Anemia of chronic kidney disease: Protocol of study, management and referral to Nephrology

Cases, Aleix; Egocheaga, M.I.; Tranche, Salvador; Pallarés, Vicente; Ojeda, Raquel; Górriz, José Luis; Pórtoles, José

doi:10.1016/j.nefroe.2018.01.007

Cited by 48 publications

(37 citation statements)

References 4 publications

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“…Previous studies have suggested that an abnormal concentration of Hb is a consequence of preclinical cardio-or cerebrovascular disease and not a predisposing factor. 28 There are also numerous causes of anemia, including chronic disease states, bone marrow depression from increased levels of proinflammatory cytokines, 29,30 iron or vitamin deficiency, 31 malnutrition, kidney dysfunction, 32,33 impaired erythropoietin production or resistance, hemoglobinopathies, and some angiotensin-converting enzyme inhibitors. [34][35][36] All-cause mortality and stroke are increased when the Hb concentration was lower than 12 g/dL and higher than 14 g/dL.…”

Section: Discussionmentioning

confidence: 99%

Predicting Adverse Events beyond Stroke and Bleeding with the ABC-Stroke and ABC-Bleeding Scores in Patients with Atrial Fibrillation: The Murcia AF Project

et al. 2020

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Background The ABC (age, biomarkers, and clinical history)-stroke and ABC-bleeding are biomarker-based scores proposed to predict stroke and bleeding, but non-specificity of biomarkers is common, predicting different clinical events at the same time. We assessed the predictive performance of the ABC-stroke and ABC-bleeding scores, for outcomes beyond ischemic stroke and major bleeding, in a cohort of atrial fibrillation (AF) patients. Methods We included AF patients stable on vitamin K antagonists for 6 months. The ABC-stroke and ABC-bleeding were calculated and the predictive values for myocardial infarction (MI), acute heart failure (HF), a composite of cardiovascular events, and all-cause deaths were compared. Results We included 1,044 patients (49.2% male; median age 76 [71–81] years). During 6.5 (4.3–7.9) years, there were 58 (5.6%) MIs, 98 (9.4%) acute HFs, 167 (16%) cardiovascular events, and 418 (40%) all-cause deaths. There were no differences in mean ABC-stroke and ABC-bleeding scores in patients with/without MI (p = 0.367 and p = 0.286, respectively); both scores were higher in patients with acute HF, cardiovascular events, or death (all p < 0.05). Predictive performances for the ABC-stroke and ABC-bleeding scores were similar, ranging from “poor” for MI (c-indexes ∼0.54), “moderate” for acute HF and cardiovascular events (c-indexes ∼0.60 and ∼0.64, respectively), and “good” for all-cause mortality (c-indexes > 0.70). Clinical usefulness whether assessed by ABC-stroke or ABC-bleeding was similar for various primary endpoints. Conclusion In AF patients, the ABC-stroke and ABC-bleeding scores demonstrated similar predictive ability for outcomes beyond stroke and bleeding, including MI, acute HF, a composite of cardiovascular events, and all-cause deaths. This is consistent with nonspecificity of biomarkers that predict “sick” patients or poor prognosis overall.

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Section: Discussionmentioning

confidence: 99%

Predicting Adverse Events beyond Stroke and Bleeding with the ABC-Stroke and ABC-Bleeding Scores in Patients with Atrial Fibrillation: The Murcia AF Project

et al. 2020

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“…Erythropoietin deficiency, decreased red blood cells life span, abnormal iron metabolism, and chronic inflammation were the known mechanisms of anemia in CKD [9,11]. Anemia in CKD was also associated with the disease progression, increased mortality rate, and unfavorable outcome [12]. A study from Hoshino et al showed that increased hemoglobin levels alleviated some symptoms in CKD such as depressions and insomnia in non-hemodialysis patients [13].…”

Section: Introductionmentioning

confidence: 99%

The Association of Hemoglobin Levels With Quality of Life and Physical Activity in Hemodialysis Patient in Wangaya Regional General Hospital, Denpasar

