Anaemia secondary to erythropoietin resistance: important predictor of adverse outcomes in chronic obstructive pulmonary disease

Sharma, Rahul Kumar; Chakrabarti, Shibdas

doi:10.1136/postgradmedj-2015-133814

Cited by 15 publications

(15 citation statements)

References 13 publications

(18 reference statements)

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“…Further analyses indicated that age, potassium ion concentration before dialysis, and anti-EPO antibody OD level were independent associated factors of higher EPO demand or higher EDI. As mentioned in the Introduction, anemia is one of the most frequent complications accompanying ESRD, especially in the maintenance dialysis patient subpopulation (1,7,11,12). In the present study, more than half of the maintenance dialysis patients had various severities of anemia.…”

Section: Discussionsupporting

confidence: 52%

“…Erythropoietin demand reflects the need for erythropoietin (including endogenous and exogenous EPO) in ESRD patients in order to produce sufficient Hb to eliminate anemia (6,7). Previous studies have shown that maintenance of dialysis patients with ESRD may be characterized by a greater erythropoietin demand or require a larger amount of ESA (1,6).…”

Section: Introductionmentioning

confidence: 99%

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Baseline Soluble Anti-erythropoietin Antibody Level Is an Independent Associated Factor for Follow-Up Erythropoietin Demand in Maintenance Dialysis Patients With End-Stage Renal Disease: A Prospective Cohort Study

et al. 2020

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The aim of this study was to identify the predictive role of baseline anti-erythropoietin (anti-EPO) antibody levels in follow-up EPO demand in maintenance dialysis patients with end-stage renal disease (ESRD). Methods: Baseline routine blood parameters, clinical data, dialysis-related parameters, EPO, anti-EPO antibody, and anti-EPO-receptor antibody were also measured. Differences in the abovementioned variables were compared among four intervals of the EPO demand index (EDI). Further univariate and adjusted logistic regression analyses were performed to identify the independent predictors for higher EPO demand. Results: The predialysis potassium ion concentration was significantly higher in the fourth quartile (Q4) population than in the other three populations (p < 0.05). Furthermore, the anti-EPO antibody level showed significant differences among the four intervals (p = 0.006). The baseline anti-EPO antibody level was correlated with the follow-up EDI (r 2 = 0.0377, p = 0.030). Furthermore, the follow-up EDI was significantly higher in the anti-EPO antibody-positive group (p = 0.02). Age (OR = 1.071, p = 0.005), ferritin (OR = 1.001, p = 0.038), potassium ion concentration before dialysis (OR = 2.781, p = 0.012), dialysis duration (OR = 1.025, p = 0.030), and anti-EPO antibody level (OR = 7.694, p = 0.004) were potential predictors for higher EPO demand. After adjustment, age (OR = 1.072, p = 0.026), potassium ion concentration before dialysis (OR = 3.425, p = 0.013), and EPO level (OR = 5.27, p = 0.007) were independent predictors for higher EDI demand. Conclusion: The baseline anti-EPO antibody level combined with an older age and a higher predialysis potassium ion concentration are independent predictors for a higher follow-up EPO demand in maintenance dialysis patients with ESRD.

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Section: Discussionsupporting

confidence: 52%

Section: Introductionmentioning

confidence: 99%

Baseline Soluble Anti-erythropoietin Antibody Level Is an Independent Associated Factor for Follow-Up Erythropoietin Demand in Maintenance Dialysis Patients With End-Stage Renal Disease: A Prospective Cohort Study

et al. 2020

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“…Serum erythropoietin was previously found increased in COPD patients with severe nocturnal and diurnal hypoxemia [ 17 ], and patients with severe COPD [ 18 ], although the response to EPO in COPD appears to be blunted [ 19 ]. EPO, in general, drops with hypoxemia treatment in COPD [ 20 ] and sleep apnea [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical Markers of Chronic Hypoxemia in Respiratory Patients Residing at Moderate Altitude

