Renal clearance of endogenous erythropoietin in patients with proteinuria

Nowicki, Michał; Kokot, F; Kokot, M; A, Bar; Duława, Jan

doi:10.1007/bf02767726

Cited by 12 publications

(7 citation statements)

References 17 publications

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“…In chronic renal insufficiency, a decreased Epo production leads to anemia, usually with creatinine clearance lower than 40 mL/min/1.73 m 2 [8]. Therefore, the presence of CRI in FAP patients is a relevant parameter to explain, at least in part, the finding of inappropriately low Epo values in anemic patients.…”

Section: Discussionmentioning

confidence: 95%

Kidney and anemia in familial amyloidosis type I

Beirão¹,

Lobato²,

Costa³

et al. 2004

Kidney International

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Section: Discussionmentioning

confidence: 95%

Kidney and anemia in familial amyloidosis type I

Beirão¹,

Lobato²,

Costa³

et al. 2004

Kidney International

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“…Time to death due to end-stage renal disease in individuals living with HIV is significantly shorter for those with low hemoglobin values compared to normal values [26]. Kidney-related morbidities, such as albuminuria and renal hyperfiltration, are also highly correlated with HIV infection and low hemoglobin [27].…”

Section: Discussionmentioning

confidence: 99%

Tenofovir Use and Renal Insufficiency among Pregnant and General Adult Population of HIV-infected, ART-Naïve Individuals in Lilongwe, Malawi

et al. 2012

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BackgroundThe Malawian government recently changed its prevention of mother-to-child transmission (PMTCT) regimen and plans to change its first-line antiretroviral therapy (ART) regimen to Tenofovir(TDF)/Lamivudine/Efavirenz as a fixed-dose combination tablet. Implementation could be challenging if baseline creatinine clearance (CrCl) screening were required to assess renal function prior to TDF therapy. Our goal is to determine predictors of CrCl<50 ml/min among HIV-infected, ART-naïve individuals.MethodologyData on HIV-infected, ART-naïve adults screened for enrollment into 5 HIV clinical trials in Lilongwe, Malawi were combined for a pooled analysis of predictors for CrCl<50 ml/min. CrCl was derived from the Cockroft-Gault equation. Multivariable logistic regression modeled the association of age, body mass index (BMI), hemoglobin, CD4 cell count <350 cells/mm3, gender, and pregnancy with CrCl<50 ml/min.ResultsThe analysis included 3508 patients with values for creatinine clearance. Most subjects were female (90.6%) with a median age of 26 years (IQR 22–29). The median CD4 cell count was 444 (IQR 298.0–561.0), and 85.2% percent of women in our study were pregnant. Few patients had CrCl<50 ml/min (n = 38, 1.1%). A BMI less than 18.5 in non-pregnant females (OR = 8.87, 95% CI = 2.45–32.09)) was associated with CrCl<50 ml/min. Hemoglobin level higher than 10 g/dL in males (OR = 0.69, 95% CI = 0.56–0.86) and non-pregnant females (OR = 0.21, 95% CI = 0.04–0.97) was protective against CrCl<50 ml/min.DiscussionOur findings indicate few patients would be excluded from a TDF-based antiretroviral regimen, suggesting baseline creatinine clearance assessment may not be necessary for implementation. However, in ART settings individuals with low BMI or anemia could potentially be at increased risk for lower CrCl.

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“…Our studies have demonstrated that patients with proteinuria have an increased prevalence of anaemia, independent to renal function [36]. However, neither the urinary excretion of erythropoietin nor its fractional excretion appears to be significantly increased in diabetes in the absence of heavy protein losses [69].…”

Section: The Renal Erythropoietin Response In Diabetesmentioning

confidence: 97%

Anaemia in Diabetes: An Emerging Complication of Microvascular Disease

Thomas

Tsalamandris

MacIsaac

et al. 2005

CDR

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Diabetes as the dominant cause of ESRD is also the major cause of renal anaemia. However, most patients with diabetic kidney disease will succumb to co-morbid vascular disease or heart failure before developing severe renal impairment. In these patients, anaemia is also common finding, with a 2-3 times greater prevalence and earlier onset than in patients with renal impairment from other causes. We have recently shown that at least one in five outpatients with type 1 or type 2 diabetes in tertiary referral clinics have anaemia, in whom it constitutes a significant additional burden. Impaired renal erythropoietin release in response to declining haemoglobin levels appears to be the major contributor to anaemia in diabetes. This may be due to the predominance of damage to cells and vascular architecture of the renal tubulointerstitium associated with diabetic nephropathy that may be apparent, like albuminuria, before demonstrable changes in renal function. In addition, systemic inflammation, autonomic neuropathy and reduce red cell survival may also compound anaemia in diabetes. While anaemia may be considered a marker of diabetic kidney disease, reduced haemoglobin levels, even within the normal range, identify diabetic patients with an increased risk of hospitalisation and mortality. Anaemia may also be significant in determining the outcome of heart failure and hypoxia-induced organ damage in patients with diabetes. Upcoming studies will determine whether correction of anaemia in diabetes will lead to improved outcomes in these patients.

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Renal clearance of endogenous erythropoietin in patients with proteinuria

Cited by 12 publications

References 17 publications

Kidney and anemia in familial amyloidosis type I

Kidney and anemia in familial amyloidosis type I

Tenofovir Use and Renal Insufficiency among Pregnant and General Adult Population of HIV-infected, ART-Naïve Individuals in Lilongwe, Malawi

Anaemia in Diabetes: An Emerging Complication of Microvascular Disease

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