 weeks,the difference between the two groups were compared and analyzed.Results Statistical data were analyzed by t-test,percentage of red blood cell count after treatment,the patients in the two groups of red blood cell count (RBC),hemoglobin (HB),red blood cell hematocrit (HCT),net fabric (RET),serum iron (SI) and ferritin (SF),transferrin saturation (TSAT),total iron binding capacity (TIBC) and other indicators are on the rise,blood urea nitrogen (BUN),serum creatinine (SCR) and cystatin C (Cys),brain natriuretic peptide (BNP) and other indicators declined,in which each index of the experimental group were improved significantly greater than that of the control group,the difference is statistically significant (P ＜ 0.05).Using chi square test analysis of data statistics,the total effective rate of the experimental group was significantly higher than the control group,the difference was statistically significant (P＜ 0.05).Conclusion Themodified six gentleman Decoction in the treatment of renal anemia is effective,can produce a synergistic effect with western medicine,help to improve the symptoms of anemia in patients with renal anemia,improve the prognosis of patients.

Renoprotective action by erythropoietin via BMP/SMAD signaling pathway in renal anemia in rats and its mechanism / 西安交通大学学报(医学版)

Objective To investigate the protective effect of erythropoietin (EPO)on the kidney of renal anemia rats and further explore the renoprotective action and possible mechanisms.Methods A total of 90 SD rats were randomly divided into 5 groups:normal control rats (NC),simple anemia group (SA),iron + EPO group (IR+EPO),erythropoietin group (EPO),and iron group (IR)with 18 in each.The rats were sacrificed after 4 weeks’ treatment with intragastrically-injected adenine.Serum creatinine (Scr),blood urea nitrogen (Bun),hemoglobin (Hb),hematocrit (Hct),and hepcidin were measured with automated hematology analyzer.The expressions of bone morphogenetic protein-6 (BMP-6 ),a serine/threonine kinase receptor-1 (SMAD-1 )and serine/threonine kinase receptor-4 (SMAD-4)in the kidney were detected by immunohistochemistry and Western blot.Results ①The results of general indicators:BUN and Scr in IR + EPO group and EPO group were lower than those in SA group (P <0.01).Hb and Hct in IR + EPO group and EPO group were increased significantly compared with those in SA group (P <0.01).Hepcidin was significantly increased in simple anemia group (P <0.01).② ELISA results showed that Hepcidin was lower in IR + EPO group and EPO group than in SA group (P <0.01).③ The results of pathological observation indicated that EPO could reduce rat renal pathology and function.④ Immunohistochemistry revealed that SMAD-4,SMAD-1 and BMP-6 were expressed in the rat glomerular cells and renal tubular epithelial cells.⑤ Western blot further indicated that the expression of SMAD-4 was significantly decreased in IR + EPO group and EPO group (P < 0.01 ).The expression of SMAD-1 in IR+EPO group and EPO group was decreased (P <0.05)while that of BMP-6 was elevated in IR+EPO group and EPO group (P <0.01 ).Conclusion The expression and secretion of hepcidin were inhibited by EPO via the BMP/SMAD pathway,which further corrects anemia and exerts a renal protective effect.

Clinical effects observation of levocarnitine combined with sucrose iron injection for treatment of maintenance hemodialysis patients with renal anemia / 中国综合临床

Objective To observe the clinical effects of levocarnitine combined with sucrose iron injection for treatment of maintenance hemodialysis patients with renal anemia.Methods Forty-four cases of patients with maintenance hemodialysis merged renal anemia were randomly divided into control group (n =22) and treatment group(n=22).All patients were administrated conventional therapy.The sucrose iron injection was administrated with control group at hemodialysis, while treatment group administrated levocamitine after hemodialysis on this basis.The hemoglobin (Hb) and erythrocyte specific volume (Hct) were compared after treatment for 8 weeks,and the clinical effects were evaluated.Results After treatment for 8 weeks, the Hb and Hct(treatment group: (105.69±11.94) g/L, (0.31±0.04);control group: (86.31±11.39) g/L,0.27±0.05) had increased significantly compared with prior treatment(treatment group:(62.65± 12.74) g/L, (0.19±0.04;control group: (63.33 ± 13.23) g/L, 0.20± 0.06) in two groups, and the treatment group increased more significant than control group accompanied with significant statistically difference (t =3.197,2.978;P ＜0.05).Also,the total effective rate of treatment group was 86.4％(19/22) ,which higher than control group(50.0％ (11/22)) accompanied with significant statistically difference (x2 =6.705, P＜0.05).Conclusion The therapy of levocarnitine combined with sucrose iron injection can obviously improve anemia symptoms in patients with maintenance hemodialysis and worthy of popularization and application.

