2015 Japanese Society for Dialysis Therapy: Guidelines for Renal Anemia in Chronic Kidney Disease

Yamamoto, Hiroyasu; Nishi, Shinichi; Tomo, Tadashi; Masakane, Ikuto; Saito, Kazuhide; Nangaku, Masaomi; Hattori, Motoshi; Suzuki, Takahiro; Morita, Satoshi; Ashida, Akira; Ito, Yasuhiko; Kuragano, Takahiro; Komatsu, Yasuhiro; Sakai, Ken; Tsubakihara, Yoshiharu; Tsuruya, Kazuhiko; Hayashi, Terumasa; Hirakata, Hideki; Honda, Hirokazu

doi:10.1186/s41100-017-0114-y

Cited by 165 publications

(222 citation statements)

References 246 publications

(339 reference statements)

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“…Furthermore, ERI was significantly reduced by ferric citrate hydrate treatment with increasing serum iron, ferritin levels, and TSAT in patients with or without iron deficiency. In the present study, serum ferritin levels at baseline were lower from those in other clinical studies conducted in other countries [18]. The criteria for iron supplementation recommended in international guidelines differ greatly from those used in clinical practice in Japan.…”

Section: Discussioncontrasting

confidence: 49%

“…Other studies have shown that the risk of infections and the incidence of sepsis and vascular access-related infections significantly increased in hemodialysis patients with serum ferritin levels > 331 and > 500 ng/mL [22-24]. Therefore, to minimize the risk of iron overload, based on the 2015 JSDT guidelines, iron supplementation that maintain a high serum ferritin level should be avoided for safety reasons in CKD patients [18]. Moreover, 36% of dialysis patients in Japan have serum ferritin levels of < 50 ng/mL, 58% have serum ferritin levels of < 100 ng/mL, and only 10% have serum ferritin levels ≥300 ng/mL in Japan [18].…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, to minimize the risk of iron overload, based on the 2015 JSDT guidelines, iron supplementation that maintain a high serum ferritin level should be avoided for safety reasons in CKD patients [18]. Moreover, 36% of dialysis patients in Japan have serum ferritin levels of < 50 ng/mL, 58% have serum ferritin levels of < 100 ng/mL, and only 10% have serum ferritin levels ≥300 ng/mL in Japan [18]. The JSDT guidelines therefore do not recommend iron administration that aims to raise the serum ferritin level to ≥300 ng/mL.…”

Section: Discussionmentioning

confidence: 99%

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Ferric Citrate Decreases Fibroblast Growth Factor 23 and Improves Erythropoietin Responsiveness in Hemodialysis Patients

et al. 2018

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Background: Serum phosphate and vitamin D receptor activator regulate fibroblast growth factor 23 (FGF23), and iron may modulate FGF23 metabolism. The aim of the present study was to elucidate the effects of ferric citrate hydrate and lanthanum carbohydrate on serum FGF23 levels in hemodialysis patients. Methods: This prospective, open-label, multicenter study enrolled 60 patients on hemodialysis treated with lanthanum carbonate. Patients were randomly assigned to 2 groups: those switching from lanthanum carbonate to ferric citrate hydrate (ferric citrate group, n = 30) or those continuing lanthanum carbonate (control group, n = 30). Patients were monitored for 24 weeks. Endpoints included changes in FGF23, phosphate, and the dose of erythropoiesis stimulating agent (ESA), erythropoietin responsiveness index (ERI), and adverse events. Results: FGF-23 levels were significantly lower in the ferric citrate group compared with the levels in the control group (change from baseline –6,160 vs. –1,118 pg/mL; p = 0.026). There were no significant changes in serum calcium, phosphate, and intact parathyroid hormone levels in either group. The ferric citrate group had significantly increased serum iron, ferritin, and transferrin saturation. Hemoglobin levels were significantly elevated, and the dose of ESA was significantly decreased in the ferric citrate group but not in the control group. ERI and the dose of intravenous saccharated ferric oxide were significantly lower in the ferric citrate group compared with those of the control group (p = 0.015 and p = 0.002). Conclusion: In patients on hemodialysis, 24-week treatment with ferric citrate hydrate resulted in significant reduction in FGF23 and ERI independently of serum phosphate level.

