Acute-phase response predicts erythropoietin resistance in hemodialysis and peritoneal dialysis patients

Gunnell, Jennifer; Yeun, Jane Y.; Depner, Thomas A.; Kaysen, George A.

doi:10.1016/s0272-6386(99)70259-3

Cited by 290 publications

(238 citation statements)

References 36 publications

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“…These facts corroborate data in medical literature that show a strong influence of inflammation on erythropoiesis 9 .…”

Section: Discussionsupporting

confidence: 91%

“…Laboratory data were obtained, the erythropoietin resistance rate was calculated, and the malnutrition-inflammation score (MIS) was determined before and after the treatment. Treatment lasted for eight weeks, time known to be long enough to observe the effects of simvastatin on the lipid profile and CRP 9 . Patients excluded from the program were those who underwent transplantation, a change of technique or center, as well as patients who lost the hemodialysis access, developed infectious processes or neoplasms, were hospitalized, and those who chose to leave.…”

Section: Study Population and Designmentioning

confidence: 99%

“…The resistance to erythropoietin (EPO) is defined by the ratio EPOs/Hct, as described by GUNNELL J. et al 9 , where EPOs represent the mean weekly EPO dose in the previous month and Hct, the mean hematocrit values during the previous two months. There is no adjustment for the patient's body weight, since the initial dose of erythropoietin is defined according to the weight, and dose adjustment depends on the patient's response with hematocrit elevation and treatment goals 9 .…”

Section: Erythropoietin Resistance Indexmentioning

confidence: 99%

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Doses intermitentes de estatina em pacientes em hemodiálise com LDL-colesterol espontaneamente baixo

Suassuna¹,

Bastos²

2008

Arq. Bras. Cardiol.

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SummaryBackground: Mortality in dialysis patients remains high and is due mainly to cardiovascular causes. Inflammation has a role in the genesis of accelerated atherosclerosis, vascular calcification, malnutrition and anemia, and a huge impact on the survival of these patients. The pleiotropic effects of statins can be a therapeutic option for reducing chronic inflammatory processes of patients undergoing hemodialysis.

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“…These facts corroborate data in medical literature that show a strong influence of inflammation on erythropoiesis 9 .…”

Section: Discussionsupporting

confidence: 91%

Section: Study Population and Designmentioning

confidence: 99%

Section: Erythropoietin Resistance Indexmentioning

confidence: 99%

See 1 more Smart Citation

Doses intermitentes de estatina em pacientes em hemodiálise com LDL-colesterol espontaneamente baixo

Suassuna¹,

Bastos²

2008

Arq. Bras. Cardiol.

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“…However, the persistence of anemia despite Epo, iron and vitamin supplementation suggests a concomitant bone marrow hypo-responsiveness in these patients. Indeed, another major determinant of the anemia in CHD is the chronic inflammatory state, in which cytokines further decrease Epo production, induce apoptosis of erythroid precursors, and also reduce iron absorption and availability for erythropoiesis [2]. CHD is typically associated with alterations of circulating markers of iron metabolism, namely decreased transferrin saturation and increased serum ferritin levels, mostly due to iron retention in monocytes/macrophages [3].…”

Section: Anemia and Iron Status In Chronic Hemodialysis Patientsmentioning

confidence: 99%

Hepcidin levels in chronic hemodialysis patients: a critical evaluation

Valenti

Pelusi

Campostrini

et al. 2014

Clinical Chemistry and Laboratory Medicine

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Altered systemic iron metabolism is a key element of uremia, and functional iron deficiency mainly related to subclinical inflammation makes it difficult to maintain proper control of anemia in chronic hemodialysis patients (CHD). In the last decade, the hepatic hormone hepcidin has been progressively recognized as the master regulator of circulating iron levels through the modulation of cellular iron fluxes in response to iron stores, as well as to erythroid and inflammatory stimuli. Hepcidin is cleared by the kidney and progression of renal disease has been associated to increased serum hepcidin levels. This, in turn, reduces iron availability for erythropoiesis, suggesting anti-hepcidin strategies for improving anemia control. Moreover, hepcidin has been recently implicated in the pathogenesis of long-term complications of dialysis, like accelerated atherosclerosis. Initial studies almost invariably reported a sustained increase of serum hepcidin in chronic hemodialysis patients. Noteworthy, such studies included relatively few patients and controls that were poorly matched for major determinants of serum hepcidin at population level, i.e., age and gender. More recent data based on accurately matched larger series challenge the view that hepcidin is intrinsically increased in hemodialysis patients, showing a marked inter-and intra-individual variability of hormone levels. Here we take a critical look to the data published so far on hepcidin levels in CHD, analyze the reasons underlying the discrepancies in available studies and the hepcidin variability in CHD, and point out the need for further studies in large series of well-characterized CHD patients and controls.

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“…In fact, one study of children undergoing chromic hemodialysis found that highdose erythropoietin was needed more often in the case of hyperparathyroidism than in children with normal or low parathyroid hormone levels, likely due to renal osteodystrophy [20]. Other studies have shown that hematocrit, serum erythropoietin levels, and erythropoietin resistance (defined as weekly erythropoietin dose/hematocrit) are unaffected by serum levels of parathyroid hormone [21,22]. Thus, it is unlikely that our patient's anemia was secondary to hypoparathyroidism per se.…”

Section: Discussionmentioning

confidence: 99%

Erythropoietin‐deficient anemia associated with autoimmune polyglandular syndrome type I

2004

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Autoimmune polyglandular syndrome type I (APS1), a relatively common disorder in some populations, is frequently associated with adrenal insufficiency, hypoparathyroidism, and other endocrine and skin abnormalities. We describe an 18-year-old male with APS1, as documented by genotyping, who presented with hypoparathyroidism and a normocytic, hypoproliferative, isolated anemia. An extensive hematological work-up revealed a low serum erythropoietin, without any other hematological abnormalities. His renal function was normal, and he did not have many of the laboratory or clinical findings associated with an anemia of chronic disease. His anemia was responsive to superphysiologic doses of erythropoietin. We thus suggest that erythropoietin deficiency may be one of the endocrine abnormalities associated with APS1, and clinicians should be cognizant of the association of treatable anemia in patients with APS1. Am.

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Acute-phase response predicts erythropoietin resistance in hemodialysis and peritoneal dialysis patients

Cited by 290 publications

References 36 publications

Doses intermitentes de estatina em pacientes em hemodiálise com LDL-colesterol espontaneamente baixo

Doses intermitentes de estatina em pacientes em hemodiálise com LDL-colesterol espontaneamente baixo

Hepcidin levels in chronic hemodialysis patients: a critical evaluation

Erythropoietin‐deficient anemia associated with autoimmune polyglandular syndrome type I

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