Erythropoiesis-stimulating agent slows the progression of chronic kidney disease: a possibility of a direct action of erythropoietin

Tsuruya, Kazuhiko; Yoshida, Haruhiko; Suehiro, Takaichi; Fujisaki, Kiichiro; Masutani, Kosuke; Kitazono, Takanari

doi:10.3109/0886022x.2015.1136874

Cited by 14 publications

(8 citation statements)

References 35 publications

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“…Multivariate analysis of this study showed that anemia was an independent risk factor of CKD progression [30]. Some randomized controlled trials indicated that correcting anemia using erythropoiesisstimulating agents (ESAs) slows renal function deterioration [31][32][33][34]. On the other hand, anemia may be caused by the reduction of erythropoietin due to renal tubulointerstitial lesions [35].…”

Section: Discussionmentioning

confidence: 86%

The Association of Low Hemoglobin Levels with IgA Nephropathy Progression: A Two-Center Cohort Study of 1,828 Cases

Zhu¹,

Liu²,

Yu³

et al. 2020

Am J Nephrol

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Aim: To investigate the relationship between hemoglobin levels and the progression of IgA nephropathy (IgAN). Methods: In a two-center cohort of 1,828 cases with biopsy-proven IgAN, we examined the association of hemoglobin levels with the primary outcome of a composite of all-cause mortality or kidney failure defined as a 40% decline in eGFR, or ESKD (defined as eGFR <15 mL/min/1.73 m 2 or need for kidney replacement therapy including hemodialysis, peritoneal dialysis, or kidney transplantation), or the outcome of kidney failure, assessed using Cox and logistic regression models, respectively, with adjustment for confounders. Results: At baseline, mean age, eGFR, and hemoglobin levels were 33.75 ± 11.03 years, 99.70 ± 30.40 mL/min/1.73 m 2 , and 123.47 ± 18.36 g/L, respectively. During a median of approximately 7-year follow-up, 183 cases reached the composite outcome. After adjustment for demographic and IgAN-specific covariates and treatments, a lower quartile of hemoglobin was nonlinearly associated with an increased risk of the primary outcome or kidney failure in the Cox proportional hazards models (primary outcome: HR for quartile 3 vs. 4, 1.37; 95% CI, 0.83-2.25; HR for quartile 2 vs. 4, 1.18; 95% CI, 0.68-2.07; HR for quartile 1 vs. 4, 1.91; 95% CI, 1.15-3.17; kidney failure: HR for quartile 3 vs. 4, 1.39; 95% CI, 0.84-2.31; HR for quartile 2 vs. 4, 1.20; 95% CI, 0.68-2.11; HR for quartile 1 vs. 4, 1.83; 95% CI, 1.09-3.07) in the fully adjusted model. Then, hemo-Bin Zhu and Wen-hua Liu contributed equally to this work.

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Section: Discussionmentioning

confidence: 86%

The Association of Low Hemoglobin Levels with IgA Nephropathy Progression: A Two-Center Cohort Study of 1,828 Cases

Zhu¹,

Liu²,

Yu³

et al. 2020

Am J Nephrol

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“…Anemia is one of the most important complications of chronic renal failure (7).Anemia is also one of the mortality predictive factors in patients suffering from advanced chronic renal failure that leads to numerous pathophysiological disorders in these patients and brings about problems such as reduced tissue oxygenation, left ventricular hypertrophy, angina pectoris, heart failure, and immune system disorders.…”

Section: Discussionmentioning

confidence: 99%

The effect of erythropoietin on glomerular filtration rate in patients with chronic kidney disease and mild anemia in terms of diabetic nephropathy

Alidadi¹,

Heydari²

2017

Int. J. Adv. Res. Biol. Sci.

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Introduction: Chronic kidney disease refers to the progressive and irreversible loss of renal function that ultimately results in ESRD (end-stage renal disease) and calls for conducting one of the alternative diseases or transplantation. Given the contradictory findings of the studies conducted previously and the lack of precise information on the effects of erythropoietin on the renal function of CKD patients and its effect on GFR, the present study was conducted to investigate these effects in CKD patients. Method:The present study is a randomized clinical trial that was conducted to investigate the effect of prescribing erythropoietin on CKD patients' GFR. For this purpose, as many as 60 patients diagnosed with CKD entered the present study. These patients were in the second stage of CKD (with the GFR of 60-89). The patients were well explained and justified about the purpose and conditions of the study. Findings: The mean of GFR levels in CKD patients was as follows: 74.95±5.81 two months after prescribing erythropoietin, 74.10±5.70 four months after prescribing erythropoietin, and 72.80±5.18 six months after prescribing erythropoietin. The comparison of the mean of GFR before the intervention, and the intervals of two months, four months, and six months after the intervention indicated that there was no significant statistical difference in these rates (P=0.089). Discussion and conclusion :The general conclusion of the present study is that the reduction of GFR over a six-month study in patients receiving erythropoietin was less than that of the patients who did not receive erythropoietin. This indicates that the anemia treatment reduces GFR reduction rate in patients suffering from CKD.

