Recombinant Human Erythropoietin Treatment in Pre-Dialysis Patients

Lim, Victoria S.; DeGowin, Richard L.; Zavala, Donald C.; Kirchner, Peter T.; Abels, Robert; Perry, Paul J.; Fangman, Jerry

doi:10.7326/0003-4819-110-2-108

Cited by 234 publications

(104 citation statements)

References 11 publications

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“…rhEPO treatment has been reported to be useful for improving anemia in predialysis patients with CRF (11,12) without progression to renal failure (17,18). Accumulating evidence suggests that SBI of rhEPO is more effective than i.v.…”

Section: Discussionmentioning

confidence: 99%

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Therapeutic use of continuous subcutaneous infusion of recombinant human erythropoietin in malnourished predialysis anemic patients with diabetic nephropathy

Sohmiya

Kakiba

Kato

1998

European Journal of Endocrinology

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We compared the effect of recombinant human erythropoietin (rhEPO) administration by continuous s.c. infusion (CSI) with that of a weekly bolus s.c. injection (SBI) in five malnourished predialysis anemic patients with diabetic nephropathy. rhEPO was either continuously infused at a flow rate of 6000 IU per week (36 IU/h) (CSI group) or injected s.c. at a dose of 6000 IU once a week (SBI group) for 4 weeks, in a cross-over comparative study with a washout period of 4 weeks. Mean Ϯ S.D. plasma EPO levels increased from a basal value of 18.0 Ϯ 4.9 mIU/ml to a steady state value of 70.5 Ϯ 38.9 mIU/ml 2 weeks after the start of CSI of rhEPO (P < 0.05). Increases in reticulocyte count above the basal value were greater in the CSI group than the SBI group at 3 weeks after the start of treatment (0.94 Ϯ 0.35% vs ¹0.03 Ϯ 0.46%, P < 0.05). Increases in Hb concentration above the basal value were much greater in the CSI group than the SBI group at 4 weeks after the start of treatment (2.56 Ϯ 0.77 g/dl vs 0.28 Ϯ 0.62 g/dl, P < 0.05). These findings suggest that rhEPO administration by CSI is more effective than by SBI for improving anemia in malnourished predialysis patients with diabetic nephropathy.

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Section: Discussionmentioning

confidence: 99%

“…rhEPO therapy has been delivered using a number of different dosages and administration methods in anemic patients with CRF during the predialysis period (10)(11)(12). However, malnourished patients with diabetic nephropathy often show a poor response to EPO administration.…”

Section: Introductionmentioning

confidence: 99%

Therapeutic use of continuous subcutaneous infusion of recombinant human erythropoietin in malnourished predialysis anemic patients with diabetic nephropathy

Sohmiya

Kakiba

Kato

1998

European Journal of Endocrinology

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“…Few patients in our cohort had iron studies, or received iron supplementation or rHuEPO, although the proportions of patients undergoing investigation and treatment of anemia did increase among patients with the lowest Hct levels. Earlier studies raising concerns that rHuEPO use may hasten the decline of the GFR may have limited its use, although these concerns have since been dispelled (36)(37)(38). Lastly, the era of our investigation precedes recent heightened attention to treating the complications of chronic kidney disease, resulting from the National Kidney Foundation Kidney Disease Outcomes Quality Initiative (K/DOQI) (1).…”

