Pattern and Severity of Anaemia in Predialysis Chronic Kidney Disease Patients in Bangladesh: A Tertiary Care Hospital Study

Background: Anemia is a common complication in chronic kidney disease (CKD), and is associated with a reduced quality of life, and increased morbidity and mortality. The mechanisms involved in ananaemiassociated with CKD are diverse and complex. They include a decrease in endogenous erythropoietin (EPO) production, absolute and/or functional iron deficiency, and inflammation with increased hepcidin levels, among others. Objective: The objective of our study was to investigate the prevalence and severity of anaemia in pre-dialysis patients, and chronic kidney disease patients in Bangladesh.Material & Methods:This was a case-control prospective study conducted with over 300 Bangladeshi non-patients as the control group A and 87 with different stages of chronic kidney disease (CKD) patients as the case group B in the department of Nephrology BSMMU from April’2004 to June 2006. The normal people who had no history of diabetes mellitus, hypertension, or CKD and were not on any medication were controlled and different stages of the CKD patients who had no history of blood transfusion, erythropoietin and parental iron infusion were cases.Results:Out of 300 normal populations male was 158(52.7%) and the female was 142(47.3%) and the mean haemoglobin level of the male was 13.94 g/dl and the female was 12.29 g/dl. Among males 24(15.2%) and females 55(38.7%) were anaemic and the overall prevalence of anaemia was noted at 26.3%. Of the total anaemic people, 25% was microcytic anemia. Out of 87 CKD patients, 56 (64%) were male and 31 (36%) were female. The overall prevalence of anaemia in CKD patients was 95.4%. The haemoglobin level was <11g/dl in 57.14% patients with CCr 30-59 ml/min/1.73m2 which increases to 87.5 % in patients with CCr 15-29 ml/min/1.73m2, which also increases to 94.2 % in patients with CCr<15 ml/min/1.73m2. Mean haemoglobin was observed at 8.6 g/dl, 9.54 g/dl and 11.25 g/dl in stage V, stage IV and stage III CKD patients respectively. Anaemia appeared at 43.53 ml/min/1.73 m2 of CCR.Conclusions:The results demonstrate that patient with reduced renal function is more likely to have anaemia and the prevalence and severity of anaemia increase with declining kidney function. CCr and TSAT is the important predictor of anaemia. In a significant number of the CKD, patient anaemia was associated with iron deficiency.

Multidisciplinary treatment for patients with chronic kidney disease in pre-dialysis minimizes costs: a four-year retrospective cohort analysis / O tratamento multidisciplinar para pacientes com doença renal crônica em pré-diálise minimiza os custos: uma análise de coorte retrospectiva de quatro anos

Abstract Introduction: Chronic kidney disease (CKD) can progress to end-stage renal disease (ESRD), and clinical studies show that this progression can be slowed. The objective of this study was to estimate the costs to Brazil's public health system (SUS) throughout the course of CKD in the pre-dialysis stage compared to the costs to the SUS of dialysis treatment (DT). Methods: A retrospective cohort study was conducted to analyze clinical and laboratory variables; the outcome analyzed was need for DT. To assess cost, a microcosting survey was conducted according to the Methodological Guidelines for Economic Evaluations in Healthcare and the National Program for Cost Management, both recommended by the Brazilian Ministry of Health for economic studies. Results: A total of 5,689 patients were followed between 2011 and 2014, and 537 met the inclusion criteria. Average costs increased substantially as the disease progressed. The average cost incurred in stage G1 in Brazilian reals was R$ 7,110.78, (US$1,832.06) and in stage G5, it was R$ 26,814.08 (US$6,908.53), accumulated over the four years. Conclusion: A pre-dialysis care program may reduce by R$ 33,023.12 ± 1,676.80 (US$ 8,508.26 ± 432.02) the average cost for each year of DT avoided, which is sufficient to cover the program's operation, minimizing cost. These results signal to public health policy makers the real possibility of achieving significant cost reduction in the medium term for CKD care (4 years), to a program that disbursed R$ 24 billion (US$ 6.8 billion) for DT in Brazil between 2009 and 2018.

