Erythropoiesis-stimulating agents for anaemia in adults with chronic kidney disease: a network meta-analysis

Chung, Edmund Y. M.; Palmer, Suetonia C.; Saglimbene, Valeria; Craig, Jonathan C.; Strippoli, Giovanni F.M.

doi:10.1002/14651858.cd010590.pub3

Cited by 7 publications

(5 citation statements)

References 361 publications

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“…Die erfolgreiche Einführung der EPO-Substitution führte zu einer deutlichen Reduktion des Transfusionsbedarfs und damit assoziierter Risiken wie Übertragung von Infektionen und Immunisierungen. Nominell kam es ebenfalls zu einem Rückgang der Mortalität bei nierenkranken Patient*innen 7 . Der erhoffte günstige Effekt der Anämiekorrektur auf kardiovaskuläre Ereignisse blieb allerdings aus.…”

Section: Erythropoetin In Der Therapie Der Renalen Anämieunclassified

Epos EPO

Naas,

Schödel,

Grampp

2024

Nephrologie aktuell

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ZUSAMMENFASSUNGDie Substitution des Hormons Erythropoetin (EPO) stellte bisher den Grundpfeiler der Therapie der renalen Anämie bei nierenkranken Patienten*innen dar. Die seit über 30 Jahren in der Praxis etablierte Anwendung macht die verwendeten rekombinanten Substanzen zu Medikamenten, für die ein reicher Erfahrungsschatz vorliegt. Aufgrund seiner umschriebenen Wirkweise, des bekannten Nebenwirkungsprofils sowie der aktuellen Studienlage, die bisher überwiegend eine Gleichwertigkeit gegenüber neuen Erythropoese stimulierenden Agenzien (ESA) zeigt, ist wohl kein Ende der EPO-Substitutionstherapie abzusehen. Die Therapie der renalen Anämie wird allerdings durch neue Erkenntnisse zum Eisenhaushalt sowie die nun zugelassenen HIF-Stabilisatoren optimiert und individualisiert werden können.

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Section: Erythropoetin In Der Therapie Der Renalen Anämieunclassified

Epos EPO

Naas,

Schödel,

Grampp

2024

Nephrologie aktuell

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“…(5) women who were pregnant or breastfeeding; (6) the researcher judged that the life expectancy was <12 months; (7) screening visits revealed severe liver function abnormalities that met any of the following criteria -alanine aminotransferase (ALT) or aspartate aminotransferase (AST) ≥3× upper limit of normal (ULN) and total bilirubin ≥2× ULN, ALT or AST >8× ULN, or total bilirubin ≥5× ULN; (8) disorder compromises the ability to provide informed consent and/or comply with study procedures; (9) active participation in another clinical trial.…”

Section: Study Participantsmentioning

confidence: 99%

“…Recombinant human erythropoietin (rHuEPO) is the most important drug for the management of renal anaemia, but it increases the odds of hypertension [7]. Moreover, cardiovascular safety findings from the Normal Haematocrit Cardiac Trial (NHCT), Correction of Hemoglobin and Outcomes in Renal Insufficiency (CHOIR) study, the Cardiovascular Risk Reduction by Early Anemia Treatment with Epoetin Beta (CREATE) study and the Trial to Reduce Cardiovascular Events with Aranesp Therapy (TREAT) showed that a high dose of erythropoietin stimulating agent (ESA) is associated with an increased risk of cardiovascular events and mortality, regardless of haemoglobin levels.…”

Section: Introductionmentioning

confidence: 99%

Roxadustat reduces left ventricular mass index compared to rHuEPO in haemodialysis patients in a randomized controlled trial

