Erythropoietin hyporesponsiveness: From iron deficiency to iron overload

Tarng, Der Cherng; Huang, Tung Po; Chen, Tzen Wen; Wu, Yang Chang

doi:10.1038/sj.ki.4490858

Cited by 86 publications

(71 citation statements)

References 8 publications

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“…These may be infection, inflammatory disease, malignancy, blood loss or hyperparathyroidism. Aluminium overload can produce a functional deficiency that does not respond to iron therapy (Cavill et al ., 1997; Tarng et al ., 1999). Best practice guidelines on the strategies for managing anaemia in renal failure are available (Cameron, 1999).…”

Section: Problem Areasmentioning

confidence: 99%

A systematic approach to the assessment of erythropoiesis

Waters

Seal

2001

Clinical &Amp; Laboratory Haematology

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The pathogenesis of anaemia may be simple or complex and the differential diagnosis can be difficult. An appreciation of the erythropoietic processes is required, together with regular review of investigations, to ensure that appropriate protocols are adopted. The application of tests, which define different facets of erythropoiesis, should be appropriate to the clinical circumstances. In some situations, such as the anaemia of chronic disorders, pregnancy and chronic renal failure, a detailed analysis of erythropoiesis is often required. Guidelines for investigating anaemia due to megaloblastosis or haemoglobinopathy are well established, whereas disturbances of iron metabolism are often difficult to classify. These require a clear distinction between storage and functional iron to differentiate whether the defect is due to readily treatable simple iron deficiency or more complex mechanisms, which do not respond to iron supplementation. Determination of red cell haemoglobin content, reticulocyte analysis and the assay of serum transferrin receptors are new generation parameters developed to address this. Practice pressures and new treatment options have contributed to investigations becoming more complex, especially those of the secondary anaemias, as new tests have become more readily available and often automated. This has resulted in reduced turnaround times and clinical demand has driven request patterns. Initiatives to develop evidence-based anaemia management protocols are welcomed but, wherever possible, should be developed through collaboration between the haematology department and the user unit, and based on available guidelines.

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Section: Problem Areasmentioning

confidence: 99%

A systematic approach to the assessment of erythropoiesis

Waters

Seal

2001

Clinical &Amp; Laboratory Haematology

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“…An estimate of dialysis efficiency was determined by the monthly urea reduction ratio (URR). Parathyroid hormone and aluminum levels were recorded because of their effects on hematopoiesis [5,6]. The patients' weights were determined by the mean post-dialysis weight for each month.…”

Section: Methodsmentioning

confidence: 99%

Maintenance intravenous iron therapy in pediatric hemodialysis patients

Morgan

Gautam

Geary

2001

Pediatric Nephrology

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Iron supplementation is required for optimal response to erythropoietin (EPO) in hemodialysis patients. This is due to blood lost in the dialysis tubing after dialysis and the increased demand for iron by EPO therapy. Maintenance intravenous (IV) iron was administered according to a standardized protocol to pediatric patients on hemodialysis in our institution. The effect of this protocol on EPO dose, iron indices, anemia, and medication costs was evaluated. Data on two groups of patients were retrieved from the health records. Group 1 (n=14) consisted of patients treated in the 18 months prior to the protocol. These patients received oral iron supplements and occasional IV iron. Group 2 (n=5) consisted of all patients treated with the IV iron protocol. There was no difference in clinical characteristics and mean values for monthly hemoglobin, serum iron, ferritin, and transferrin saturation between groups. The dose of EPO was significantly reduced in group 2 compared with group 1 (193.9 +/- 121.4 vs. 73.9 +/- 39.0 units/kg per week, P<0.05). Medication costs were reduced by 26% in group 2. No significant adverse events were seen. Maintenance IV iron reduced the dose of EPO required to maintain blood hemoglobin levels. Our results also suggest that maintenance IV iron is a more-economic method of iron supplementation for pediatric hemodialysis patients.

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“…5 It is still debatable whether iron deficiency in hemodialysis patients is excluded when serum ferritin level is above 1,124 pmol/l. 6 The Dialysis Patients' Response to IV Iron with Elevated Ferritin (DRIVE) Study demonstrated that 6 weeks of intravenous ferric gluconate (125 mg doses at eight consecutive hemodialysis sessions) significantly improved hemoglobin levels (P = 0.028 vs no iron administration) in patients on hemodialysis with a serum ferritin concentration between 1,124 pmol/l and 2,696 pmol/l and a transferrin saturation of 25% or less. 7 However, another recent study showed that intravenous administration of iron sucrose (100 mg given once weekly for 12 weeks) was associated with exacerbation of oxidative DNA damage in peripheral blood lymphocytes, particularly in patients with ferritin levels above 1,124 pmol/l.…”

Section: Abstract Anemia Chronic Kidney Disease Ferritin Hemodialymentioning

confidence: 99%

The conundrum of serum ferritin measurement in patients with chronic kidney disease

Tarng

2008

Nat Rev Nephrol

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Serum ferritin level, the most commonly used marker for determining iron status in patients with chronic kidney disease, is influenced by factors such as inflammation and malnutrition. Moreover, there seems to be considerable biological variability and analytical variation between different serum ferritin assays. This Practice Point commentary discusses a recent paper by Ford et al. that examined the interassay differences and short-term intraindividual variability of serum ferritin measurements in patients on chronic hemodialysis. A comparison of six commonly used serum ferritin immunoassays revealed intermethod variation of up to 337 pmol/l among hemodialysis and nonhemodialysis patients. The intraindividual coefficients of variation for serum ferritin level in 60 stable hemodialysis patients ranged from 2% to 62% over an initial 2-week period and from 3% to 52% over a 6-week period. This commentary discusses Ford et al.'s paper and supports the conclusion that nephrologists should not use a single serum ferritin value to guide intravenous iron treatment in patients on chronic hemodialysis.

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Erythropoietin hyporesponsiveness: From iron deficiency to iron overload

Cited by 86 publications

References 8 publications

A systematic approach to the assessment of erythropoiesis

A systematic approach to the assessment of erythropoiesis

Maintenance intravenous iron therapy in pediatric hemodialysis patients

The conundrum of serum ferritin measurement in patients with chronic kidney disease

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