Resumo Introdução: Doença renal crônica (DRC) pode progredir para doença renal estágio terminal (DRET). Estudos clínicos mostram que esta progressão pode ser retardada. Objetivo: estimar custos para o sistema público de saúde (SUS) do Brasil durante o curso da DRC no estágio pré-diálise, comparado com os custos para o SUS do tratamento dialítico (TD). Métodos: Conduziu-se estudo de coorte retrospectivo para analisar variáveis clínicas e laboratoriais; o desfecho analisado foi a necessidade de TD. Para avaliar os custos, realizou-se pesquisa de microcustos de acordo com as Diretrizes Metodológicas para Avaliações Econômicas em Saúde e o Programa Nacional de Gestão de Custos, ambos recomendados pelo Ministério da Saúde Brasileiro para estudos econômicos. Resultados: Acompanhou-se um total de 5.689 pacientes entre 2011-2014; 537 preencheram os critérios de inclusão. Os custos médios aumentaram substancialmente à medida que a doença progrediu. O custo médio incorrido no estágio G1 em reais foi R$ 7.110,78 (US$ 1.832,06) e no estágio G5 foi R$ 26.814,08 (US$ 6.908,53), acumulado durante os quatro anos. Conclusão: Um programa de atendimento pré-dialítico pode reduzir em R$ 33.023,12 ± 1.676,80 (US$ 8.508,26 ± 432,02) o custo médio para cada ano de TD evitado. Isso é suficiente para cobrir a operação do programa, minimizando custos. Estes resultados sinalizam aos formuladores de políticas de saúde pública a possibilidade real de alcançar redução significativa de custos em médio prazo para o cuidado da DRC (4 anos), para um programa que desembolsou R$ 24 bilhões (US$ 6,8 bilhões) para TD no Brasil entre 2009-2018.

Periodontal Health of Pre-Dialysis Chronic Kidney Disease Patients in a Northeast Peninsular Malaysia Tertiary Hospital

@#Introduction: Chronic kidney disease (CKD) is associated with periodontal disease due to its hyperinflammatory state. Limited studies have explored the prevalence of periodontal disease among CKD patients in Malaysia. Objective: To assess the periodontal status of pre-dialysis CKD patients in Hospital Universiti Sains Malaysia. Methods: A total of 46 pre-dialysis CKD patients who attended the nephrology clinic at Hospital Universiti Sains Malaysia were enrolled in this study. Periodontal examination was performed using the periodontal probing depth (PPD), clinical attachment loss (CAL) and plaque index. Results: The majority of the CKD patients were Malay (95.7%) and 80.4% were males. The mean age of the patients was 58.5 years. Using PPD measurement, 37 (74.0%) of the patients had mild periodontitis, 9 (20.0%) had moderate periodontitis and 3 (6.0%) had no periodontitis. Based on CAL measurement, 12 (26%) patients had mild periodontitis, 29 (63.0%) had moderate periodontitis and 5 (11%) had severe periodontitis. The mean (standard deviation [SD]) value of mild and moderate-to-severe periodontitis by PPD measurement were 4.26 (0.26) and 5.24 (0.36), respectively. The mean of mild and moderate-to-severe periodontitis by CAL measurement were 2.66 (0.62) and 4.98 (0.73), respectively. There was no correlation between the periodontal parameters and estimated glomerular filtration rate (PPD: r = −0.160, P = 0.914; CAL: r = −0.135, P = 0.372; plaque index: r = 0.005, P = 0.974). Conclusion: This study revealed a greater prevalence and severity of chronic periodontitis among CKD patients. Thus, the periodontal health of CKD patients’ needs to be screened and monitored.

Covid-19 (sars-cov-2 infection) information for patients with predialytic chronic kidney disease / Informações para pacientes com doença renal crônica pré-dialítica sobre Covid-19 (infecção pelo SARS-CoV-2)

ABSTRACT Patients with Chronic Kidney Disease are among those individuals at increased risk for developing more serious forms of Covid-19. This increased risk starts in the pre-dialysis phase of the disease. Providing useful information for these patients, in language that facilitates the understanding of the disease, can help nephrologists and other healthcare professionals to establish a more effective communication with these patients and help minimize contagion and the risks of serious illness in this population.