Daniella¹,

Marianto²,

I³

2020

Asian J Pharm Clin Res

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Objective: Anemia in chronic kidney disease (CKD) contributes in decreasing quality life, but specific hemoglobin associated with quality of life is still in debate. Anemia was thought to be one of contributing factors of low physical activity in CKD, but this finding is inconsistent across studies. This research study aims to investigate the association of hemoglobin levels with quality of life and physical activity in hemodialysis patients in our settings. Methods: This study was conducted between March 30, 2020, and April 30, 2020, in hemodialysis unit, Wangaya Regional General Hospital, Bali. The study included 50 subjects on regular hemodialysis. Subject-reported quality of life was evaluated by interview, based on Kidney Disease Quality of Life (KDQOL)-36TM questionnaire. Self-reported physical activity level was assessed by International Physical Activity Questionnaires (IPAQ). Results: Quality of life in burden of kidney disease categories is different significantly between hemoglobin levels group (*p=0.034). There is significant difference between hemoglobin levels < 8 g/dL with 8.1–12 g/dL (**p=0.01) and hemoglobin levels < 8 g/dL with > 12 g/dL (*p=0.034). For self-reported physical activity, hemoglobin level was not associated with physical activity in Fisher’s exact test analysis (p=1.000). Conclusion: We found that hemoglobin levels > 8 g/dL were associated with higher quality of life in hemodialysis patient. Hemoglobin levels were not associated with physical activity. Recommended hemoglobin levels to support the best quality of life and physical activity without increasing mortality rate are still in need to be further evaluated.

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“…These patients suffer from renal anemia, especially in the end stages of the disease, since their kidneys cannot secrete enough erythropoietin to produce red blood cells (RBCs) [3]. Protocols of treatment include RBC transfusion (RBCT) or erythropoietin-stimulating agents (ESA) such as epoetin-alfa, epoetin-beta, and darbepoetin-alfa [4]. ESAs are a group of medications that are directed towards bone marrow in order to stimulate the differentiation of progenitor cells to RBCs in the treatment of anemia associated with endstage CKD.…”

Section: Introductionmentioning

confidence: 99%

The Cost-Effectiveness of Using Epoetin-Beta Versus Darbepoetin-Alfa for the Treatment of Anemia Among Chronic Hemodialysis Patients

AlKharboush

Alshehri

Alatwi

et al. 2020

Cureus

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Background and objective Anemia is a common prognosis of chronic kidney disease (CKD). It is predominantly managed with synthetic erythropoietin. The principal objective of this study was to compare the cost-effectiveness of the use of short-acting erythropoietin with the long-acting one to maintain serum hemoglobin (Hb) concentration within the range of 10.5-12 g/dL. Method This was a retrospective cohort study involving patients diagnosed with stage 5 CKD according to the Saudi Society of Nephrology and Transplantation conducted at eight tertiary care centers in the Tabuk region, Saudi Arabia. We compared the cost-effectiveness of long-acting erythropoietin with the short-acting one. The decision analysis model and Markov model were established to simulate a cohort of 55-year-old patients to estimate the incremental cost and quality-adjusted life-year (QALY) for chronic hemodialysis patients (CHP) treated with either darbepoetin-alfa or epoetin-beta for at least nine months. The incremental cost per QALY was the main outcome marker for using both medications. Serum HB levels were monitored on a monthly basis and costs were calculated. Results A total of 291 CHP met our inclusion criteria; 194 of them were treated with darbepoetin-alfa while 97 were treated with epoetin-beta. The mean age was 56.3 ± 11.2 years for the darbepoetin-alfa group and 55.2 ± 7.8 years for the epoetin-beta cohort. The baseline serum Hb was 10.68 ± 0.98 g/dL for darbepoetin-alfa patients and 11.63 ± 0.32 g/dL for the epoetin-beta group (p=0.003). We observed a significant difference between the percentage of patients successfully treated with epoetin-beta and those managed with darbepoetinalfa (80.4% vs. 63.92%, p=0.01) with considerably less cardiovascular side effects. The average annual cost per patient was estimated at $919.47 and $12,319.41 for epoetin-beta and darbepoetin-alfa respectively. Also, the average effectiveness was 0.58 for darbepoetin-alfa vs. 0.

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Anemia of chronic kidney disease: Protocol of study, management and referral to Nephrology

Cited by 48 publications

References 4 publications

Predicting Adverse Events beyond Stroke and Bleeding with the ABC-Stroke and ABC-Bleeding Scores in Patients with Atrial Fibrillation: The Murcia AF Project

Predicting Adverse Events beyond Stroke and Bleeding with the ABC-Stroke and ABC-Bleeding Scores in Patients with Atrial Fibrillation: The Murcia AF Project

The Association of Hemoglobin Levels With Quality of Life and Physical Activity in Hemodialysis Patient in Wangaya Regional General Hospital, Denpasar

The Cost-Effectiveness of Using Epoetin-Beta Versus Darbepoetin-Alfa for the Treatment of Anemia Among Chronic Hemodialysis Patients

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