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“…The proposed mechanisms for the cardioprotective and nephroprotective effects of dapagliflozin include64,65 (i) the improvement of hyperglycemia and insulin sensitivity, along with other metabolic effects such as uric acid reduction, (ii) the reduced inflammation, oxidative stress and oxygen‐consuming transport workload owing to reduced sodium and glucose reabsorption in the proximal renal tubules (indeed, it has been demonstrated that dapagliflozin may reduce proximal tubular cell injury),66,67 (iii) the blood pressure lowering effect, (iv) the increase in fasting glucagon,68 (v) the reduction in intraglomerular pressure owing to SGLT2 inhibition-induced increased sodium delivery to the macula densa, leading to constriction of afferent renal arterioles, (vi) the reduction of kidney fat deposition, which is considered ectopic fat that promotes diabetic kidney disease progression,60 (vii) the reversal of hypomagnesemia, which is correlated with a more rapid decline of renal function,69,70 (viii) the increase in erythropoietin levels that exhibits direct renoprotective effects,71 (ix) the increase in the production of ketone bodies, since they can be used as a more efficient energy substrate leading to reduction in renal hypoxia 72…”

Section: Effects Of Dapagliflozinmentioning

confidence: 99%

<p>Differential pharmacology and clinical utility of dapagliflozin in type 2 diabetes</p>

Papakitsou

Vougiouklakis

Elisaf

et al. 2019

CPAA

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Dapagliflozin belongs in the family of sodium-glucose cotransporter 2 (SGLT2) inhibitors and acts by reducing glucose reabsorption in the proximal tubule. The aim of this review is to present the differential pharmacology and clinical utility of dapagliflozin. Dapagliflozin is orally administered, has a long half-life of 12.9 hours and (similar to empagliflozin) is a much weaker SGLT1 inhibitor compared with canagliflozin. Dapagliflozin significantly decreases glycated hemoglobin and fasting glucose levels in patients with type 2 diabetes mellitus (T2DM). The drug improves body weight, blood pressure, uric acid, triglycerides and high-density lipoprotein cholesterol. In the DECLARE-TIMI 58 trial, a large trial of 17,160 T2DM patients with established cardiovascular disease (CVD) or without established CVD but with multiple risk factors, dapagliflozin compared with placebo resulted in a significantly lower rate of the composite outcome of CVD death or hospitalization for heart failure (HHF); this effect was mainly due to a lower rate of HHF in the dapagliflozin group (HR: 0.73; 95%CI: 0.61–0.88), whereas no difference was observed in the rate of CVD death (HR: 0.98; 95%CI: 0.82–1.17). Moreover, dapagliflozin was noninferior to placebo with respect to major adverse CVD events. Dapagliflozin exerts beneficial effects on albuminuria. Additionally, in the DECLARE-TIMI 58 trial it significantly reduced the composite renal endpoint (40% decrease in glomerular filtration rate, end stage renal disease, or renal death) in both patients with established CVD and patients with multiple risk factors (overall HR: 0.53; 95%CI: 0.43–0.66). However dapagliflozin, like the other SGLT2 inhibitors, is associated with an increased risk of genital and urinary tract infections (usually mild mycotic infections) and acute kidney injury in cases of reduced extracellular volume. Dapagliflozin is a useful antidiabetic treatment which also exerts beneficial effects in the management of heart failure and diabetic kidney disease.

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Erythropoiesis-stimulating agent slows the progression of chronic kidney disease: a possibility of a direct action of erythropoietin

Cited by 14 publications

References 35 publications

The Association of Low Hemoglobin Levels with IgA Nephropathy Progression: A Two-Center Cohort Study of 1,828 Cases

The Association of Low Hemoglobin Levels with IgA Nephropathy Progression: A Two-Center Cohort Study of 1,828 Cases

The effect of erythropoietin on glomerular filtration rate in patients with chronic kidney disease and mild anemia in terms of diabetic nephropathy

<p>Differential pharmacology and clinical utility of dapagliflozin in type 2 diabetes</p>

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