RESUMO Pacientes com Doença Renal Crônica estão entre os indivíduos de risco aumentado para desenvolvimento de formas mais sérias de Covid-19. Esse risco aumentado inicia-se já na fase pré-dialítica da doença. Fornecer informações úteis para esses pacientes, em linguagem que facilite o entendimento da doença, pode ajudar nefrologistas e outros profissionais de saúde a estabelecerem uma comunicação mais efetiva com esses pacientes e ajudar a minimizar o contágio e os riscos de doença grave nessa população.

Spectrum of Chronic Kidney Disease-Mineral Bone Disorders in Newly Detected Advanced Renal Failure Elderly Patients (CKD Stage 4 and 5)

Introduction: CKD MBD remains a complex issue in elderlypatients that has yet to be clearly defined. We aimed to evaluatethe disturbances in mineral bone disease in newly detected,untreated stage 4 and 5 elderly chronic kidney disease patients.Material and Methods: A cross-sectional observational studywith total of 93 newly detected patients underwent clinicalevaluation, biochemical assessment [serum albumin, calcium,intact parathyroid hormone(iPTH), 25- hydroxyvitamin D,phosphorus, alkaline phosphatase(ALP), creatinine], BMDmeasurement by dual-energy X-ray absorptiometry(DXA)and Lateral Abdominal X ray for aortic calcification(AAC).Results: Symptoms related to CKD-mineral bone disorderwere seen in 33.6% of the study patients. Prevalence ofhypocalcemia, hyperphosphatemia, hyperparathyroidism,and hypovitaminosis D were 64.2%, 81.1%, 49.5%,and 89.5%, respectively. Prevalence and severity ofhyperphosphatemia, hyperparathyroidism, hypocalcemia andraised ALP increases from stage 4 to stage 5 CKD, whilehypovaitaminosis D is equally prevalent in both stages.Secondary hyperparathyroidism is most common form ofCKD MBD in untreated elderly CKD population. BMD byDXA showed a low bone mass in 26.81% of our patients atdistal forearm. Patients older than 75 years more commonlyhad osteoporosis, lower ALP, phosphorus and iPTH. AAC wasseen in 13.98% of study group. Patients with AAC had higherphosphorus, iPTH and ALP. Compared to non diabetic CKDpatients, lower levels of phosphorus, ALP and iPTH wereobserved in diabetic CKD patients.Conclusion: Our study shows CKD MBD is prevalent inelderly population where symptoms alone are not enough todiagnose the bone disease.

Arterial stiffness and its impact on prognosis in patients with stage 3-5 chronic kidney disease(pre-dialysis) / 中国实用内科杂志

OBJECTIVE: To assess the impact of arterial stiffness on prognosis in patients with chronic kidney disease(CKD)stages 3-5(pre-dialysis).METHODS: 141 patients suffered from chronic kidney disease(CKD)stages 3-5 pre-dialysis were enrolled in this study between April 2006 and November 2010.Automatic pulse wave velocity(PWV)measuring system was used to examine carotid-femoral pulse wave velocity(CFPWV).According to CFPWV level,we divided the patients into elevated CFPWV group(CFPWV ≥12 m/s)and the normal group(CFPWV<12 m/s).Patients were followed up for the occurrence of cardiovascular event,cardiovascular death and all-cause death.Kaplan-Meier methods were used for survival analysis and Cox's proportional hazard regression model were used to analyze risk factors.RESULTS: Two groups were followed-up(93.72±47.93)months.The incidences of cardiac-cerebral vascular event,cardiac-cerebral vascular death and all-cause death were higher in high CFPWV level groups(62.2%vs.21.6%,56.7%vs.15.7%,64.4%vs.19.6%,P<0.05).The level of CFPWV was higher in patients with cardiac-cerebral vascular event,cardiac-cerebral vascular death and all-cause death than those without those events[(15.31±3.41)m/s vs.(12.08±2.94)m/s,(15.66±3.40)m/s vs.(12.14±2.88)m/s,(15.38±3.38)m/s vs.(11.97±2.87)m/s,P<0.01].Kaplan-Meier curve for overall survivals and cardiac-cerebral vascular event free survivals showed a significant distinct between high and normal CFPWV level groups,suggesting that the incidence of cardiac-cerebral vascular events,cardiac-cerebral vascular mortality and all-cause mortality were significantly higher in high CFPWV level group than in normal CFPWV group(P=0.000).Multivariate Cox regression analysis revealed that increased CFPWV and commencing dialysis were the independent risk factors for cardiac-cerebral vascular event,increased CFPWV and CRP and decreased ALB and commencing dialysis were the independent risk factors for cardiac-cerebral vascular mortality and all-cause mortality(P<0.05).CONCLUSION: The levels of CFPWV in pre-dialysis chronic kidney disease(CKD)stage 3-5 patients increases significantly.The incidence of cardiac-cerebral vascular events,cardiac-cerebral vascular mortality and all-cause mortality are significantly higher in elevated CFPWV group than those of normal group in patients with CKD G3-5.The elevated CFPWV is one of independent risk factors of cardiac-cerebral vascular event,cardiac-cerebral vascular mortality and all-cause mortality in patients with pre-dialysis chronic kidney disease.

