Maintenance hamatocrit levels and mortality in hemodialysis patients with renal anemia receiving recombinant human erythropoietin(rHuEPO) treatment(rHuEPO survey).

Hirasawa, Yoshihei; Suzuki, Masashi; Itami, Noritomo; Ohira, Suguru; Mizuno, Tsuguo; Mera, Kentaro; Haga, Yoshiharu; Kawai, Hironobu; Mashimo, Keiichi; Obara, Isahiro; Kurosawa, Norio; Nakamoto, Yasushi; Numazawa, Kazuo; Furuhashi, Mitsuyoshi; Maruyama, Yukitaka; Miki, Ryuji; Koike, Shigefumi; Seno, Hachiro; Kawahara, Hirohisa; Kobayashi, Hiroyuki; Ono, Toshihiko; Okuno, Senji; Kim, Masao; Miyazaki, Ryoichi; Saika, Yasushi; Motomiya, Yoshihiro; Taniai, Kazuhi; Usui, Koji; Shigemoto, Kazuhiro; Mizuguchi, Takashi; Kawashima, Seiichiro; Yuasa, Kenji; Ohta, Kazumichi; Sato, Takashi; Fukunari, Kenichi; Kimura, Yuzo; Takahashi, Hisashi; Yuu, Kougi

doi:10.4009/jsdt.36.1265

Cited by 12 publications

(9 citation statements)

References 4 publications

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“…Since in Japan blood samples are usually collected at the beginning of the week, after the longest interval of dialysis and in the supine position, whereas in Europe and the United States they are generally collected in the middle of the week and in the sitting position, the ideal serum hemoglobin level may be different in Japan. In some retrospective studies, the recommended serum hemoglobin level was 10 g/dL to 11 g/dL (10,11), and the serum hemoglobin level in the >30 group was almost within the recommended value in Japan. There have been no prospective investigations of anemia control in Japan, and a randomized prospective study is needed to identify the optimal serum hemoglobin value in Japan.…”

Section: Discussionmentioning

confidence: 99%

Characteristics of Patients on Hemodialysis Therapy for More Than 30 Years

Otsubo¹,

Otsubo²,

Sugimoto³

et al. 2007

Ther Apher Dial

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Since its experimental introduction in 1960, hemodialysis has become a widely performed and relatively safe procedure. Therapeutic strategies have been developed, and the numbers of long-term survivors of hemodialysis therapy have been increasing. Hemodialysis therapy was introduced at Sangenjaya Hospital in October 1970, and the 16 patients who have survived for more than 30 years on hemodialysis therapy since its introduction at the hospital were enrolled in this study to investigate the characteristics of long-term hemodialysis patients. For comparison, 50 patients on hemodialysis for less than 30 years were also studied (21 patients with <10 years hemodialysis, 13 with 10-20 years hemodialysis and 16 with 20-30 years hemodialysis). Background information (age, gender, and cause of renal disease), dialysis dose (single pool [sp.] Kt/V), mineral metabolism (serum phosphate), anemia management (serum hemoglobin), and nutrition (serum albumin and reduced interdialytic weight gain) were assessed. Hemodialysis was instituted at 28.7 +/- 6.4 years of age. The primary cause of end-stage renal disease was chronic glomerulonephritis in all of the patients except one, and in that patient it was polycystic kidney disease. As an index of the dialysis dose, sp. Kt/V was 1.2 +/- 0.11. As an index of mineral metabolism, serum phosphate was 5.4 +/- 0.9 mg/dL. As an index of anemia management, serum hemoglobin was 10.2 +/- 1.2 g/dL. As indexes of nutrition, serum albumin was 4.0 +/- 0.2 g/dL and interdialytic weight gain was 4.43 +/- 1.36%. The sp. Kt/V-value, serum phosphate, serum hemoglobin and interdialytic weight gain did not differ between the four different hemodialysis duration groups. Serum albumin was lower in the >30 group (4.0 +/- 0.2 g/dL) than in the <10 group (4.2 +/- 0.3 g/dL) (P = 0.046). As the duration of hemodialysis has increased, the age at hemodialysis induction has become younger. The cause of the renal failure was chronic glomerulonephritis in most of the cases. None had diabetic nephropathy. Improvement of the prognosis of patients with diabetic nephropathy is required. Most of the indexes of these patients nearly satisfied the recommended values.

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Section: Discussionmentioning

confidence: 99%

Characteristics of Patients on Hemodialysis Therapy for More Than 30 Years

Otsubo¹,

Otsubo²,

Sugimoto³

et al. 2007

Ther Apher Dial

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“…retrospectively investigated a 3‐year prognosis in 2654 Japanese maintenance dialysis patients receiving rHuEPO at 22 institutions, based on mean Ht levels divided into 3% intervals. Evaluation of the survival prognosis using the Ht levels adjusted by age, sex, primary disease, concomitant disease, albumin (Alb) level, and other parameters revealed that the prognosis was most favorable in the group with Ht levels between 30 and 33% (Table 2‐2) (23) (Level B*).…”

Section: Chaptermentioning

confidence: 99%

“…This table is quoted from the study described by Hirasawa et al. (23). Alb, albumin; CI, confidence interval; RR, relative risk.…”

