Trends in Anemia Care in Older Patients Approaching End-Stage Renal Disease in the United States (1995-2010)

Winkelmayer, Wolfgang C.; Mitani, Aya A.; Goldstein, Benjamin A.; Brookhart, M. Alan; Chertow, Glenn M.

doi:10.1001/jamainternmed.2014.87

Cited by 18 publications

(26 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, after several randomized trials failed to demonstrate a prognostic benefit of ESA treatment in CKD [32–34], the safety of this treatment strategy came into question. This led to significantly reduced prescription rates for ESA since 2008 and a subsequent decrease in mean haemoglobin levels among CKD patients [7], rendering alternative treatment strategies for anaemia of CKD mandatory.…”

Section: Discussionmentioning

confidence: 99%

“…Against this background, the use of iron preparations regained popularity in the last decade [7]. Since there is a broad consensus that oral iron preparations are poorly absorbed least in patients with advanced CKD, current guidelines recommend early application of i.v.…”

Section: Discussionmentioning

confidence: 99%

“…iron preparations has substantially increased [7]. In parallel, awareness of their potential systemic side effects has also increased, which may include renal, cardiovascular and immunologic reactions [8–10].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Impact of individual intravenous iron preparations on the differentiation of monocytes towards macrophages and dendritic cells

Fell¹,

Seiler-Mußler²,

Sellier³

et al. 2016

Nephrol. Dial. Transplant.

View full text Add to dashboard Cite

BackgroundTreatment of iron deficiency with intravenous (i.v.) iron is a first-line strategy to improve anaemia of chronic kidney disease. Previous in vitro experiments demonstrated that different i.v. iron preparations inhibit differentiation of haematopoietic stem cells to monocytes, but their effect on monocyte differentiation to macrophages and mature dendritic cells (mDCs) has not been assessed. We investigated substance-specific effects of iron sucrose (IS), sodium ferric gluconate (SFG), ferric carboxymaltose (FCM) and iron isomaltoside 1000 (IIM) on monocytic differentiation to M1/M2 macrophages and mDCs.MethodsVia flow cytometry and microRNA (miRNA) expression analysis, we morphologically and functionally characterized monocyte differentiation to M1/M2 macrophages and mDCs after monocyte stimulation with IS, SFG, FCM and IIM (0.133, 0.266 and 0.533 mg/mL, respectively). To assess potential clinical implications, we compared monocytic phagocytosis capacity in dialysis patients who received either 500 mg IS or IIM.ResultsPhenotypically, IS and SFG dysregulated the expression of macrophage (e.g. CD40, CD163) and mDC (e.g. CD1c, CD141) surface markers. Functionally, IS and SFG impaired macrophage phagocytosis capacity. Phenotypic and functional alterations were less pronounced with FCM, and virtually absent with IIM. In miRNA expression analysis of mDCs, IS dysregulated miRNAs such as miR-146b-5p and miR-155-5p, which are linked to Toll-like receptor and mitogen-activated protein kinase signalling pathways. In vivo, IS reduced monocytic phagocytosis capacity within 1 h after infusion, while IIM did not.ConclusionsThis study demonstrates that less stable i.v. iron preparations specifically affect monocyte differentiation towards macrophages and mDCs.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Impact of individual intravenous iron preparations on the differentiation of monocytes towards macrophages and dendritic cells

Fell¹,

Seiler-Mußler²,

Sellier³

et al. 2016

Nephrol. Dial. Transplant.

View full text Add to dashboard Cite

show abstract

“…Intravenous iron is widely and extensively used to manage iron deficiency anaemia in people without and with CKD [8, 9], and effects on circulating FGF23 concentrations have proven variable. Increased levels of iFGF23 (with post-infusion hypophosphatemia) have been demonstrated in people without CKD in case reports [10, 11] as well as one prospective study [12]; and a randomized controlled trial of iron-deficient women showed an increase in iFGF23 but dramatically reduced cFGF23 following intravenous ferric carboxymaltose [13].…”