Oral Manifestation and Caries Experience in Pre-Dialysis Chronic Kidney Disease Patients

@#Patients with chronic kidney disease (CKD) are prone to develop oral lesions due to the disease process or the therapy or both. The systemic problems started to develop in the pre-dialysis stages of CKD. Oral lesions and caries experience are the non-traditional risk factors in progression of CKD. This research was conducted to study and compare the oral manifestation and caries experience of pre-dialysis patients and healthy subjects in Hospital Universiti Sains Malaysia (HUSM). Fifty-eight patients, which consist of 29 pre-dialysis patients and 29 controls were recruited. CKD patients (stage III and IV) who attended nephrology clinic and CKD Resource Centre Unit of HUSM were selected. The control group consisted of healthy patients without any systemic disease who attended dental clinic of HUSM. The patients were examined for the oral manifestation. The decayed, missing, filled teeth (DMFT) index were also recorded. Oral lesions were present in 96.6% of pre-dialysis patients and 51.7% of control group (p < 0.001). The significant oral manifestations in pre-dialysis patients were xerostomia, halitosis, abnormal taste, mucosa pallor, enamel hypoplasia, gingival enlargement and abnormal lip pigmentation. There was significant difference in caries experience between pre-dialysis patients and healthy controls but no correlation between estimated glomerular filtration rate (eGFR) and caries experience in the predialysis patients. Thus, dental screening needs to be done to control the problems. Future studies with multicentred and larger sample size are warranted to explore the magnitude of this problem.

Efectividad y seguridad del uso de ior® EPOCIM en pacientes en prediálisis Ensayo clínico / Effectiveness and safety in the use of ior® EPOCIM in predialysis patients:Clinical trial

Introducción: El ior® EPOCIM (eritropoyetina humana recombinante) es un medicamento cubano que se produce en el Centro de Inmunología Molecular, el cual ha resultado ser seguro y no se han reportado eventos adversos graves asociados a su uso en pacientes dialíticos; sin embargo, en pacientes en prediálisis la información divulgada sobre su uso es insuficiente. Objetivo: Evaluar la efectividad y seguridad de ior® EPOCIM en pacientes con Enfermedad Renal Crónica en prediálisis, estadios 3 y 4: Material y Métodos: Se realizó un ensayo clínico multicéntrico, abierto, no aleatorizado, fase IV, que incluyó una muestra de 242 pacientes con y sin anemia. Durante 12 meses se evaluó el tratamiento con iorâ EPOCIM, dosis inicial de 30 U/Kg/dosis e incrementó según respuesta hematológica hasta 150 U/Kg/dosis, para lograr estabilización de la hemoglobina entre 10,5-12,5 g/dl y/o hematocrito entre 33-36 por ciento. Resultados: La hemoglobina inicial promedio fue 10 ± 1,5 g/dl, se incrementó rogresivamente hasta el cuarto mes, estabilizando su valor en 11,7 ± 1,2 g/dl, y el hematocrito tuvo similar comportamiento. La función renal se mantuvo estable; la calidad de vida mejoró; hubo mayor beneficio en las escalas de rol físico y salud general. Se reportaron 147 eventos adversos; tuvieron alguna relación causal 13,6 por ciento. El evento más frecuente fue la hipertensión arterial. Ninguna muerte estuvo relacionada con el producto. Conclusiones: El ior® EPOCIM fue seguro y efectivo en los pacientes estudiados con Enfermedad Renal Crónica en prediálisis, estadios 3 y 4(AU)