Fernández-Plata

Thirión-Romero

Nava-Quiroz

et al. 2021

Life

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Supplemental oxygen (SO) increases survival in hypoxemic patients. In hypoxia, mammals respond by modulating O2-sensitive transducers that stabilize the transcription factor hypoxia-inducible factor-1-alpha (HIF-1α), which transactivates the genes that govern angiogenesis and metabolic pathways. Residing at high altitudes exposes millions of people to hypoxemia with potential adverse consequences on their health. We aimed to identify markers of hypoxemia that can be used in the evaluation of patients in addition to pulse oximetry and arterial blood gases, especially those that could respond after 1 month of oxygen use. We performed a prospective pilot study at 2240 m above sea level, with repeated measurements before and after (b/a) 1-month home oxygen therapy in 70 patients with lung diseases, of which 24/20 have COPD, 41/39 obstructive sleep apnea (OSA), and 5/2 with interstitial lung diseases (ILD), all of them having chronic hypoxemia, as well as 70 healthy subjects as controls. Proteins evaluated included HIF-1α, vascular endothelial growth factor (VEGF), and erythropoietin (EPO). Among the main results, we found that hypoxemic patients had normal levels of HIF-1α but increased EPO compared with healthy controls. VEGF levels were heterogeneous in the sample studied, similar to the control group in COPD, slightly increased in OSA, and decreased in fibrosis. With oxygen treatment, the HIF-1α and EPO decreased in COPD and OSA but not in fibrosis, and VEGF remained constant over time. In conclusion, erythropoietin and HIF-1α identified hypoxemia initially and responded to oxygen. In pulmonary fibrosis, HIF-1α, EPO, and VEGF increased with oxygen therapy, which is likely linked to the disease’s pathogenesis and clinical course rather than hypoxemia.

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“…We hypothesize that iron www.nature.com/scientificreports www.nature.com/scientificreports/ accumulates as a biological response to continuous smoke exposure. Specifically, smoke exposure leads to altered responses to hypoxia, higher erythropoietin (EPO) levels 43 and expanded, but inefficient erythropoiesis in the bone marrow (unpublished data) 44 . This may in turn lead to changes in iron uptake and release in macrophages globally, including in the lung, to increase iron availability for hemoglobin synthesis 45 .…”

Section: Discussionmentioning

confidence: 99%

Increased airway iron parameters and risk for exacerbation in COPD: an analysis from SPIROMICS

Zhang

Oromendia

Kikkers

et al. 2020

Sci Rep

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Levels of iron and iron-related proteins including ferritin are higher in the lung tissue and lavage fluid of individuals with chronic obstructive pulmonary disease (COPD), when compared to healthy controls. Whether more iron in the extracellular milieu of the lung associates with distinct clinical phenotypes of COPD, including increased exacerbation susceptibility, is unknown. We measured iron and ferritin levels in the bronchoalveolar lavage fluid (BALF) of participants enrolled in the SubPopulations and InteRmediate Outcome Measures In COPD (SPIROMICS) bronchoscopy sub-study (n = 195). BALF Iron parameters were compared to systemic markers of iron availability and tested for association with FEV 1 % predicted and exacerbation frequency. Exacerbations were modelled using a zero-inflated negative binomial model using age, sex, smoking, and FEV 1 % predicted as clinical covariates. BALF iron and ferritin were higher in participants with copD and in smokers without copD when compared to non-smoker control participants but did not correlate with systemic iron markers. BALF ferritin and iron were elevated in participants who had COPD exacerbations, with a 2-fold increase in BALF ferritin and iron conveying a 24% and 2-fold increase in exacerbation risk, respectively. Similar associations were not observed with plasma ferritin. increased airway iron levels may be representative of a distinct pathobiological phenomenon that results in more frequent COPD exacerbation events, contributing to disease progression in these individuals.

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Anaemia secondary to erythropoietin resistance: important predictor of adverse outcomes in chronic obstructive pulmonary disease

Abstract: Anaemia is a significant comorbidity of COPD with a negative prognostic impact on lung health. It can be ascribed to a state of systemic inflammation resulting in blunting of erythropoietin response with increasing severity of disease, leading to greater morbidity and hospitalisation.

Cited by 15 publications

References 13 publications

Baseline Soluble Anti-erythropoietin Antibody Level Is an Independent Associated Factor for Follow-Up Erythropoietin Demand in Maintenance Dialysis Patients With End-Stage Renal Disease: A Prospective Cohort Study

Baseline Soluble Anti-erythropoietin Antibody Level Is an Independent Associated Factor for Follow-Up Erythropoietin Demand in Maintenance Dialysis Patients With End-Stage Renal Disease: A Prospective Cohort Study

Clinical Markers of Chronic Hypoxemia in Respiratory Patients Residing at Moderate Altitude

Increased airway iron parameters and risk for exacerbation in COPD: an analysis from SPIROMICS

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