Association between human recombinant EPO and peripheral vascular disease in diabetic patients receiving peritoneal dialysis

Wakeen, Maureen; Zimmerman, Stephen W.

doi:10.1053/ajkd.1998.v32.pm9740167

Cited by 36 publications

(17 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Considering above-mentioned reports, the present study that demonstrated a correlation between cardiovascular mortality and higher Hb levels in high IDWG patients may suggest that an over-correction of Hb after HD is correlated to cardiovascular death. Higher Hb levels after HD could be reached resulting in severe hypertension and hypercoagulability or decreased perfusion to major arteries already at risk [56–58], and then be related to cardiovascular events. However, either high IDWG or high Hb levels of pre-HD are more involved in the higher Hb levels of post-HD is unknown in this study, and the definite relationship between cardiovascular death and the Hb level of post-HD remains unclear.…”

Section: Discussionmentioning

confidence: 99%

Relationship between Hemoglobin Levels Corrected by Interdialytic Weight Gain and Mortality in Japanese Hemodialysis Patients: Miyazaki Dialysis Cohort Study

et al. 2017

View full text Add to dashboard Cite

BackgroundAlthough hemoglobin (Hb) levels are affected by a change in the body fluid status, the relationship between Hb levels and mortality while taking interdialytic weight gain (IDWG) at blood sampling into account has not yet been examined in hemodialysis patients.Study designCohort study.Setting, ParticipantsData from the Miyazaki Dialysis cohort study, including 1375 prevalent hemodialysis patients (median age (interquartile range), 69 (60–77) years, 42.3% female).PredictorPatients were divided into 5 categories according to baseline Hb levels and two groups based on the median value of IDWG rates at blood sampling at pre-HD on the first dialysis session of the week.OutcomesAll-cause and cardiovascular mortalities during a 3-year follow-up.MeasurementsHazard ratios were estimated using a Cox model for the relationship between Hb categories and mortality, and adjusted for potential confounders such as age, sex, dialysis duration, erythropoiesis-stimulating agent dosage, Kt/V, comorbid conditions, anti-hypertensive drug use, serum albumin, serum C-reactive protein, serum ferritin, and serum intact parathyroid hormone. Patients with Hb levels of 9–9.9 g/dL were set as our reference category.ResultsA total of 246 patients (18%) died of all-cause mortality, including 112 cardiovascular deaths. Lower Hb levels (<9.0g/dL) were associated with all-cause mortality (adjusted HRs 2.043 [95% CI, 1.347–3.009]), while Hb levels were not associated with cardiovascular mortality. When patients were divided into two groups using the median value of IDWG rates (high IDWG, ≥5.4% and low IDWG, <5.4%), the correlation between lower Hb levels and all-cause mortality disappeared in high IDWG patients, but was maintained in low IDWG patients (adjusted HRs 3.058 [95% CI,1.575–5.934]). On the other hand, higher Hb levels (≥12g/dL) were associated with cardiovascular mortality in high IDWG patients (adjusted HRs 2.724 [95% CI, 1.010–7.349]), but not in low IDWG patients.ConclusionIn hemodialysis patients, target Hb levels may need to be selected in consideration of IDWG at blood sampling.

show abstract

Section: Discussionmentioning

confidence: 99%

Relationship between Hemoglobin Levels Corrected by Interdialytic Weight Gain and Mortality in Japanese Hemodialysis Patients: Miyazaki Dialysis Cohort Study

et al. 2017

View full text Add to dashboard Cite

show abstract

“…Preliminary findings of a recent study [40] suggest that elevated erythropoietin levels in diabetic patients receiving dialysis are associated with increased risk of vascular disease and vascular events. Homocystinemia in these patients may also have a prominent role in pathogenesis of vascular disease.…”