Introduction: The ior® EPOCIM (human recombinant erythropoietin) is a Cuban medicament produce by the Molecular Immunology Center, which result safety, not being adverse results associated to its use in dialytic patients, but regarding predialysis patients the disclosed information is not enough. Objective: To evaluate effectiveness and safety of ior® EPOCIM in patients with Chronic Kidney Disease (CKD) in pre-dialysis, stages 3 and 4. Material and Methods: Was performed a multicenter, opened, non-randomized phase IV clinical trial, which included 242 patients with and without anemia. During a 12 months period was evaluated the treatment with iorâ EPOCIM, with an initial dose of 30 U/kg/dose; and them increase according to the hematologic response up to a dose of 150 U/Kg/ to achieve the hemoglobinas stabilization between 10.5-12.5 g/dL and/or hematocrit between 33-36 percent. Results: The initial mean value for hemoglobin was 10 (SD ± 1.5 g / dl) it gradually increased until the 4th month stabilizing its value in 11.7 (SD ± 1.2 g / dl); hematocrit had similar behavior. Renal function remained stable. The life quality improved, was a greater benefit in the scale of the physical role and general health. 147 adverse events were reported; they had some causal relationship 13.6 percent. The most frequent event was hypertension (44.9 percent). No death was related with the product. Conclusions: ior® EPOCIM was safe and effective in this population(AU)

Uremic Encephalopathy with Basal Ganglia Lesions in a Diabetic Predialysis Patient.

Syndromes associated with acute bilateral lesions of the basal ganglia in diabetic uremic patients are uncommon, and usually have reversible clinical and imaging findings. Such syndromes are seen almost exclusively in patients with diabetes mellitus and renal failure. Previously reported cases have described diabetic men with uremia on dialysis. Here, we report a case of uremic encephalopathy with lesions of the basal ganglia in a diabetic predialysis patient. A 44-year-old man with uremic encephalopathy presented with dysarthria, chorea, and right upper extremity paresthesia. Magnetic resonance imaging of the brain showed classic findings of hyper intensity in the bilateral basal ganglia. The patient had no family history of psychiatric or neurological disease. Laboratory findings revealed elevated levels of blood urea nitrogen, creatinine, and glucose. Haloperidol and ropinirole therapy was continued, resulting in significant improvement without dialysis. The patient recovered from his episode without apparent sequelae.

Research in predialysis education for dialysis timing in patients with end-stage renal disease / 中国实用护理杂志

Objective To investigate the predialysis education on dialysis timing of patients with end-stage renal disease (ESRD). Methods 129 patients with chronic renal failure (CRF) and serum creatinine(Scr)＞442μmol/L, endogenous creatinine clearance rate (Ccr)＜20 ml/min were randomly divided into the experimental group(70 cases) and the control group(59 cases), the experimental group received predialysis education, the control group received routine care.The basic situation, dialysis timing, depression and quality of life on the 6th,12th months after dialysis were assessed. Results There was no significant difference in age, sex, education background, health care payment manners, employment, serum creatinine, endogenous creatinine clearance rate before education.For the timing of dialysis, Ccr for the experimental group was (9.49 ± 0.77)ml/min, Ccr for the control group was (4.54 ±1.79) ml/min,the difference was significant, depression and quality of life between two groups after 6,12 months of dialysis was also statistically different. Conclusions Strengthening predialysis education is conducive to a timely start of dialysis and can effectively improve the quality of life in patients with ESRD.

