Ferrokinetics in Azathioprine-Treated Uraemic Patients on Erythropoietin

Anastassiades, E.; Howarth, Deborah; Gokal, R.; Howarth, J. C.; Shanks, Dennis; Waters, H M; Hyde, K; Geary, C. G.; Ja, Yin

doi:10.1042/cs079011pc

Cited by 3 publications

(6 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Results similar to the present study were also published using IV Fe dextran or IV Fe gluconate [18,19,27], Recently, Anastassiades et al [11] using high-dose oral Fe supplementation com bined with EPO (100-120 IU/kg BW) in HD patients achieved a mean hemoglobin of only 9.4% (equivalent to an Hct of 28-29%).…”

Section: Discussionsupporting

confidence: 79%

“…This deficiency may become even more marked once the patient starts on chronic hemodialysis (HD) because of blood loss from gastrointestinal bleeding. bleeding from the needle puncture sites, blood left in the tubing and dialyser and from frequent blood tests [6,7], The problem of Fe deficiency has become even further compounded by the use of recombinant erythropoietin (EPO) because of the sudden marked increase in iron util isation [8][9][10][11], Oral Fe supplements in low [9] or even high doses [10,11] may not supply adequate amounts of iron in all patients in this setting, so that parenteral iron may sometimes be needed [8][9][10][11],…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Intravenous Ferric Saccharate as an Iron Supplement in Dialysis Patients

Silverberg¹,

Blum²,

Peer³

et al. 1996

Nephron

View full text Add to dashboard Cite

In the present prospective study we examined the long-term effect of intravenous supplementation with ferric saccharate (IV Fe) in the treatment of the anemia of chronic dialysis patients. All patients, 64 on chronic hemodialysis (HD) and 9 on chronic ambulatory peritoneal dialysis (CAPD), were treated intravenously with this preparation in a dose of 100 mg elemental iron twice monthly. There were five groups. Group 1:41 HD patients who were receiving erythropoietin (EPO) for at least 6 months prior to the addition of IV Fe. In this group, when IV Fe was given over 6 months, the hematocrit (Hct) increased from a mean of 28.7 to 33.7%. Over the next 6 months, the EPO dose was gradually reduced by a mean of 61.1 %, but the mean Hct remained unchanged. Group 2:11 HD patients who started IV EPO simultaneously with the IV Fe. In this group, over 6 months, the mean Hct increased from 28.1 to 34.1. Over the next 6 months, the EPO dose was gradually reduced by 75.7%, but the mean Hct remained unchanged. Group 3: 12 HD patients who received IV Fe alone for 12 months. The mean Hct increased from 30.5 to 37.9%. Group 4: 4 CAPD patients who had been receiving subcutaneous EPO for at least 6 months prior to IV Fe therapy. Over the subsequent 6 months of IV Fe, the mean Hct increased from 28.4 to 33.3%. Group 5: 5 CAPD patients not on EPO who received IV Fe for 6 months. The mean Hct increased from 27.7 to 35.6%. No adverse effects were seen in any patients throughout the study. In conclusion, adequate Fe supplementation may allow the target Hct of about 33% to be reached without, or with only very low doses of EPO. IV Fe as ferric saccharate is a new and safe form of parenteral iron therapy of the anemia of chronic dialysis patients.

show abstract

Section: Discussionsupporting

confidence: 79%

Section: Introductionmentioning

confidence: 99%

Intravenous Ferric Saccharate as an Iron Supplement in Dialysis Patients

Silverberg¹,

Blum²,

Peer³

et al. 1996

Nephron

View full text Add to dashboard Cite

show abstract

“…In our study, the SF levels significantly declined and offered a mean elemental iron of 487 ± 136 mg for erythropoiesis in group I, whilst the tissue iron reserves were only reduced from 655 ± 114 to 563 ± 126 mg. The formula to measure tissue iron reserves may be flawed in patients with high SF levels because logarithmic transformation by using logio may underestimate the iron stores [14,15,26], This finding was also reported by Anastassiades et al [26]. Nevertheless, the iron availability met the anticipated demand in hemodialysis patients with SF > 100 pg/1 and TfS >25%.…”

Section: Iron Needs In Hemodialysis Patients On Erythropoietin Therapysupporting

confidence: 44%

“…Many authors have also demonstrated that oral iron is unlikely to keep pace with the iron demand for optimal rHuEPO response [5,10]. They have suggested that patients with functional iron deficiency will require intensive iron supplements, almost always in the form of intravenous iron [3][4][5][6][7][26][27][28], Rosenlof et al [28] found that intravenous iron therapy failed to improve iron availability in most patients. These authors hypothesized that chronic inflammation may blunt the efficacy of iron therapy.…”

