Anaemia in Yirrkala

Watson, David S.; Tozer, R. A.

doi:10.5694/j.1326-5377.1986.tb115956.x

Cited by 9 publications

(14 citation statements)

References 3 publications

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“…This is the first study, to our knowledge, to explore the relationship among iron studies, inflammation, and ESA responsiveness in indigenous patients of Northern Australia on MHD. In indigenous people of Northern Australia, published data have shown that absolute iron deficiency is common . In MHD patients, this is compounded by functional iron deficiency .…”

Section: Discussionmentioning

confidence: 99%

“…In indigenous people of Northern Australia, published data have shown that absolute iron deficiency is common. 8,28 In MHD patients, this is compounded by functional iron deficiency. 3 Results from this study suggest that in our MHD patients, where the majority of patients have high ferritin levels above the international guidelines levels, ferritin and TSAT alone may be inadequate measures to guide iron therapy.…”

Section: Discussionmentioning

confidence: 99%

“…3 Iron deficiency causes hyporesponsiveness to ESAs treatment in hemodialysis patients. [4][5][6][7] It is thought to be common among indigenous people of Northern Australia 8,9 and is expected to worsen in hemodialysis patients. Inflammation is a major cause of ESAs hyporesponsiveness.…”

Section: Introductionmentioning

confidence: 99%

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Inflammation, high ferritin, and erythropoietin resistance in indigenous maintenance hemodialysis patients from the Top End of Northern Australia

Majoni

Ellis

Hall

et al. 2014

Hemodialysis International

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Use of erythropoiesis-stimulating agents (ESAs) has improved the management of anemia in patients on maintenance hemodialysis (MHD). Iron deficiency and inflammation cause ESAs resistance and are both common among indigenous people of Northern Australia. As part of quality assurance in our Renal Anaemia Management program, we observed that there was use of higher doses of ESAs and adjuvant iron therapy in our MHD patients. This study aimed to explore the relationship among iron studies, inflammation, ESA responsiveness, and ESAs and iron requirements in indigenous patients on MHD from the Top End of Northern Australia. We performed a retrospective cohort analysis of anemia management in a cohort of our patients on MHD. We extracted data for 178 indigenous and 19 non-indigenous patients from 1 March 2009 to 28 February 2010 from the Renal Anaemia Management database, which collects data prospectively in MHD patients. Ninety-nine percent of the whole sample had a ferritin level above the international guidelines threshold of >500 µg/L. Indigenous patients had higher ferritin (1534 ± 245.5 µg/L vs. 1013 ± 323.3 µg/L, P = 0.002). C-reactive protein (CRP) was high in 56.9% of the total cohort. One hundred percent of those with normal CRP had high ferritin (>500 µg/L). C-reactive protein was higher in indigenous than in non-indigenous patients. Erythropoiesis-stimulating agents hyporesponsiveness was higher in indigenous patients (P < 0.0001). There was no significant difference in ESAs hyporesponsiveness among different levels of CRP (P = 0.116), ferritin (P = 0.408), and transferrin saturation (P = 0.503). Indigenous patients required higher total iron dose (2820.30 [2000-4350] vs. 2336.12 [1912-2900], P = 0.02). There was no significant relationship between the high ferritin and CRP. In indigenous dialysis patients, iron therapy and ESAs use are higher. The high iron use is due to a lack of published evidence to guide the administration of iron in patients with high ferritin. The high ferritin and ESAs resistance could not be fully explained by inflammation and need further evaluation. Further studies are required to determine the safe use of iron and management of ESAs resistance in our hemodialysis population.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Inflammation, high ferritin, and erythropoietin resistance in indigenous maintenance hemodialysis patients from the Top End of Northern Australia

Majoni

Ellis

Hall

et al. 2014

Hemodialysis International

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“…17 Iron deficiency (85%) and folate deficiency (15%) were found to be the major causes of anaemia in an analysis of over 5 year olds in an Indigenous community. 18 None were vitamin B12 deficient and there was no haemoglobinopathy, thalassaemia trait or glucose-6phosphate dehydrogenase deficiency detected. The haematology of Indigenous Australians was analysed by Erber et al with the similar conclusion of the aetiology of anaemia.…”

Section: Discussionmentioning

confidence: 96%

Anaemia in school‐aged children in an Australian Indigenous community

Udovicich

Perera

Leahy

2016

Australian J Rural Health

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“… 55 , 56 Evidence from our work and other researchers has shown the coexistence of iron deficiency, evidence of recurrent infection, and/or inflammation in adult Indigenous Australians particularly in those with dialysis dependent ESKD. 5 , 46 , 47 , 48 , 55 , 57 , 58 …”

Section: Anemia—a Major Complication Of Ckdmentioning

confidence: 99%

Narrative Review of Hyperferritinemia, Iron Deficiency, and the Challenges of Managing Anemia in Aboriginal and Torres Strait Islander Australians With CKD

Majoni

Lawton

Rathnayake

et al. 2021

Kidney International Reports

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Aboriginal and Torres Strait Islander Australians (Indigenous Australians) suffer some of the highest rates of chronic kidney disease (CKD) in the world. Among Indigenous Australians in remote areas of the Northern Territory, prevalence rates for renal replacement therapy (RRT) are up to 30 times higher than national prevalence. Anemia among patients with CKD is a common complication. Iron deficiency is one of the major causes. Iron deficiency is also one of the key causes of poor response to the mainstay of anemia therapy with erythropoiesis-stimulating agents (ESAs). Therefore, the effective management of anemia in people with CKD is largely dependent on effective identification and correction of iron deficiency. The current identification of iron deficiency in routine clinical practice is dependent on 2 surrogate markers of iron status: serum ferritin concentration and transferrin saturation (TSAT). However, questions exist regarding the use of serum ferritin concentration in people with CKD because it is an acute-phase reactant that can be raised in the context of acute and chronic inflammation. Serum ferritin concentration among Indigenous Australians receiving RRT is often markedly elevated and falls outside reference ranges within most national and international guidelines for iron therapy for people with CKD. This review explores published data on the challenges of managing anemia in Indigenous people with CKD and the need for future research on the efficacy and safety of treatment of anemia of CKD in patients with high ferritin and evidence iron deficiency.

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Anaemia in Yirrkala

Cited by 9 publications

References 3 publications

Inflammation, high ferritin, and erythropoietin resistance in indigenous maintenance hemodialysis patients from the Top End of Northern Australia

Inflammation, high ferritin, and erythropoietin resistance in indigenous maintenance hemodialysis patients from the Top End of Northern Australia

Anaemia in school‐aged children in an Australian Indigenous community

Narrative Review of Hyperferritinemia, Iron Deficiency, and the Challenges of Managing Anemia in Aboriginal and Torres Strait Islander Australians With CKD

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