The Intensity of Hemodialysis and the Response to Erythropoietin in Patients with End-Stage Renal Disease

Ifudu, Onyekachi; Feldman, Joseph; Friedman, Eli A.

doi:10.1056/nejm199602153340702

Cited by 224 publications

(136 citation statements)

References 24 publications

(40 reference statements)

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“…The current analysis confirms previous reports describing a statistical association between hemodialysis dose, hematocrit, and EPO dose (29,42,47). These relationships may reflect direct or indirect benefits of better solute clearance, such as enhanced removal of putative soluble erythropoietic inhibitors (48,49) and/or improved nutrition and substrate availability for erythropoiesis (41,42). Alternatively, improved anemia correction with increased dialysis doses may be reflective of diligence to other components of patient care that could improve EPO responsiveness, diminish blood losses, and/or enhance erythrocyte survival.…”

Section: Discussionsupporting

confidence: 92%

“…Small solute clearance from a single hemodialysis session was quantified by the URR. The current analysis confirms previous reports describing a statistical association between hemodialysis dose, hematocrit, and EPO dose (29,42,47). These relationships may reflect direct or indirect benefits of better solute clearance, such as enhanced removal of putative soluble erythropoietic inhibitors (48,49) and/or improved nutrition and substrate availability for erythropoiesis (41,42).…”

Section: Discussionsupporting

confidence: 89%

“…This contention is supported by the demonstration of the inverse relationship between EPO dose and hematocrit. The cause of the heterogeneity on EPO responsiveness is unclear and may be a consequence of other comorbid conditions like overt or covert inflammatory processes (35)(36)(37), hyperparathyroidism (38), trace mineral toxicity such as aluminum (39,40), protein-calorie and malnutrition (41), and inadequate hemodialysis (29,42).…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Trends in Anemia Management among US Hemodialysis Patients

Coladonato¹,

Frankenfield²,

Reddan³

et al. 2002

Journal of the American Society of Nephrology

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Abstract. This study was undertaken to describe the relationship between hematocrit (Hct) and changes in the prescribed dose of erythropoietin (EPO) as well as selected patient and process care measures across annual national samples of hemodialysis patients from 1994 to 1998. This study uses the cohorts identified in the ESRD Core Indicators Project, random samples of 6181, 6241, 6364, 6634, and 7660 patients, stratified by ESRD Networks drawn for each year from 1994 to 1998. Patient demographic and clinical information was collected from October to December for each year. Surrogates of iron stores and patterns of iron and EPO administration were profiled from 1996 to 1998. Multivariable stepwise linear regression analyses were performed to adjust for potential confounding variables and to identify independent variables associated with Hct and EPO dose. Mean Hct and EPO dose increased each year from 31.1 Ϯ 5.2% to 34.1 Ϯ 3.7% and from 58.2 Ϯ 41.8 U/kg to 68.2 Ϯ 55.0 U/kg, respectively (P ϭ 0.0001). Increasing Hct was positively associated with male gender, more years on dialysis, older age, higher urea reduction ratio and transferrin saturation, prescription of intravenous iron, and lower ferritin and EPO dose in multivariable models (all P ϭ 0.0001). Male gender, older age, diabetes, higher Hct, and increasing weight, urea reduction ration, and transferrin saturation were associated with lower EPO doses (all P Ͻ 0.01). Conversely, intravenous EPO and iron were associated with higher prescribed EPO doses (all P ϭ 0.0001). Although increasing Hct is associated with decreasing EPO dose at the patient level, the increase in Hct seen across years among the cohorts of hemodialysis patients in the United States has been associated with increasing doses of EPO at the population level.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Trends in Anemia Management among US Hemodialysis Patients

Coladonato¹,

Frankenfield²,

Reddan³

et al. 2002

Journal of the American Society of Nephrology

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“…A number of factors may have contributed to this finding. Anemia is extremely common in dialysis patients and may have prompted workup for sources of gastrointestinal blood loss (26). Uremic platelet dysfunction combined with anticoagulation given during hemodialysis results in a bleeding diathesis that may bring gastrointestinal lesions to attention earlier (27).…”

Section: Discussionmentioning

confidence: 99%

Comparison of Stage at Diagnosis of Cancer in Patients Who Are on Dialysis versus the General Population

Taneja

Mandayam

Kayani

et al. 2007

Clinical Journal of the American Society of Nephrology

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Results: A total of 1629 patients with ESRD and incident cancer were identified. Overall, the likelihood of nonlocalized stage at diagnosis was not significantly different for patients with ESRD versus the standardized Surveillance, Epidemiology, and End Results general population or matched Medicare control subjects. Stratifying by cancer site, colorectal cancers were significantly more likely to be diagnosed earlier in the ESRD group, whereas prostate cancers were significantly more likely to be diagnosed at a later stage.Conclusions: With the exception of prostate cancer, patients with ESRD are not more likely to present with later stage malignancies compared with the general population.

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“…In Japan, ESA hyporesponsiveness is defined as a failure of improvement of anemia with a darbepoetin dose of 60 µg/week or an epoetin dose of 9000 IU/week without iron deficiency (Tsubakihara et al, 2010). Insufficient dialysis, malnutrition, unclean dialysate, and drug effects have been suggested as causes of ESA hyporesponsiveness (Ifudu et al, 1996). In this study, there were no significant differences in any parameters except ferritin between the low dose and high dose darbepoetin subgroups.…”

Section: Factors Responsible For Determining a Poor Response To An Esamentioning

confidence: 52%

Differences in Erythrocyte Index and Hyporesponsiveness to Erythropoiesis in Hemodialysis Patients Treated with Different Erythropoiesis-Stimulating Agents

Saito¹,

Furusawa²,

Okuda³

et al. 2011

Hemodialysis - Different Aspects

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The Intensity of Hemodialysis and the Response to Erythropoietin in Patients with End-Stage Renal Disease

Abstract: In patients with end-stage renal disease, inadequate hemodialysis is associated with a suboptimal response to erythropoietin therapy. Increasing the intensity of dialysis in patients with anemia who are receiving inadequate dialysis results in a significant increase in the hematocrit.

Cited by 224 publications

References 24 publications

Trends in Anemia Management among US Hemodialysis Patients

Trends in Anemia Management among US Hemodialysis Patients

Comparison of Stage at Diagnosis of Cancer in Patients Who Are on Dialysis versus the General Population

Differences in Erythrocyte Index and Hyporesponsiveness to Erythropoiesis in Hemodialysis Patients Treated with Different Erythropoiesis-Stimulating Agents

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