Utilization Patterns of IV Iron and Erythropoiesis Stimulating Agents in Anemic Chronic Kidney Disease Patients: A Multihospital Study

Joshi, Avani; Holdford, David A.; Brophy, Donald F.; Harpe, Spencer E.; Mays, Darcy P.; Gehr, Todd W.B.

doi:10.1155/2012/248430

Cited by 6 publications

(4 citation statements)

References 48 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The low prescription rate of erythropoietin indicates lacunae of current treatment practices and signals an opportunity for improvement in prescribing practices in CKD patients. [ 25 ]…”

Section: Discussionmentioning

confidence: 99%

Prescribing pattern of medicines in chronic kidney disease with emphasis on phosphate binders

et al. 2014

View full text Add to dashboard Cite

Objectives:Patients with chronic kidney disease (CKD) suffer with multiple comorbidities and complications like secondary hyperparathyroidism and hyperphosphotemia. Altered mineral metabolism contributes to bone disease and cardiovascular disease. In patients of CKD, despite dietary phosphorus restriction, phosphate binders (PBs) are recommended to control phosphorous level. No studies about the utilization pattern of PBs in CKD patients have been reported from India. This study analyses the current prescribing trends in the management of CKD patients undergoing tertiary care with focus on PBs.Materials and Methods:This cross-sectional, observational study was conducted in nephrology department of a government super speciality hospital over 8-month period from January to August 2011. Demographic, clinical, and medication details were collected in a specially designed proforma.Results:A total 111 prescriptions were included in the study. Average number of drugs per prescription was 9.47. About 41.53% of the prescribed drugs were from the World Health Organization essential medicines list. Out of total prescribed drugs (1052), most commonly prescribed were vitamins and minerals (24.71%), cardiovascular drugs, (22.14%), and hematopoietic agents (20.15%). Considering individual drugs, five most commonly prescribed drugs were multivitamins (14.82%), iron (8.65%), folic acid (8.55%), calcium carbonate (8.17%), and calcitriol (5.60%). A total of 11.02% of prescribed drug were PBs. Among PBs, calcium carbonate was the most frequently prescribed and sevelamer was the least prescribed PB. No patient was prescribed lanthanum carbonate.Conclusion:This study identified a wide variety of drug classes including PBs prescribed in CKD patients. Although sevelamer hydrochloride has less side effects as compared to calcium salts, it was less prescribed since it is costlier.

show abstract

“…The low prescription rate of erythropoietin indicates lacunae of current treatment practices and signals an opportunity for improvement in prescribing practices in CKD patients. [ 25 ]…”

Section: Discussionmentioning

confidence: 99%

Prescribing pattern of medicines in chronic kidney disease with emphasis on phosphate binders

et al. 2014

View full text Add to dashboard Cite

show abstract

“…Therefore, focus on causal treatment is the primary treatment for the anemia of chronic disease. Nevertheless, extensive iron (oral or intravenous), vitamin C, folic acid and vitamin B 12 supplementation should be considered, and in advanced chronic kidney disease and in malignancy during chemotherapy, additionally administration of erythropoietin preparations [50][51][52]. In clinical observation, the implementation of such treatment significantly delays or prevents the occurrence of anemia of chronic diseases.…”

Section: Treatment Of Anemia Of Chronic Diseasesmentioning

confidence: 99%

Anemia of Chronic Diseases: Wider Diagnostics—Better Treatment?