Retrospective analysis of renal anemia variability on the patients with chronic kidney disease / 中国综合临床

Objective To investigate the effect of renal anemia variability on the progression of renal function in patients with chronic kidney disease and hemoglobin variability on the incidence of cardiovascularevents,mortality and re-hospitalization rate.Methods one hundred and twenty-three patients with chronickidney disease with stage Ⅲ-Ⅴ were enrolled in this study.The information of hemoglobin variability,creatinineclearance rate (Ccr),renal function,the incidence of cardiovascular events,mortality and rehospitalization rate,the incidence of cardiovascular events,mortality and rehospitalization rate were recorded and analyzed.ResultsThe change of hemoglobin level was (20.6 ± 10.7) g/L and Ccr change level was (16.3 ± 4.1) ml/min inpatients,and the pearson correlation coefficient was 0.82.Multiple covariance analysis showed that Ccr increaselevel was higher in CKD Ⅲ-Ⅴ period patients with hemoglobin fluctuations than that of hemoglobin stabilitypatients after adjusting smoking history,blood pressure,24 h urinary protein quantitative factors (F =7.6,9.1,4.3;P＜0.05).The incidence of cardiovascular events in patients,mortality,rehospitalization rate of hemoglobinwave group were higher than those of hemoglobin stabilizing group(x2 =26.9,5.1,10.6,P＜0.05 or P＜0.01).Conclusion The fluctuation of hemoglobin is able to aggravate quickly of renal function development,increasethe incidence,mortality and rehospitalization rate of cardiovascular events.

Síndrome cardio-renal-anemia en la insuficiencia cardíaca sistólica / Cardio-renal-anaemia syndrome in systolic heart failure

Introducción: en los últimos años ha surgido el término síndrome cardio-renal-anemia (SCRA) para explicar la asociación de insuficiencia cardíaca (IC), disfunción renal y anemia. Tanto la insuficiencia renal como la anemia son reconocidos factores de riesgo de morbimortalidad cardiovascular en la IC. El objetivo de este estudio fue determinar la prevalencia del SCRA y evaluar la asociación entre anemia y disfunción renal, en pacientes portadores de IC sistólica seguidos en forma ambulatoria. Metodología: estudio observacional y transversal de pacientes atendidos en una Unidad Multidisciplinaria de Insuficiencia Cardíaca (UMIC). Participaron en el estudio 339 pacientes. Criterios de inclusión: pacientes con IC sistólica, en condición estable, en ausencia de fracaso renal agudo. Se definió como IC sistólica una fracción de eyección del ventrículo izquierdo (FEVI) < 40%. La función renal se evaluó mediante la estimación del filtrado glomerular (FG), por la ecuación del estudio Modification of Diet in Renal Disease, (MDRD). Se definió como insuficiencia renal (IR) a la presencia de un FG inferior a 60 ml/min/1,73 m2. Resultados: Los 339 pacientes tenían una edad media de 63,2 años con un predominio del sexo masculino (70,5%). El 34,8% de los pacientes tenían IR moderada, severa o falla renal y el 26,5% tenían anemia. La edad media fue mayor en la población con IR (65,7 años) que en el grupo sin IR (61 años) (p = 0,006). Un 27,1% del grupo con IR se encontraba en clase funcional (CF) III-IV en relación con un 12,2% de los pacientes con función renal normal (p < 0.0001). De los pacientes con IR, el 42,8% presentaron anemia, en comparación con un 18,1% del grupo con FG>60 ml/min/1,73 m2 (p < 0,0001). Se observó un fuerte aumento de la anemia por debajo de 35 ml/min/1,73 m2 de FG. (p < 0,001). La prevalencia del SCRA fue de 14,7%, asociándose con una CF más avanzada (p < 0,0001) y una menor FEVI (p = 0,042). Conclusiones: Dada la elevada prevalencia ...

Abstract: Introduction: The recently proposed term of cardio-renal-anemia syndrome (CRAS) stands for the association of heart failure (HF), renal dysfunction and anemia. Both renal failure and anemia are well recognized risk factors for cardiovascular morbidity and mortality in patients with HF. The aim of this study was to determine the prevalence of CRAS and assess the association between anemia and renal dysfunction in ambulatory systolic HF patients. Methods: 339 patients from a Multidisciplinary Heart Failure Unit enrolled in this observational cross-sectional study. Inclusion criteria were to have systolic HF in stable condition in the absence of acute renal failure. Systolic HF was defined by a left ventricular ejection fraction (LVEF) < 40%. Renal function was evaluated though the glomerular filtration rate estimation according to the Modification of Diet in Renal Disease (MDRD) study equation. Renal failure (RF) was defined by the presence of a glomerular filtration rate (GFR) < 60 ml/min/1.73 m2. Results: The mean age of the patients was 63.2. A 70.5% of the total were male. The 34.8% of patients suffered from moderate to severe RF or renal failure, and 26.5% had anemia. The mean age was superior in the RF group (mean 65.7) in comparison with the group without RF (mean 61.0) (p = 0.006). A 27.1% of the RF group had a III-IV NYHA functional class (FC) in comparison with 12.2% of the patients with normal renal function (p < 0.0001). Among RF patients, 42.8% had anemia in comparison with 18.1 % in the group with GFR > 60 ml/min/1.73 m2 (p < 0.0001). A great increase of anemia was observed in patients below 30 ml/min of GFR (p < 0.001). The prevalence of CRAS was 14.7% and it presence was associated with more advanced FC (p < 0.0001) and less LVEF (p = 0.042). Conclusions: In view of the high prevalence of concomitant RF and anemia in patients with heart failure, exploration and early diagnosis of them is essential.