Tan,

Wang,

Sun

et al. 2024

J Intern Med

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BackgroundLeft ventricular hypertrophy (LVH) is highly prevalent in haemodialysis (HD) patients and is associated with an increased risk of death. Roxadustat and recombinant human erythropoietin (rHuEPO, abbreviated as EPO) are the main treatment strategies for renal anaemia in HD patients, but it has not been clear whether there is a difference in their effect on LVH.MethodsIn this multi‐centre, prospective, randomized trial of 12‐month duration, study participants were randomized in a 1:1 ratio to the roxadustat group or the EPO group. The doses of both treatment regimens were adjusted so that the patients had a haemoglobin level of 10.0–12.0 g per dL. The primary study endpoint was the change from baseline to 12 months in the left ventricular mass index (LVMI, g/m2) measured by echocardiography.ResultsIn total, 114 patients were enrolled. The mean age was 50 years, and the median dialysis duration was 33 months. Sixty‐one patients were men, and 24 were diabetic. LVMI decreased from 116.18 ± 27.84 to 110.70 ± 25.74 g/m2 in the roxadustat group. However, it increased from 109.35 ± 23.41 to 114.99 ± 28.46 g/m2 in the EPO group, with a significant difference in the change in LVMI between the two groups [−5.48 (−11.60 to 0.65) vs. 5.65 (0.74 to 10.55), p < 0.05]. Changes in left ventricular mass, end‐diastolic volume and 6‐min walk test seemed superior in the roxadustat group. There were no significant differences in other cardiac geometry, biochemical parameters and major adverse cardiovascular events between the two groups.ConclusionsCompared to EPO, roxadustat is more helpful in the regression of LVH in HD patients.

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“…Anemia, a condition marked by a reduction in the number of red blood cells (RBCs) or a decrease in their hemoglobin (Hb) content, is a common comorbidity in CKD patients and is diagnosed when Hb falls below 13.0 g/dl for males and 12.0 g/dl for females. An epidemiological investigation showed that the occurrence of renal anemia was documented as follows: 8.4%, 12.2%, 17.4%, 50.3%, and 53.4% among individuals at various stages (1)(2)(3)(4)(5) of CKD [1]. Separate research findings unveiled that anemia was identified in roughly 60% of patients not undergoing dialysis and a substantial 93% of those undergoing dialysis treatment.…”

Section: Introductionmentioning

confidence: 99%

“…Anemia in CKD patients can exacerbate their symptoms, leading to increased fatigue, weakness, increased risk for hospitalization and reduced quality of life. Treatments for anemia often involve erythropoiesis-stimulating agents (ESAs) [2] or iron supplementation to help manage the condition and improve patients' overall well being. In recent years, the development of Hypoxia-inducible factor (HIF)-stabilizing medications has shown promise in treating anemia associated with CKD, as these medications mimic the body's natural response to low oxygen levels and stimulate the production of RBCs [3].…”

Section: Introductionmentioning

confidence: 99%

Eryptosis: a driver of anemia in chronic kidney disease

Bissinger,

Qadri,

Artunc

2023

Current Opinion in Nephrology &Amp; Hypertension

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Purpose of review Anemia, characterized by a reduction in red blood cell (RBC) count or hemoglobin concentration, commonly accompanies chronic kidney disease (CKD), significantly impacting patients’ quality of life. This review delves into the multifaceted nature of anemia in CKD, with a focus on novel mechanisms, particularly the dysregulation of eryptosis or programmed cell death of RBCs, leading to shortened RBC lifespan. Recent findings Recent studies in CKD patients and mouse models revealed that eryptosis, driven by factors such as uremic toxins, inflammation, and imbalances in calcium homeostasis, plays a pivotal role in the development of renal anemia. Dysregulated eryptosis results in premature RBC destruction, exacerbating the hypoproliferative character of anemia in CKD. Summary Recognizing the intricate relationship between eryptosis and anemia in CKD opens promising prospects for improving patient outcomes and enhancing our understanding of this complex condition. Future research and therapeutic development in this area hold the potential to improve anemia treatment of CKD patients.

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Erythropoiesis-stimulating agents for anaemia in adults with chronic kidney disease: a network meta-analysis

Cited by 7 publications

References 361 publications

Epos EPO

Epos EPO

Roxadustat reduces left ventricular mass index compared to rHuEPO in haemodialysis patients in a randomized controlled trial

Eryptosis: a driver of anemia in chronic kidney disease

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