Section: Discussionmentioning

confidence: 99%

Anemia: A Continuing Problem Following Kidney Transplantation

Mix¹,

Kazmi²,

Khan³

et al. 2003

American Journal of Transplantation

156

115

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Cardiovascular disease is a leading cause of death among kidney transplant recipients. Anemia, a risk factor for cardiovascular complications among patients with chronic kidney disease, has not been well characterized in kidney transplant recipients. We performed a retrospective cohort study of the prevalence of and factors associated with anemia among 240 patients who underwent kidney transplantation at our institution. The mean hematocrit (Hct) rose from 33% at 1 month after transplantation to 40% at 12 months after transplantation. The proportion of patients with Hct < 36% was 76% at transplantation and 21% and 36%, 1 year and 4 years after transplantation, respectively. Six months after transplantation, women had higher likelihood (OR = = 3.61) of Hct < 36%, while higher Hct at 3 months (OR = = 0.67 for 1% higher Hct) and diabetes (OR = = 0.14) were associated with a lower likelihood of Hct < 36%. Similar associations were seen 12 months after transplantation. Even among patients with Hct < 30%, only 36% had iron studies, 46% received iron supplementation and 40% received recombinant human erythropoietin. Awareness of factors associated with a lower Hct may prompt better anemia screening and management, potentially improving cardiovascular outcomes among kidney transplant recipients.

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“…Anemia per se is well established as a factor that limits exercise in the normal population (25,26), and a direct relationship between Hb and VO 2 also has been demonstrated in patients with CKD (5,6). Furthermore, when anemic patients with CKD are treated with erythropoietin to increase [Hb], exercise capacity (12) and VO 2peak (27) have been shown to improve, although only modestly compared with the increase in [Hb]. The patients in this study had not previously been anemic, and they maintained a near-normal [Hb] throughout; however, of note is that these patients already had a reduced VO 2peak at entry to the study despite the preserved [Hb].…”

Section: Discussionmentioning

confidence: 99%

Exercise Performance Falls over Time in Patients with Chronic Kidney Disease Despite Maintenance of Hemoglobin Concentration

Leikis

McKenna

Petersen

et al. 2006

Clinical Journal of the American Society of Nephrology

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Physical function is limited in patients with kidney disease, although previous studies have been confounded by anemia. What is not clear is how physical performance changes over time as renal function deteriorates. A cohort of 12 patients (10 male, two female; mean ؎ SD age 49 ؎ 11 yr) who had stages 3 to 4 chronic kidney disease without previous anemia were examined, and nine were followed for a 2-yr period. Assessments were made of peak oxygen consumption (VO 2peak ) by cycle ergometry, leg extension strength, and fatigue on an isokinetic dynamometer and thigh muscle cross-sectional area (TMCSA) by computed tomography. At baseline, creatinine clearance was 31 ؎ 13 ml/min and hemoglobin concentration ([Hb]) was 129 ؎ 9g/L. VO 2peak was low (1.88 L/min, 82% of predicted), and maximal isometric voluntary contraction was 188 ؎ 42 Nm, with a TMCSA of 144 ؎ 27 cm 2 . VO 2peak correlated with creatinine clearance corrected for body surface area (r ‫؍‬ 0.613, P ‫؍‬ 0.034) but not to [Hb]. VO 2peak adjusted for patient weight correlated with leg fatigue (r ‫؍‬ ؊0.693, P ‫؍‬ 0.012). For those with follow-up tests, there were falls in renal function by 28% (P ‫؍‬ 0.007) and VO 2peak by 9% (P ‫؍‬ 0.03), whereas [Hb] did not change. Leg strength fell across a range of isokinetic speeds (P ‫؍‬ 0.04), whereas no change in TMCSA was observed. In conclusion, exercise performance as measured by aerobic (VO 2peak ) and leg strength tests were reduced in patients with stages 3 to 4 chronic kidney disease. As renal function declined over time, there was a corresponding decline in exercise performance even when [Hb] was maintained.

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Recombinant Human Erythropoietin Treatment in Pre-Dialysis Patients

Abstract: Recombinant human erythropoietin is effective and safe in ameliorating the anemia of pre-dialysis patients.

Cited by 234 publications

References 11 publications

Therapeutic use of continuous subcutaneous infusion of recombinant human erythropoietin in malnourished predialysis anemic patients with diabetic nephropathy

Therapeutic use of continuous subcutaneous infusion of recombinant human erythropoietin in malnourished predialysis anemic patients with diabetic nephropathy

Anemia: A Continuing Problem Following Kidney Transplantation

Exercise Performance Falls over Time in Patients with Chronic Kidney Disease Despite Maintenance of Hemoglobin Concentration

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