Intravenous iron supplementation for the treatment of anaemia in pre-dialyzed chronic renal failure patients.

BACKGROUND: Intravenous iron is a recognized therapy of anaemia in chronic haemodialyzed patients, especially in those receiving erythropoietin (Epo), while its role in the anaemia of pre-dialyzed chronic renal failure (CRF) patients is much less clear. This study attempted to evaluate the effects of intravenous iron in anaemic pre-dialyzed patients. METHODS: Sixty anaemic (haemoglobin<11 g/dl) non-diabetic patients with moderate CRF [32 males, 28 females; mean age 52.2+/-12.5 years; mean glomerular filtration rate 36.2+/-5.2 ml/min], without iron deficiency, iron overload or inflammation, without concomitant erythropoietin treatment and without any previous iron therapy were enrolled. Intravenous iron was administered as iron sucrose, 200 mg elemental iron per month for 12 months, with 1 month pre-study survey and 1 month follow-up after the last iron dose. RESULTS: Intravenous iron supplementation was associated with a significant increase in haemoglobin (from 9.7+/-1.1 at the baseline to 11.3+/-2.5 g/dl after 12 months, a mean increase of 1.6 g/dl), a further 36% of patients reaching the target haemoglobin of 10 g/dl. There was a significant increase in serum iron from 73.9+/-17.2 to 101.8+/-12.2 microg/dl, in serum ferritin from 98.0 (24.8-139.0) to 442.5 (86.0-496.0) microg/l and in transferrin saturation from 21.6+/-2.6 to 33.6+/-3.2%. No worsening of renal function, no increase in blood pressure and no other side effects were noted. CONCLUSIONS: Intravenous iron therapy in pre-dialysis patients with no Epo seems often to ameliorate the anaemia, avoiding the necessity of Epo or blood transfusions in one-third of pre-dialyzed non-diabetic patients. Intravenous iron supplementation appears to be an effective and safe treatment for anaemia in pre-dialysis CRF patients.

Global assessment of serum antioxidant status in hemodialysis patients.

BACKGROUND: Since chronic renal failure (CRF) was described as a state of oxidant/antioxidant imbalance augmented after hemodialysis (HD) initiation, we assessed the total antioxidant activity and single antioxidants in sera from uremic patients dialyzed or not, compared to subjects with normal renal function. METHODS: Serum total antioxidant activity (TAA--measured as Trolox equivalent antioxidant capacity; mmol/L), total plasma free thiols (Pt-SH; micromol/g protein), albumin (g/dL) and uric acid (mg/dL) were determined in 19 hemodialyzed patients, 15 CRF non-dialyzed patients (serum creatinine (Cr) = 4.4 +/- 2.7 mg/dL) and in 16 healthy controls. The "antioxidant gap" (mmol/L), as a measure of the combined activity of plasma antioxidants other than albumin and uric acid, was calculated. RESULTS: TAA and the "antioxidant gap" were higher in HD patients (1.21 +/- 0.12 vs. 0.96 +/- 0.13 in the non-HD group, p<0.001, and vs. 0.9 +/- 0.14 in controls, p<0.001, respectively, for TAA; 0.46 +/- 0.15 vs. 0.2 +/- 0.15, p<0.001, and vs. 0.21 +/- 0.16, p<0.001, respectively, for residual antioxidant activity). However, no differences existed in major plasma antioxidant levels (albumin and uric acid) among uremic patients, hemodialyzed or not. Pt-SH were reduced in nondialyzed patients as compared to controls (6.21 +/- 1.1 vs. 7.33 +/- 0.83, p=0.002), but were elevated in HD patients (11.9 +/- 1.1). CONCLUSIONS: These results suggest that HD patients appear to have improved plasma antioxidant status, hyperuricemia not being the sole contributor. Therefore, it seems reasonable to speculate that other antioxidants (thiols or some as yet unrecognized substances) could also be contributors. However, more reliable assays for extracellular antioxidant defense evaluation are required to validate this hypothesis.

Nephrology and renal replacement therapy in Romania--transition still continues (Cinderella story revisited).

UNLABELLED: INTRODUCTION. This report describes the current status of nephrology and renal replacement therapy (RRT) in Romania, a country with previously limited facilities, highlighting national changes in the European context. METHODS: Trends in RRT development were analysed in 2003, on a national basis, using the same questionnaires as in previous surveys (1991, 1995). Survival data and prognostic risk factors were calculated retrospectively from a large representative sample of 2284 patients starting RRT between January 1, 1995 and December 31, 2001 (44% of the total RRT population investigated). RESULTS: In 2003, RRT incidence [128 per million population (p.m.p.)] and prevalence (250 p.m.p.) were six and five times higher, respectively, than in 1995. The annual rate of increase in the stock of RRT patients (11%) was supported mainly by an exponential development of the continuous ambulatory peritoneal dialysis (CAPD) population (+600%), while the haemodialysis (HD) growth rate was stable (+33%) and renal transplantation made a marginal contribution. Renal care infrastructure followed the same trend: nephrology departments (+100%) and nephrologists (+205%). The characteristics of RRT incident patients changed accordingly to current European epidemiology (increasing age and prevalence of diabetes and nephroangiosclerosis). The estimated overall survival of RRT patients in Romania was 90.6% at 1 year [confidence interval (CI) 89.4-91.8] and 62.2% at 5 years (CI 59.4-65.0). Patients' survival was negatively influenced (Cox regression analysis) by age >65 years (P < 0.001), lack of pre-dialysis monitoring by a nephrologist [P = 0.01, hazards ratio (HR) = 0.8], severe anaemia, lack of erythropoetin treatment (P < 0.001, HR = 0.6), and co-morbidity, e.g. cardiovascular diseases (P < 0.001, HR = 1.8) and diabetes mellitus (P < 0.001, HR = 2.2). CONCLUSIONS: Although the rate of increase in RRT patient stock in 1996-2003 in Romania was the highest in Europe, the prevalence remained below the European mean. As CAPD had the greatest expansion, followed by HD, an effective transplantation programme must be set up to overcome the imbalance. The quality of RRT appears to be good and survival was similar to that in other registries. Further evolution implies strategies of prevention, based on national surveys, supported by the Romanian Renal Registry.