Section: Chaptermentioning

confidence: 99%

2008 Japanese Society for Dialysis Therapy: Guidelines for Renal Anemia in Chronic Kidney Disease

Tsubakihara

Nishi

Akiba³

et al. 2010

Ther Apher Dial

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276

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The Japanese Society for Dialysis Therapy (JSDT) guideline committee, chaired by Dr Y. Tsubakihara, presents the Japanese guidelines entitled "Guidelines for Renal Anemia in Chronic Kidney Disease." These guidelines replace the "2004 JSDT Guidelines for Renal Anemia in Chronic Hemodialysis Patients," and contain new, additional guidelines for peritoneal dialysis (PD), non-dialysis (ND), and pediatric chronic kidney disease (CKD) patients. Chapter 1 presents reference values for diagnosing anemia that are based on the most recent epidemiological data from the general Japanese population. In both men and women, hemoglobin (Hb) levels decrease along with an increase in age and the level for diagnosing anemia has been set at <13.5 g/dL in males and <11.5 g/dL in females. However, the guidelines explicitly state that the target Hb level in erythropoiesis stimulating agent (ESA) therapy is different to the anemia reference level. In addition, in defining renal anemia, the guidelines emphasize that the reduced production of erythropoietin (EPO) that is associated with renal disorders is the primary cause of renal anemia, and that renal anemia refers to a condition in which there is no increased production of EPO and serum EPO levels remain within the reference range for healthy individuals without anemia, irrespective of the glomerular filtration rate (GFR). In other words, renal anemia is clearly identified as an "endocrine disease." It is believed that defining renal anemia in this way will be extremely beneficial for ND patients exhibiting renal anemia despite having a high GFR. We have also emphasized that renal anemia may be treated not only with ESA therapy but also with appropriate iron supplementation and the improvement of anemia associated with chronic disease, which is associated with inflammation, and inadequate dialysis, another major cause of renal anemia. In Chapter 2, which discusses the target Hb levels in ESA therapy, the guidelines establish different target levels for hemodialysis (HD) patients than for PD and ND patients, for two reasons: (i) In Japanese HD patients, Hb levels following hemodialysis rise considerably above their previous levels because of ultrafiltration-induced hemoconcentration; and (ii) as noted in the 2004 guidelines, although 10 to 11 g/dL was optimal for long-term prognosis if the Hb level prior to the hemodialysis session in an HD patient had been established at the target level, it has been reported that, based on data accumulated on Japanese PD and ND patients, in patients without serious cardiovascular disease, higher levels have a cardiac or renal function protective effect, without any safety issues. Accordingly, the guidelines establish a target Hb level in PD and ND patients of 11 g/dL or more, and recommend 13 g/dL as the criterion for dose reduction/withdrawal. However, with the results of, for example, the CHOIR (Correction of Hemoglobin and Outcomes in Renal Insufficiency) study in mind, the guidelines establish an upper limit of 12 g/dL for patients with serious c...

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“…investigated the 3‐year mortality rate based on the mean Ht values at 3 points in 2654 patients undergoing maintenance dialysis and receiving rHuEPO in 22 hospitals in Japan. They evaluated the prognosis with respect to the Ht value corrected by age, gender, underlying disease, complications, and albumin level, and reported that the survival rate was highest in patients with an Ht value of 30–33% (Table 7)(10).…”

Section: Chapter IImentioning

confidence: 99%

2004 Japanese Society for Dialysis Therapy Guidelines for Renal Anemia in Chronic Hemodialysis Patients*

et al. 2004

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The guideline committee of Japanese Society for Dialysis Therapy (JSDT), chaired by Professor F. Gejyo of Niigata University, now publishes an original Japanese guideline entitled 'Guidelines for Renal Anemia in Chronic Hemodialysis Patients'. It includes the re-evaluation of the usage of recombinant human erythropoietin (rHuEPO) with the medical and economical arguments regarding the prognosis and the quality of life of Japanese hemodialysis patients. This guideline consists of 7 sections. The first section comprises the general definition and the differential diagnosis of anemia. The hemoglobin (Hb) level of the Japanese population seemed to be low when compared with that of the European and American populations. The second section describes the target Hb level in hemodialysis patients. Multivariate analysis of the data that were collected from dialysis institutions throughout the country showed that an Hb level of 10-11 g/dL (Ht level 30-33%) at the first dialysis session in a week is the ideal range for chronic hemodialysis patients in terms of the 3-5 year survival rate. The supine position at blood sampling and the sampling timing at the first dialysis session in a week might affect the lower setting of target Hb hematocrit (Ht), compared to that of European and American guidelines. However, we particularly recommended that an Hb level of 11-12 g/dL (Ht level from 33 to 36%) at the first dialysis session in a week is desirable in relatively young patients. In the third section, the markers of iron deficiency are discussed. The Transferin saturation test (TSAT) and serum ferritin were emphasized as the standard markers. The routes of administration of rHuEPO and its dosages are written in the fourth section. The subcutaneous route was associated with the occurrence of secondary red cell aplasia due to anti-rHuEPO antibodies; however, secondary red cell aplasia was seldom observed in the venous injection. From this fact we recommend venous injection for chronic hemodialysis patients. We advocate an initial dosage of 1500 U three times per week. The fifth section deals with the factors refractory to treatment with rHuEPO. If the patient shows an inadequate response to the usage of 9000 U per week, this condition defines the inadequate response to rHuEPO in Japan. Blood transfusion must be avoided where possible. The reasons for this and the adverse effects are interpreted in section six. In the final section, the adverse effects of rHuEPO are listed. Among them, hypertension, thrombotic events and secondary red cell aplasia were emphasized as the major complications.

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Maintenance hamatocrit levels and mortality in hemodialysis patients with renal anemia receiving recombinant human erythropoietin(rHuEPO) treatment(rHuEPO survey).

Cited by 12 publications

References 4 publications

Characteristics of Patients on Hemodialysis Therapy for More Than 30 Years

Characteristics of Patients on Hemodialysis Therapy for More Than 30 Years

2008 Japanese Society for Dialysis Therapy: Guidelines for Renal Anemia in Chronic Kidney Disease

2004 Japanese Society for Dialysis Therapy Guidelines for Renal Anemia in Chronic Hemodialysis Patients*

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