Section: Introductionmentioning

confidence: 99%

Effects of intravenous iron on fibroblast growth factor 23 (FGF23) in haemodialysis patients: a randomized controlled trial

et al. 2016

View full text Add to dashboard Cite

BackgroundIntravenous iron affects serum levels of intact fibroblast growth factor-23 (iFGF23) and its cleavage product c-terminal FGF23 (cFGF23) in iron-deficient people with normal renal function. We hypothesized that intravenous iron modulates iFGF23 and cFGF23 in haemodialysis patients differently according to the type of iron used.MethodsPrevalent, stable haemodialysis patients requiring protocol-based intravenous iron therapy were randomized to a single 200 mg dose of either ferric carboxymaltose (FCM) or iron sucrose (IS). The primary outcome was change in iFGF23 and cFGF23 from pre-infusion to Day 2 post-infusion. Serum hepcidin, ferritin and phosphate were also measured. Pair-wise comparisons utilised the Wilcoxon rank sum test; linear mixed models with an interaction term for treatment and time evaluated between-group effects.ResultsForty-two participants completed the study. In those randomized to FCM (n = 22), median (interquartile range) values pre-infusion and Day 2, respectively, were 843 pg/mL (313–1922) and 576 pg/mL (356–1296, p = 0.05) for iFGF23, 704RU/mL (475–1204) and 813RU/mL (267–1156, p = 0.04) for cFGF23, and 1.53 mmol/L (1.14–1.71) and 1.37 (1.05–1.67, p = 0.03) for phosphate. These parameters did not change following IS. Both serum ferritin (p < 0.001) and hepcidin (p < 0.001) increased in both groups, and the increase in hepcidin was greater in the FCM group (p = 0.03 for between-group difference).ConclusionsContrary to iron-deficient people with normal renal function, haemodialysis patients given protocol-driven intravenous FCM demonstrated a fall in iFGF23 and a rise in cFGF23, changes not evident with IS. This suggests a differential effect of intravenous iron treatment according to both formulation and renal function.Trial registrationAustralian and New Zealand Clinical Trials Register ACTRN12614000548639. Registered 22 May 2014 (retrospectively registered).Electronic supplementary materialThe online version of this article (doi:10.1186/s12882-016-0391-7) contains supplementary material, which is available to authorized users.

show abstract

“…10–18 However, no information exists regarding trends in anemia treatment among patients with both ESRD and cancer.…”

Section: Introductionmentioning

confidence: 99%

Trends in Anemia Management in Hemodialysis Patients with Cancer

Butler

Kshirsagar²,

Olshan³

et al. 2015

Am J Nephrol

Self Cite

View full text Add to dashboard Cite

Background: Erythropoiesis-stimulating agents (ESAs), intravenous iron, and blood transfusion are used to treat anemia in both end-stage renal disease (ESRD) and cancer. However, anemia treatment patterns have not been described among ESRD patients undergoing hemodialysis with concurrent cancer, especially in the recent era of ESA-related safety concerns. Methods: We analyzed Medicare data from a cohort of hemodialysis patients diagnosed with incident cancer. We used multivariable generalized linear models to estimate trends and patterns in ESA use, iron use, transfusion use, epoetin alfa (EPO) dose, iron dose, and resulting hemoglobin levels (2000-2011). Results: Of 43,760 eligible patients, quarterly ESA use declined slightly from a peak of 94.1 to 90.0%. Quarterly EPO dose increased from 2000 to 2004, then declined; quarterly hemoglobin levels followed a similar pattern. Iron use increased rapidly from 46.9 to 79.3%. Iron dose increased until 2010 and then declined. There was an increase in the quarterly transfusion use (6.3-11.7%) and in the mean number of transfusion days per year (1.4-1.8). Anemia treatment patterns varied by demographic/clinical subgroups, especially among patients receiving chemotherapy, who required higher ESA use, EPO dose, and frequency of transfusions. Conclusions: Despite safety concerns about ESAs in both the ESRD and cancer populations, the proportion of hemodialysis patients with cancer who used ESAs between 2000 and 2011 remained extremely high. EPO dose and hemoglobin levels increased and then decreased. Iron use, iron dose, and transfusions increased substantially. Future research examining the risk-benefit profile of different anemia management strategies in the dialysis population with cancer is needed.

show abstract

Trends in Anemia Care in Older Patients Approaching End-Stage Renal Disease in the United States (1995-2010)

Cited by 18 publications

References 25 publications

Impact of individual intravenous iron preparations on the differentiation of monocytes towards macrophages and dendritic cells

Impact of individual intravenous iron preparations on the differentiation of monocytes towards macrophages and dendritic cells

Effects of intravenous iron on fibroblast growth factor 23 (FGF23) in haemodialysis patients: a randomized controlled trial

Trends in Anemia Management in Hemodialysis Patients with Cancer

Contact Info

Product

Resources

About