Adequacy of dialysis reduces the doses of recombinant erythropoietin independently from the use of biocompatible membranes in haemodialysis patients

Movilli, Ezio; Cancarini, Giovanni; Zani, Roberta; Camerini, Corrado; Sandrini, Massimo; Maiorca, R

doi:10.1093/ndt/16.1.111

Cited by 80 publications

(60 citation statements)

References 17 publications

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“…18 In a study involving 68 patients, Movilli and colleagues emphasize that adequate dialysis in iron-replete patients contributes to optimize rhEPO responsiveness independent of the use of biocompatible synthetic membranes. 19 The results of the present study are in agreement with these statements: no difference in Hgb and DA dose could be found using 3 different membranes (the number of patients using polyacrylonitrile is too small). We observed that, with an adequate dialysis ensuring stable biological parameters, the use of 3 different membranes and different times of injections during the HD session did not result in a clinical difference in the management of anemia with DA.…”

Section: Discussionsupporting

confidence: 91%

Timing of the administration of intravenous darbepoetin alfa during the dialysis session: Does it impact efficacy?

Rottembourg¹,

Kpade²,

Dansaert³

et al. 2009

Dialysis & Transplantation

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BACKGROUND: Darbepoetin alfa (DA) is an erythropoietin-stimulating agent (ESA) preferably administered through intravenous (IV) route in hemodialysis (HD) patients. Although some in vitro studies suggest the possibility of partial adsorption of ESAs in dialysis membranes (Mb) and lines, these data are not clinically confi rmed.METHODS: This 12-month, prospective, single-center cross-over study assessed the impact of the time of IV DA injection during HD on hemoglobin (Hgb) level and ESA dosing. A total of 90 HD patients received IV DA once every other week (Q2W), delivered at 2 possible time points: the middle or end of the HD session. After 6 months, the injection time point was crossed over to the other timing modality for another 6 months.RESULTS: Demographics for both groups of patients were similar. Mean Hgb level remained stable from baseline to month 6 (not signifi cant) for both timing modality groups. The same was observed for DA dose. Hemodialysis session parameters, nutritional status, and Kt/V were similar and stable during the study. Mean transferrin saturation was 44% and serum ferritin was Ն100 g/L in more than 92% of patients. Iron supplementation remained unchanged and there were no blood transfusions during the study.CONCLUSIONS: Q2W DA maintained target Hgb concentrations. The lack of difference in Hgb levels and DA dosing between the 2 injection timings suggests a lack of clinically signifi cant adsorption/interaction between DA and dialysis Mb/lines. Therefore, timing of IV DA administration can be fl exible and adapted to the routine practice of each local dialysis unit.

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Section: Discussionsupporting

confidence: 91%

Timing of the administration of intravenous darbepoetin alfa during the dialysis session: Does it impact efficacy?

Rottembourg¹,

Kpade²,

Dansaert³

et al. 2009

Dialysis & Transplantation

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show abstract

“…Kt, the top part of the fraction, is clearance multiplied by time, representing the volume of fluid completely cleared of urea during a single treatment V, the bottom part of the fraction, is the volume of water a patient's body contains. Many studies confirmed the idea of association of well removal of uremic inhibitors of erythropoiesis through adequate dialysis dose and getting the target responsiveness to the Epo treatment suggesting that the more inflamed patients could have a lower Kt/V because of difficulties in performing HD [47,48]. However, our finding in the studied patients was that increased dialysis dose (Kt/V) is associated with higher ERI.…”

Section: Individual Response Variations To Erythropoietin Stimulatingsupporting

confidence: 69%

Individual Response Variations to Erythropoietin Stimulating Agents in Patients on Maintenance Hemodialysis.

Ebid¹,

Elsawy²,

Taha³

2017

IOSRJPBS

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“…The physiologic mechanism through which the erythropoietic response is compromised at high ferritin levels could be explained by the malnutrition-inflammation complex syndrome inhibiting the erythropoiesis (28). A link between the dialysis adequacy and the erythropoietic response has been established before (14,15,29). Our results confirm the finding by Movilli et al (29), who established a negative correlation between the total Epo dose and Kt/V when Kt/V is below 1.33 and no correlation when it is above 1.33.…”

Section: Discussionmentioning

confidence: 99%

“…Among these factors, iron stores are most thoroughly described (7)(8)(9)(10)(11). Other factors include inflammation (12,13), adequacy of dialysis (14,15), nutritional status (16), and hyperparathyroidism (17).…”

mentioning

confidence: 99%

Iron, Inflammation, Dialysis Adequacy, Nutritional Status, and Hyperparathyroidism Modify Erythropoietic Response

Gawęda

Goldsmith²,

Brier³

et al. 2010

Clinical Journal of the American Society of Nephrology

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Background and objectives: The erythropoietic response in hemodialysis patients depends on several physiologic factors. Most epidemiologic studies include the effect of these factors by representing them as confounders. This study tested the hypothesis that iron stores, inflammation, dialysis adequacy, nutritional status, and hyperparathyroidism act as nonlinear effect modifiers of the erythropoietic response and quantified the magnitude of those effects over clinically relevant ranges.Design, setting, participants, & measurements: The following retrospective data from 209 hemodialysis patients receiving Epoetin alfa (Epo) were collected: monthly: predialysis hemoglobin (Hgb), transferrin saturation, serum albumin, dialysis adequacy (Kt/V); quarterly: predialysis serum ferritin and intact parathyroid hormone over a period of 13 to 69 months. The study analyzed the dynamic relationship between hemoglobin and Epo, considering nonlinear effect modification by ferritin, transferrin saturation, Kt/V, albumin, and parathyroid hormone individually.Results: Maximum Hgb response to Epo was achieved for serum ferritin between 350 and 500 ng/ml, transferrin saturation greater than 30%, Kt/V greater than 1.4, and albumin greater than 3.8 g/dl. Hgb sensitivity to Epo decreases by about 30% as parathyroid hormone increases from 0 through 1000 pg/ml.Conclusions: Serum ferritin, transferrin saturation, Kt/V, serum albumin, and intact parathyroid hormone are markers of nonlinear effect modification of the erythropoietic response in hemodialysis patients.

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Adequacy of dialysis reduces the doses of recombinant erythropoietin independently from the use of biocompatible membranes in haemodialysis patients

Cited by 80 publications

References 17 publications

Timing of the administration of intravenous darbepoetin alfa during the dialysis session: Does it impact efficacy?

Timing of the administration of intravenous darbepoetin alfa during the dialysis session: Does it impact efficacy?

Individual Response Variations to Erythropoietin Stimulating Agents in Patients on Maintenance Hemodialysis.

Iron, Inflammation, Dialysis Adequacy, Nutritional Status, and Hyperparathyroidism Modify Erythropoietic Response

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