Quality of life in patients with chronic kidney disease

AIM: To compare the dimensions of quality of life in the stages of chronic kidney disease and the influence of sociodemographic, clinical and laboratory data. INTRODUCTION: The information available on the quality of life of patients on conservative treatment and the relationship between the quality of life and glomerular filtration rate is limited. METHODS: 155 patients in stages 1-5 of chronic kidney disease and 36 in hemodialysis were studied. Quality of life was rated by the Medical Outcomes Study Short Form 36-Item (SF-36) and functional status by the Karnofsky Performance Scale. Clinical, laboratory and sociodemographic variables were investigated. RESULTS: Quality of life decreased in all stages of kidney disease. A reduction in physical functioning, physical role functioning and in the physical component summary was observed progressively in the different stages of kidney disease. Individuals with higher educational level who were professionally active displayed higher physical component summary values, whereas men and those with a higher income presented better mental component summary values. Older patients performed worse on the physical component summary and better on the mental component summary. Hemoglobin levels correlated with higher physical component summary values and the Karnofsky scale. Three or more comorbidities had an impact on the physical dimension. CONCLUSION: Quality of life is decreased in renal patients in the early stages of disease. No association was detected between the stages of the disease and the quality of life. It was possible to establish sociodemographic, clinical and laboratory risk factors for a worse quality of life in this population.

Arterial stiffness and associated factors in non-diabetic pre-dialysis patients with chronic kidney disease / 中华肾脏病杂志

Objective To study the arterial stiffness in non-diabetic pre-dialysis chronic kidney disease (CKD) patients and to explore the associated factors. Methods Automatic pulse wave velocity (PWV) measuring system was used to examine carotid-femoral pulse wave velocity (CFPWV) as the parameters reflecting central elastic large arterial elasticity. Vascular calcification was quantitatively evaluated by plain radiographic film of abdomen, pelvis and hands. Blood pressure, biochemical parameters and intact parathyroid hormone (iPTH) were routinely detected. Stepwise multiple linear regression analysis was used to assess the associated factors of arterial stiffness. Results Ninety-six non-diabetic pre-dialysis CKD patients and 30 healthy people were enrolled in this trial. CFPWV in stage 3, 4 and 5 CKD patients was significantly higher than that in healthy controls [(11.63±2.39) m/s, (11.70±2.80) m/s, (12.88±2.49) m/s vs (9.70±1.66)m/s , all P<0.05]. Stepwise multiple regression analysis demonstrated that age, mean arterial pressure, vascular calcification and iPTH were independent impact factors of CFPWV. Conclusions Arterial stiffness of large artery increases in non-diabetic pre-dialysis CKD patients. Age, mean arterial pressure, vascular calcification and iPTH are independent impact factors of CFPWV.

Efficacy of erythropoietin in renal function of pre-dialysis patients with chronic renal failure / 대한내과학회지

BACKGROUND: Anemia is one of the most important risk factors for cardiovascular morbidity and mortality in patients with chronic renal failure. The most effective treatment modality for anemia is erythropoietin injection. Besides erythropoietic effect, erythropoietin has multiple beneficial effects such as anti-oxidant, anti-hypoxic, anti-apoptotic and vasculogenetic effects, and prevents tubular lesions and interstitial fibrosis. Despite lots of advantages of erythropoietin therapy, the number of patients treated with this agent is modest, particularly during the pre-dialysis chronic renal failure. We conducted a clinical trial to evaluate the effects of erythropoietin on renal function in the anemic pre-dialysis patients with chronic renal failure. METHODS: Data of 23 pre-dialysis patients with chronic renal failure were analyzed retrospectively 6 months prior, and prospectively 6 months after the initiation of erythropoietin therapy. Erythropoietin was admitted at a dose of 3000 IU weekly with supplementary iron. RESULTS: The average hematocrit and hemoglobin rose from 22.1+/-2.5%, 7.4+/-0.8 g/dL to 28.4+/-4.2%, 9.6+/-1.5 g/dL, respectively. When linear regression analysis was applied to pre- and post-erythropoietin glomerular filtration rate and 1/Cr, mean rate of decline of glomerular filtration rate were significantly delayed (p=0.039) but that of 1/Cr had a tendency to be delayed but was not statistically meaningful (p=0.099). CONCLUSIONS: Treatment of the anemia with low dose erythropoietin in pre-dialysis patients with chronic renal failure is relatively safe and may slow the rate of renal function deterioration.

