Effects of haemoglobin normalization on quality of life and cardiovascular parameters in end‐stage renal failure
Lawrence P. McMahon,Kim Mason,Sandford L. Skinner,Caroline M. Burge,Leanne E. Grigg,Gavin J. Becker +5 more
TLDR
There may be a significant haemodynamic and symptomatic advantage in maintaining a physiological [Hb] in haemodialysis patients, and a substantially higher dose of epoetin is required to maintain this level.Abstract:
BACKGROUND: The optimal haemoglobin concentration ([Hb]) for patients with end-stage renal failure is uncertain. In particular, it is unclear whether Hb normalization may be an advantage to such patients who are otherwise well. METHODS: A prospective, randomized, double-blind cross-over study was completed in 14 haemodialysis patients (12 male) aged between 23 and 65 years over a period of 18 months, using a variety of measures to examine the effect of epoetin at target [Hb] of 10 g/dl ([Hb](10)) and 14 g/dl ([Hb](14)). Patients were randomized to maintain one or other of the target levels for 6 weeks before being crossed over to the alternative [Hb]. Baseline data (mean [Hb]: 8.5+/-0.2 g/dl) were also included selectively. Six patients were known to be hypertensive. Comparisons were made between 24-h ambulatory blood pressure levels (ABP), echocardiographic findings and estimates of blood volume (BV), plasma volume (PV) and Hb mass. Quality of life estimates were obtained using the Sickness Impact Profile (SIP), and epoetin dosage requirements at target [Hb] were assessed. RESULTS: Daytime and nocturnal ABP (systolic and diastolic) were not different at the respective target [Hb], although nocturnal diastolic levels were higher compared with baseline (73+/-4 mmHg) at both [Hb](10) (83+/-3, P:<0.01) and [Hb](14) (81+/-6, P:<0.05). Significant reductions in cardiac output (5.2+/-0.3 vs 6.6+/-0.5 l/min, P:<0.01) and left ventricular end-diastolic diameter (4.8+/-0.2 vs 5.2+/-0.2 cm, P:<0. 001) were found at [Hb](14) compared with [Hb](10). Left ventricular mass index was correlated with both PV (P:<0.001) and BV (P:<0.01), but not with Hb mass. The PV decreased as the [Hb] rose (P:<0.001) but BV remained unchanged. Quality of life was significantly improved at [Hb](14) compared with [Hb](10) for both total score (6. 5+/-1.7 vs 13.4+/-3.0, P:=0.01) and psychosocial dimension score (5. 4+/-1.9 vs 15.4+/-4.0, P:<0.01). The maintenance weekly dose of epoetin required was 80% higher at [Hb](14) compared with [Hb](10) (P:<0.001). CONCLUSION: These data suggest there may be a significant haemodynamic and symptomatic advantage in maintaining a physiological [Hb] in haemodialysis patients. Although untoward effects were not identified in this study at [Hb](14), a substantially higher dose of epoetin is required to maintain this level.read more
Citations
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Quality of Life and Hemoglobin Levels of Hemodialysis Patient at Siriraj Hospital
Tanita Thaweethamcharoen,Rungpetch Sakulbumrungsil,Somkiat Vasuvattakul,Cherdchai Nopmaneejumruslers +3 more
TL;DR: The difference of the Hb levels were statistically significant differences in the effects of kidney disease, general health, role emotion, and social function scores, and mental component summary scores of the KDQOL-SF questionnaire.
Journal ArticleDOI
Epoetin trials: randomised controlled trials don't always mimic observational data
Simon D. Roger,Adeera Levin +1 more
TL;DR: Two published trials have examined whether prevention of anaemia could reduce or reverse the development of LVH in the non-dialysis CKD population, maintaining appropriate attention to other modifiable risk factors.
Journal ArticleDOI
The beneficial effect of effective control of anemia on hyperinsulinemia and hypoxemia in a hemodialysis patient with corrected transposition of the great arteries.
Naoya Igaki,Mototsugu Takashima,Minako Ohyama,Suirin Oh,Aritoshi Kida,Kimihiko Yanase,Makoto Sakai,Fumihiko Tamada,Takeo Goto +8 more
TL;DR: Control of anemia for a 10-month period was followed by a marked increase in Hb level and in aerobic work capacity, while the fasted insulin level decreased, without changes in leptin level, body mass index (BMI), fat mass, Kt/V, or protein catabolic rate (PCR).
Journal ArticleDOI
How I treat anemia in heart failure
TL;DR: Five common scenarios of patients with HF and anemia are presented and a personal approach on how they might treat them based on objective evidence where available is described and an algorithm that offers guidance in regard to personalized therapy for such patients is presented.
Journal ArticleDOI
A study of the response of elderly patients with end-stage renal disease to epoetin alfa or beta.
TL;DR: Elderly patients responded to anaemia corrective therapies as well as the younger patients, despite greater levels of comorbidity while requiring less epoetin alfa or beta, indicating that functional iron deficiency in the elderly dialysis patients is less.
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