ABSTRACT
BACKGROUND: The management of anaemia in chronic kidney disease (CKD) to achieve current guideline goals is difficult and is hindered by multiple factors, including problems with the scheduling and adjustment of dosing of erythropoiesis-stimulating agents (ESAs) and the frequency of required ESA administration to achieve target haemoglobin (Hgb) levels. OBJECTIVE: The primary objective of this study was to examine whether converting a large cohort of CKD patients receiving epoetin alfa to darbepoetin alfa would decrease the frequency of drug administration while permitting an acceptable management of CKD-related anaemia. METHODS: In this retrospective cohort study of practice in a community-based CKD anaemia clinic, we evaluated the effects of conversion of a baseline group of 283 patients from epoetin alfa to darbepoetin alfa with a goal of decreasing the frequency of ESA administration while maintaining Hgb levels within a target range. The study observation period extended for 15 months after the initial conversion. An additional 256 CKD patients were started on darbepoetin alfa during the observation period and the frequency of their injections and the range of their Hgb levels were also monitored. RESULTS: Following the conversion to darbepoetin alfa, we were able to increase the number of patients on once-monthly injections from 21% to 76% while keeping Hgb levels in the target range and maintaining stable blood pressure control. The mean number of ESA injections/patient/month decreased from 2.1 to 1.3. CONCLUSION: In a community-based CKD anaemia clinic, conversion from epoetin alfa to darbepoetin alfa resulted in a decreased frequency of injections needed to maintain Hgb levels within an accepted target range.
Subject(s)
Anemia/drug therapy , Erythropoietin/analogs & derivatives , Erythropoietin/administration & dosage , Hematinics/administration & dosage , Kidney Failure, Chronic/complications , Adult , Aged , Aged, 80 and over , Anemia/etiology , Community Health Centers , Darbepoetin alfa , Dose-Response Relationship, Drug , Drug Administration Schedule , Epoetin Alfa , Erythropoietin/therapeutic use , Female , Hematinics/therapeutic use , Hemoglobins/metabolism , Humans , Male , Middle Aged , Recombinant Proteins , Retrospective StudiesABSTRACT
The effects of alleles in many genes are believed to contribute to common complex diseases such as hypertension. Whether risk alleles comprise a small number of common variants or many rare independent mutations at trait loci is largely unknown. We screened members of the Framingham Heart Study (FHS) for variation in three genes-SLC12A3 (NCCT), SLC12A1 (NKCC2) and KCNJ1 (ROMK)-causing rare recessive diseases featuring large reductions in blood pressure. Using comparative genomics, genetics and biochemistry, we identified subjects with mutations proven or inferred to be functional. These mutations, all heterozygous and rare, produce clinically significant blood pressure reduction and protect from development of hypertension. Our findings implicate many rare alleles that alter renal salt handling in blood pressure variation in the general population, and identify alleles with health benefit that are nonetheless under purifying selection. These findings have implications for the genetic architecture of hypertension and other common complex traits.
Subject(s)
Blood Pressure/genetics , Hypertension/genetics , Potassium Channels, Inwardly Rectifying/genetics , Receptors, Drug/genetics , Sodium-Potassium-Chloride Symporters/genetics , Symporters/genetics , Adult , Amino Acid Sequence , Amino Acid Substitution , Cohort Studies , Female , Heterozygote , Humans , Hypertension/epidemiology , Kidney/metabolism , Male , Middle Aged , Molecular Sequence Data , Mutation , Prevalence , Sodium Chloride/metabolism , Solute Carrier Family 12, Member 1 , Solute Carrier Family 12, Member 3ABSTRACT
The goal of the present case report is to enhance recognition of the incidence of tissue calcifications, which are quite common in patients with end-stage renal disease. We focus on pulmonary metastatic calcifications and the potential progression of this condition to tissue necrosis and lung cavitations in the setting of severe electrolyte imbalance. This case highlights the importance of early identification of the causes and potential risk factors leading to visceral calciphylaxis.
Subject(s)
Calcinosis/etiology , Calciphylaxis/etiology , Kidney Failure, Chronic/complications , Lung Diseases/etiology , Adult , Calcinosis/diagnostic imaging , Disease Progression , Humans , Kidney Failure, Chronic/therapy , Lung Diseases/diagnostic imaging , Male , Peritoneal Dialysis, Continuous Ambulatory , Tomography, X-Ray ComputedABSTRACT
BACKGROUND/AIMS: Hemodialysis is associated with acute changes in several physiologic factors. Previous studies have suggested significant clinical and quality of life (QOL) benefits of daily hemodialysis (DHD) compared with 3 times weekly hemodialysis (CHD). We conducted a prospective trial to evaluate the effects of switching chronic hemodialysis patients to in-center DHD for a 12-month period. METHODS: There were no exclusion criteria. Patients received hemodialysis 6 times per week. The study set a standardized weekly Kt/V (stdKt/V) goal of 3.0. A broad array of clinical parameters was determined. QOL was assessed with multiple instruments. RESULTS: Eleven subjects completed 12 months and 12 completed 6 months on DHD. Significant changes relative to baseline at 12 months of DHD included decreased BP and improvements in QOL parameters by multiple techniques. 100% of patients at 12 months wished to continue DHD. CONCLUSIONS: DHD offers advantages over CHD with respect to improved QOL and BP control.