Efficacy of low dose recombinant human erythropoietin treatment in patients with pre-dialysis chronic renal failure / 대한내과학회지

BACKGROUND: Anemia is a most common complication of chronic renal failure and erythropoietin has proven to be a effective treatment for anemia in dialysis patient. However, in patients with pre-dialysis chronic renal failure, Use of erythropoietin is usually limited because of its high cost and frequent administration. The purpose of this study was to evaluate the efficacy of low dose erythropoietin treatment in patient with pre-dialysis chronic renal failure. METHODS: We administered erythropoietin 2000U weekly to 25 patients with pre-dialysis chronic renal failure untill hemoglobin and hematocrit reached to 11g/dl, 33% respectively. After then we administered erythropoietin 1000U weekly as a maintenance dose. We measured the level of hemoglobin, hematocrit, reticulocyte count, serum creatinine, BUN, serum iron, ferritin, total iron binding capacity every two weeks for 12 months. RESULTS: 1) In 25 patients treated for 16 weeks, hemoglobin and hematocrit level increased from 8.2g/dl,24.2% to 8.8g/dl,28.2%(p< 0.05) respectively. After 28 weeks treatment, 23 patients(92%) reached target hemoglobin and hematocrit value(11g/dl,33%). 2) Serum iron level increased from 180.2ug/dl to 165.1ug/dl(p< 0.05) after 16 weeks treatment. But there were no significant changes in serum ferritin and total iron binding capacitiy. 3) There was no significant change in reciprocal serum creatinine value before and after erythropoietin treatment. 5) There was no significant side effect except mild exacerabation of hypertension(2 cases) during erythropoietin treatment. CONCLUSION: This result show that relatively low dose erythropoietin treatment in patient with pre-dialysis chronic renal failure can be used as a effective treatment for anemia despite of slow and gradual response.

Dietary protein intake(DPI) and Nutritional Indices in Predialysis Patients with Different Stages of Chronic Renal Insufficiency / 대한신장학회잡지

Although dietary protein restriction may protect against progression of renal failure, it is important to consider whether protein restriction can be attained without inducing malnutrition. We assessed the calculated dietary protein intake(cDPI) by 24 hour urinary collection and food intake, biochemical nutritional indices and the results of anthropometric measurement in 83 predialysis patients with different stages of chronic renal failure(CRF) and 84 controls. Dietary interventions were minimal. We categorized patients into three groups according to whether their creatinine clearance(Ccr) was greater than 25(group A), 10 to 25(group B), or less than 10ml/min(group C). 1) The mean(+/-SD) cDPI was significantly lower in group C(0.77+/-0.17g/kg/day) and group B(0.84+/- 0.16g/kg/day) than in group A(1.04+/-0.21g/kg/day) and controls(1.14+/-0.22g/kg/day)(P<0.05). The mean (+/-SD) high biologic value protein intake was significantly lower in group C(0.29+/-0.25g/kg/day) and group B(0.39+/-0.27g/kg/day) than in group A (0.48+/-0.35g/kg/day)(P<0.05). The cDPI(r=0.50, P< 0.05), high biologic value protein intake(r=0.39, P< 0.05) were positively correlated with the Ccr. 2) The mean (SD) total lymphocyte count (TLC) was significantly lower in group C(1,554+/-368/mm3) and group B(1,972+/-470/mm3) than in group A(2,111+/-540/mm3) and controls(2,177+/-589/mm3)(P<0.05). The TLC was positively correlated with the Ccr(r= 0.28, P<0.05). The levels of albumin and transferrin were lower in patients with CRF than in controls (P<0.05). There was no difference in the levels of albumin, transferrin, prealbumin, insulin-like growth factor-1, cholesterol and anthropometric measurements among the different stages of CRF. CONCLUSION: In predialysis patients with CRF, the dietary protein and high biologic value protein intake spontaneously decreases as renal function declines. Several nutritional indices, such as TLC, albumin and transferrin were lower in predialysis patient with CRF than controls. Therefore objective measurement of DPI should be considered to educate a low protein diet in predialysis patients with CRF.