Section: Risk Factorsmentioning

confidence: 97%

Treatment of Chronic Peripheral Arterial Disease

2003

CVP

View full text Add to dashboard Cite

Peripheral arterial disease (PAD) is a common but under-recognized problem. Intermittent claudication is the most frequent symptom of PAD, although the diagnosis of PAD is often overlooked until the patient is presented with limb-threatening ischemia. Importantly, PAD is a marker of generalized atherosclerosis and is closely associated with coronary and cerebrovascular disease. The primary causes of death in patients with PAD are myocardial infarction and stroke. Reducing risk factors is an integral and aggressive part of the treatment regimen. The recognition and diagnosis of PAD, combined with its appropriate medical management, may well reduce the overall risk of cardiovascular morbidity. When diagnosed early, both exercise and pharmacotherapy can ameliorate symptoms of claudication. augment functional performance, and improve quality of life. This review focuses on the general medical management and specific therapeutic options. Because PAD is a manifestation of generalized atherosclerosis, the principal issue in medical management of PAD is a treatment plan that modifies known risk factors for atherosclerosis and its atherothrombotic complications. All patients with PAD should be receiving antiplatelet therapy to prevent ischemic events and ACE inhibitors should be used if appropriate. Medical treatment for patients with claudication includes exercise in rehabilitation and drug therapy. It is also recognized that selected patients with claudication symptoms may benefit from catheter-based interventions, and most PAD patients with critical leg ischemia require revascularization procedures. Although many therapies for claudication have been thoroughly investigated, research continues on new treatments. In contrast, more prospective, randomized trials are needed to evaluate various therapies for treating patients with PAD.

show abstract

“…Initial data reporting an increased frequency of thrombotic events came from retrospective non-randomized studies [26,27] or from prospective randomized studies conducted in chronically diseased populations receiving prolonged Epo dosings ([400 IU/kg/week for months or years) [28]. Increased hematocrits have been observed particularly with simultaneous iron administration.…”

Section: Safety Of Epo In Cardiac Patientsmentioning

confidence: 99%

Update on phase II studies of erythropoietin in acute myocardial infarction. Rationale and design of Exogenous erythroPoietin in Acute Myocardial Infarction: New Outlook aNd Dose Association Study (EPAMINONDAS)

Andreotti

Agati

Conti

et al. 2009

J Thromb Thrombolysis

View full text Add to dashboard Cite

Erythropoietin (Epo) is a hematopoietic hormone produced mainly by the kidneys in response to hypoxia. Recent acquisitions in the fields of hematology, neurology, cardiology, and experimental medicine show cytoprotective, angiogenetic and antiinflammatory effects of Epo. Exogenous erythroPoietin in Acute Myocardial Infarction: New Outlook aNd Dose Association Study (EPAMINONDAS, EudraCTno. 200500485386) is one of four ongoing randomized controlled trials, each testing the effects of Epo in >or=100 patients with STEMI. EPAMINONDAS is a multicenter, prospective, double-blind, placebo-controlled, dose-finding study assessing intravenous moderate doses of human recombinant Epo (epoietin-alpha, 100 or 200 IU/kg/die) versus placebo, given on the first 3 days, in 102 patients with first ST-segment elevation myocardial infarction. Initial dosing is within 12 h of primary percutaneous coronary revascularization. The primary endpoint is infarct size, quantified by CK-MB time-concentration curve, left ventricular wall motion score index, and pattern of contrast-enhanced magnetic resonance imaging. Secondary endpoints are ischemic recurrences, ventricular remodelling, and safety events, assessed in-hospital and at 12 months' follow-up. The results of current phase II studies will help define the safety/efficacy profile of Epo for patients with STEMI.

show abstract

Association between human recombinant EPO and peripheral vascular disease in diabetic patients receiving peritoneal dialysis

Cited by 36 publications

References 21 publications

Relationship between Hemoglobin Levels Corrected by Interdialytic Weight Gain and Mortality in Japanese Hemodialysis Patients: Miyazaki Dialysis Cohort Study

Relationship between Hemoglobin Levels Corrected by Interdialytic Weight Gain and Mortality in Japanese Hemodialysis Patients: Miyazaki Dialysis Cohort Study

Treatment of Chronic Peripheral Arterial Disease

Update on phase II studies of erythropoietin in acute myocardial infarction. Rationale and design of Exogenous erythroPoietin in Acute Myocardial Infarction: New Outlook aNd Dose Association Study (EPAMINONDAS)

Contact Info

Product

Resources

About