Section: Iron Needs In Hemodialysis Patients On Erythropoietin Therapymentioning

confidence: 99%

Mathematical Approach for Estimating Iron Needs in Hemodialysis Patients on Erythropoietin Therapy

1997

View full text Add to dashboard Cite

Functional iron deficiency occurs when recombinant human erythropoietin (rHuEPO) accelerates erythropoiesis to an extent that the iron availability cannot meet the anticipated demand. Such a phenomenon will reduce the optimal response to rHuEPO. To estimate the iron needs of functional iron deficiency in hemodialysis patients on rHuEPO therapy, we utilized a mathematical method. Forty hemodialysis patients were examined in the study, and all had a baseline serum ferritin (SF) level > 100 µg/l. They were stratified into patients with a transferrin saturation (TfS) value ≧ 25% (group I) and those below this value (group II). The treatment protocol consisted of rHuEPO therapy in the two groups for 6 months and iron supplement only in group II. The target hemoglobin level was 10.5 g/dl, and iron metabolism indices were analyzed prior to and following therapy. The results showed (1) in group I (n = 20) hemoglobin rose from 7.5 ± 0.9 to 10.7 ± 0.7 g/dl (p < 0.01) and the mean SF level declined from 1,583 ± 997 to 968 ± 664 mg (p < 0.01); (2) in group II (n = 20) hemoglobin also increased from 7.8 ± 0.9 to 10.6 ± 0.8 g/dl (p < 0.01) following iron supplement, while the SF rose from 183 ± 70 to 326 ± 125 mg (p < 0.01); (3) TfS was significantly elevated in group II following iron therapy (18.9 ± 4.8 vs. 34.5 ± 9.1%, p < 0.01), and (4) the nomogram showed a sensitivity of 80%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 83% in estimating the iron status before rHuEPO therapy. We conclude that SF levels reflect iron stores and that TfS < 25% is an index of functional iron deficiency. Iron supplementation is not necessary in patients with SF > 100 µg/l and TfS ≧25%. It seems rational to provide intravenous iron in EPO-resistant patients with functional iron deficiency (SF > 100 µg/l, TfS < 25%). This paper illustrates the importance that accurate assessment of iron needs by a mathematical method would enhance treatment efficacy and avoid iron overload in hemodialysis patients on rHuEPO therapy.

show abstract

“…Specimens were frozen at -2 0°C and stored no longer than l month. Weestimated iron stores by the formula given byAnastassiades et al [5]: Iron reserves = 400 x [In (ferritin) -In (50)]. where In is the natural logarithm, iron is measured in mg. and serum ferritin in ,ug/I.…”

Section: Methodsmentioning

confidence: 99%

Comparison of Plasma Erythropoietin Concentrations and Iron Status in Hemodialyzed Patients Not Requiring and Requiring rHuEpo Therapy

Majdan

Książek²,

Kozioł³

et al. 1996

Nephron

View full text Add to dashboard Cite

Fifty patients treated with chronic hemodialysis (HD) were observed for 1 year. 24 of them (48%) did not require treatment with recombinant human erythropoietin (rHuEpo) (group I) because the permanent hemoglobin (Hb) concentration was > 5.9 mmol/l (9.5 g/dl), hematocrit > 30%. The remaining 26 patients (group II) permanently or periodically required rHuEpo treatment. After 6 months of initial observation and after 6 months of clinical study we made a comparison of endogenous erythropoietin(Epo) and iron status in two groups of patients. Patients not requiring treatment with rHuEpo had statistically significant higher Epo concentration and lower iron reserves than patients on rHuEpo treatment. We did not find significant differences in Hb, albumin and creatinine between patients in both groups. Hb concentration did not correlate with the level of Epo, serum creatinine, transferrin saturation, ferritin, iron reserves and time of dialysis therapy in both groups. In both groups we found a significant negative correlation between the concentration of Epo and iron stores. Our results indicate that in patients on HD treatment, plasma Epo level appears to depend either directly or indirectly on iron status.

show abstract

Ferrokinetics in Azathioprine-Treated Uraemic Patients on Erythropoietin

Cited by 3 publications

References 0 publications

Intravenous Ferric Saccharate as an Iron Supplement in Dialysis Patients

Intravenous Ferric Saccharate as an Iron Supplement in Dialysis Patients

Mathematical Approach for Estimating Iron Needs in Hemodialysis Patients on Erythropoietin Therapy

Comparison of Plasma Erythropoietin Concentrations and Iron Status in Hemodialyzed Patients Not Requiring and Requiring rHuEpo Therapy

Contact Info

Product

Resources

About