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Section: Discussioncontrasting

confidence: 49%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Ferric Citrate Decreases Fibroblast Growth Factor 23 and Improves Erythropoietin Responsiveness in Hemodialysis Patients

et al. 2018

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“…One reason for this improvement might be that recombinant erythropoietin became available to treat renal anemia in dialysis patients from 1990 onward in Japan. The 2015 JSDT guidelines for renal anemia in chronic kidney disease recommend that target hemoglobin (Hb) levels be maintained in the range of 10-12 g/dL in blood samples collected at the beginning of the week of hemodialysis [15]. The guidelines state that the lower limit of this range, 10 g/dL, seems to be appropriate considering the risk of death [16] and QOL [17].…”

Section: Heart Failurementioning

confidence: 99%

Strategies for the Super-Aged Dialysis Population: Survival Benefits or Alternative Goals?

Sakurai

Hanafusa²,

Nomura

et al. 2019

Blood Purif

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Background/Aims: Japan’s aging population has prominent epidemiological and patient characteristics. The number of hemodialysis patients aged ≥70 years is increasing. Age-adjusted mortality is improving, but some cause-specific mortalities remain unchanged, including infectious disease and malignancy, requiring combative strategies. However, survival trends for patients aged 90 years or older are not known. Methods: We examined annual data reported by the Japanese Society for Dialysis Therapy Renal Data Registry for the period 1987–2014 to determine survival trends. Results: Survival in the super-aged group (≥90 years) is still mostly unimproved. In terms of cause-specific survival, especially death due to heart failure differs distinctly between this group and the remaining elderly patients, indicating that improving their survival is difficult. Alternative dialysis goals could therefore be considered. The major dialysis objective in this population could be to maintain quality of life and limit functional impairment. Conclusion: Survival of the super-aged population has not improved in the last 2 decades. Thus, withholding or withdrawing dialysis and providing conservative management without dialysis treatment could be an important option for patients aged 90 years or older.

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“…The study proceeded according to the 2008 revision of the Declaration of Helsinki. The inclusion criteria are detailed elsewhere [21,22]. All patients provided written, informed consent to participate.…”

Section: Patientsmentioning

confidence: 99%

Differential Impacts of Intravenous Iron Administration and Iron-Containing Phosphate Binders on Serum Intact Fibroblast Growth Factor 23 Levels

Honda

Tanaka²,

Michihata

et al. 2019

Blood Purif

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Aims: This study assessed the impact of iron administration on serum fibroblast growth factor 23 (FGF23) levels. Methods: Of 123 hemodialysis (HD) patients treated with erythropoiesis-stimulating agents, 22 received once-weekly intravenous iron and 17 received daily oral iron with iron-containing phosphate binders. Intact FGF23 and biomarkers of iron metabolism were measured from blood samples drawn before each HD session, at baseline and on days 3, 5, 7, and 14. Results: Phosphate levels did not differ among the 3 groups during the 14-day period. Ferritin levels were significantly increased in both iron treatment groups compared with the non-iron treatment group, but changes in transferrin saturation levels were similar in the intravenous iron and non-iron groups. However, intact FGF23 levels were continuously higher in the intravenous iron group than those in the other groups. Conclusion: Intravenous iron administration may influence intact FGF23 levels in HD patients independently of phosphate and iron metabolism.

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2015 Japanese Society for Dialysis Therapy: Guidelines for Renal Anemia in Chronic Kidney Disease

Cited by 165 publications

References 246 publications

Ferric Citrate Decreases Fibroblast Growth Factor 23 and Improves Erythropoietin Responsiveness in Hemodialysis Patients

Ferric Citrate Decreases Fibroblast Growth Factor 23 and Improves Erythropoietin Responsiveness in Hemodialysis Patients

Strategies for the Super-Aged Dialysis Population: Survival Benefits or Alternative Goals?

Differential Impacts of Intravenous Iron Administration and Iron-Containing Phosphate Binders on Serum Intact Fibroblast Growth Factor 23 Levels

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