et al. 2020

View full text Add to dashboard Cite

Anemia of chronic diseases is a condition that accompanies a specific underlying disease, in which there is a decrease in hemoglobin, hematocrit and erythrocyte counts due to a complex process, usually initiated by cellular immunity mechanisms and pro-inflammatory cytokines and hepcidin. This is the second most common type of anemia after iron deficiency anemia in the world. Its severity generally correlates with the severity of the underlying disease. This disease most often coexists with chronic inflammation, autoimmune diseases, cancer, and kidney failure. Before starting treatment, one should undertake in-depth diagnostics, which includes not only assessment of complete blood count and biochemical parameters, but also severity of the underlying disease. The differential diagnosis of anemia of chronic diseases is primarily based on the exclusion of other types of anemia, in particular iron deficiency. The main features of anemia of chronic diseases include mild to moderate lowering of hemoglobin level, decreased percentage of reticulocyte count, low iron and transferrin concentration, but increased ferritin. Due to the increasingly better knowledge of the pathomechanism of chronic diseases and cancer biology, the diagnosis of this anemia is constantly expanding with new biochemical indicators. These include: the concentration of other hematopoietic factors (folic acid, vitamin B12), hepcidin, creatinine and erythropoietin. The basic form of treatment of anemia of chronic diseases remains supplementation with iron, folic acid and vitamin B12 as well as a diet rich in the above-mentioned hematopoietic factors. The route of administration (oral, intramuscular or intravenous) requires careful consideration of the benefits and possible side effects, and assessment of the patient’s clinical status. New methods of treating both the underlying disease and anemia are raising hopes. The novel methods are associated not only with supplementing deficiencies, but also with the administration of drugs molecularly targeted to specific proteins or receptors involved in the development of anemia of chronic diseases.

show abstract

“…Iron deficiency is highly prevalent in chronic kidney disease (CKD) patients [ 1 ]. After erythropoiesis-stimulating agents failed to improve cardiovascular disease burden among CKD patients in several recent large-scale randomized clinical trials [ 2 – 4 ], the idea of iron supplementation for anaemia treatment has re-gained interest in nephrology in recent years [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Distinct immunologic effects of different intravenous iron preparations on monocytes

Fell

Zawada

Rogačev

et al. 2014

Nephrology Dialysis Transplantation

View full text Add to dashboard Cite

BackgroundIron deficiency contributes to anaemia in patients with chronic kidney disease. I.v. iron is therefore widely used for anaemia treatment, although it may induce oxidative stress and activate monocytes. Different i.v. iron preparations are available, but interestingly their substance-specific immunologic effects are poorly studied.MethodsWe analysed the effect of iron sucrose, ferric carboxymaltose, iron isomaltoside 1000, low-molecular-weight iron dextran and ferumoxytol on classical, intermediate and nonclassical monocyte biology. We therefore stimulated in vitro mature monocytes and haematopoietic CD34+ stem cells during their differentiation into monocytes with different concentrations (0.133, 0.266, 0.533 mg/mL) of i.v. iron preparations. Alterations of monocyte subset distribution, expression of surface markers (CD86, CCR5, CX3CR1), as well as production of pro-inflammatory cytokines (TNF-α, IL-1β) and reactive oxygen species were measured using flow cytometry. Additionally, we analysed phagocytosis and antigen presentation capacity.ResultsWe found specific immunologic effects after stimulation with iron sucrose which were not induced by the other iron preparations. Iron sucrose activated monocyte subsets leading to significantly increased CD86 expression. Simultaneously CD16 and CX3CR1 expression and monocytic phagocytosis capacity were decreased. Additionally, differentiation of monocytes from haematopoietic CD34+ stem cells was almost completely abolished after stimulation with iron sucrose.ConclusionsOur findings demonstrate that specific immunologic effects of distinct i.v. iron preparations exist. The clinical relevance of these findings requires further investigation.

show abstract

Utilization Patterns of IV Iron and Erythropoiesis Stimulating Agents in Anemic Chronic Kidney Disease Patients: A Multihospital Study

Cited by 6 publications

References 48 publications

Prescribing pattern of medicines in chronic kidney disease with emphasis on phosphate binders

Prescribing pattern of medicines in chronic kidney disease with emphasis on phosphate binders

Anemia of Chronic Diseases: Wider Diagnostics—Better Treatment?

Distinct immunologic effects of different intravenous iron preparations on monocytes

Contact Info

Product

Resources

About