Absence of Anemia in Maintenance Hemodialysis

Charles, G; Ap, Lundin; Bg, Delano; Brown, Clinton D.; Ea, Friedman

doi:10.1177/039139888100400605

Cited by 20 publications

(9 citation statements)

References 9 publications

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“…In 1981, before the availability of recombinant ESA therapies, Charles et al 1 reported that 11 (2.0%) of 549 patients at five HD facilities in Brooklyn, NY, had hematocrit values of Ն40% without transfusion or androgen treatment in the preceding year. In 2002, Iorio and Iodice 2 reported that 78 (2.2%) of 3617 Italian HD patients maintained hemoglobin concentrations Ͼ13.5 g/dl for 1 year without epoetin.…”

Section: Discussionmentioning

confidence: 99%

“…Women were also under-represented among the earlier reported cohorts of patients with naturally higher hemoglobin concentrations. [1][2][3] Lower androgen levels among women may be associated with diminished erythropoiesis. Inflammation would also be expected to contribute to lower hemoglobin concentrations, which likely explains the relationships between serum albumin concentration, serum ferritin concentration, and catheter hemoaccess with Endogenous EPO status.…”

Section: Discussionmentioning

confidence: 99%

“…We are aware of only three such papers, describing 11, 78, and 21 patients, respectively. [1][2][3] The Dialysis Outcomes and Practice Patterns Study (DOPPS) 4,5 follows thousands of HD patients in 12 countries, providing the opportunity to investigate much larger numbers of patients who sustain hemoglobin concentrations in excess of 12 g/dl in the absence of ESA therapy ("Endogenous erythropoietin [EPO]" patients). Uncertainty exists regarding the effects of higher hemoglobin concentration on mortality and quality of life among HD patients, and study of this Endogenous EPO group allows additional insights.…”

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confidence: 99%

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Naturally Occurring Higher Hemoglobin Concentration Does Not Increase Mortality among Hemodialysis Patients

Goodkin

Fuller

Robinson

et al. 2011

Journal of the American Society of Nephrology

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A small percentage of hemodialysis patients maintain higher hemoglobin concentrations without transfusion or erythropoietic therapy. Because uncertainty exists regarding the effects of higher hemoglobin concentration on mortality and quality of life among hemodialysis patients, studying this group of patients with sufficient endogenous erythropoietin may provide additional insights. The prospective, observational Dialysis Outcomes and Practice Patterns Study provides an opportunity to investigate this group. Among 29,796 patients in 12 nations, 545 (1.8%) maintained hemoglobin concentrations Ͼ12 g/dl for 4 months without erythropoietic support. This subset tended to be male, to have a longer duration of end-stage renal disease, and to not dialyze via a catheter. Cystic disease as the underlying cause of renal failure was over-represented in this group but was present in only 25%. Lung disease, smoking, and cardiovascular disease were associated with increased likelihood of naturally higher hemoglobin concentration. Quality-of-life scores were not higher among this subset compared with the other patients. Unadjusted mortality risk for patients with hemoglobin Ͼ12 g/dl and no erythropoietic therapy was lower than for the other patients, but after thorough adjustment for case mix, there was no difference between groups (relative risk, 0.98; 95% CI 0.80 to 1.19). These data show that naturally occurring hemoglobin concentration Ͼ12 g/dl does not associate with increased mortality among hemodialysis patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Naturally Occurring Higher Hemoglobin Concentration Does Not Increase Mortality among Hemodialysis Patients

Goodkin

Fuller

Robinson

et al. 2011

Journal of the American Society of Nephrology

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“…In Figs. 4 and 5, the separate regression lines for normal sheep and uremic sheep were tested for coincidence (equal slopes and equal intercepts) with the dummy variable multiple regression model (22). The significance of the results is expressed as a probability value.…”

Section: Introductionmentioning

confidence: 99%

The anemia of chronic renal failure in sheep. Response to erythropoietin-rich plasma in vivo.

et al. 1984

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Astract. The hypoproliferative anemia in chronic renal failure has been assumed to be the result of decreased erythropoietin (Ep) production by the damaged kidney and ofthe shortening oferythrocyte survival. However, many in vitro studies suggest that erythropoietic inhibitors in uremic plasma may contribute to the anemia. To determine the in vivo relevance of uremic inhibitors, increasing amounts of Ep as Ep-rich plasma were infused into six uremic sheep, and their erythropoietic responses were compared with those of nine normal sheep receiving similar amounts of Ep-rich plasma. Three sheep were studied in both normal and uremic states. Ep-rich plasma was obtained from phenylhydrazine-and phlebotomyinduced anemic sheep. Stable uremia was created by subtotal nephrectomy. Erythropoiesis was quantitated by reticulocyte response, ferrokinetics (plasma iron turnover and marrow transit time), and by hemoglobin C synthesis. Ep-rich plasma stimulated erythropoiesis similarly in uremic and normal sheep, regardless of the degree of uremia. Nondialyzed uremic sheep responded as well as dialyzed animals. The anemia was corrected in the uremic sheep after 15-40 daily infusions of Ep-rich plasma, the total dosage depending on the severity of the anemia. Polycythemia was induced when the infusions were continued. Reticulocytes, plasma iron turnover, and erythrocyte mass changes increased as the amount of Ep-rich plasma was increased. These dose-response effects, coupled with the identical erythropoietic response in normal

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“…These are the ranges of Hct that are most often re ported in the literature and that cover more than 90% of dialysis patients [7]. In fact, Charles et al [8] reported a prevalence of 11/549 dialysis patients (2%) with Hct lev els >40% . This could be the reason why there is very little literature about urea ki netics in patients with normal or nearly nor mal Hct levels.…”

Section: Discussionmentioning

confidence: 99%

The Role of Hematocrit in Efficiency of Dialysis

Movilli

Cancarini²,

Mombelloni³

et al. 1990

Blood Purif

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To test the role of hematocrit (Hct), particularly when in the nearly normal range, on efficiency of dialysis, we analyzed the urea kinetics for 36 metabolically and hematologically stable patients on regular dialysis treatment and for 7 patients from this group before and after 3 months of treatment with human recombinant erythropoietin (rHuEPO). The volume of distribution of urea (V), the dialyzer clearance (K_d) and Kt/V were plotted against Hct. Hct showed a significant inverse correlation with K_d(r = 0.479, p = 0.003) and Kt/V (r = 0.572, p = 0.0002). Further division of the patients into groups with respect to Hct showed that the lowest Kt/V values were in the group with Hct ≧ 37%. In the patients treated with rHuEPO, Hct rose from 18 ± 1 to 35 ± 5% (p < 0.0001), and Kt/V decreased from 1.22 ± 0.21 to 1.09 ± 0.18 (p = 0.037). We conclude that Hct exerts a negative influence on efficiency of dialysis as evaluated by Kt/V. This is important for patients with normal or nearly normal Hct levels as well as for patients treated with rHuEPO, for whom normalization of Hct is pursued.

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Absence of Anemia in Maintenance Hemodialysis

Cited by 20 publications

References 9 publications

Naturally Occurring Higher Hemoglobin Concentration Does Not Increase Mortality among Hemodialysis Patients

Naturally Occurring Higher Hemoglobin Concentration Does Not Increase Mortality among Hemodialysis Patients

The anemia of chronic renal failure in sheep. Response to erythropoietin-rich plasma in vivo.

The Role of Hematocrit in Efficiency of Dialysis

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