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Journal ArticleDOI

Effects of haemoglobin normalization on quality of life and cardiovascular parameters in end‐stage renal failure

01 Sep 2000-Nephrology Dialysis Transplantation (Oxford University Press)-Vol. 15, Iss: 9, pp 1425-1430
TL;DR: 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.

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Citations
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Journal ArticleDOI
TL;DR: In HD transfusion-dependent patients with β-thal, the administration of high EPO dose for 2 years permits the attainment and the maintenance of Hb targets without blood transfusions and permits a complete remission of concentric LV hypertrophy without any adverse effects on the vascular system.
Abstract: Background: It is unknown whether chronic erythropoietin (EPO) treatment is able to normalize hemoglobin (Hb) levels and ameliorate cardiac remodeling avoiding blood transfusions in

5 citations


Cites background from "Effects of haemoglobin normalizatio..."

  • ...However, only few prospective studies carried out in a small number of HD patients have demonstrated that correction of anemia induces regression of LVH [ , ,...

    [...]

Journal ArticleDOI
01 Apr 2010
TL;DR: Pretransplantation Hb concentration did not affect outcome except for longer initial hospital stay and 1-year creatinine concentration, and the need for post-KTx transfusions was comparable between groups.
Abstract: The effect of pretransplantation hemoglobin (Hb) concentration on the outcome of kidney transplantation (KTx) was studied in 188 adult kidney transplant recipients. Patients were divided into 2 groups: high Hb (≥10 g/dL; n = 97) and low Hb (<10 g/dL; n = 91). Both groups were matched for recipient sex, donor age and sex, donor-recipient blood groups, indications for kidney transplantation, and degree of sensitization. Acute rejection episodes occurred in 20 patients in the high-Hb group (20.6%) and 18 in the low-Hb group (19.8%). Antithymocyte globulin-Fresenius therapy was required in 6 patients in the high-Hb group compared with 5 patients in the low-Hb group. Infection rate, 1-year actuarial patient and graft survival, incidence of delayed and slow graft function, and number of surgical complications were comparable between groups. Compared with the low Hb group, in the high-Hb group, hospital stay was longer, creatinine concentration at 12 months post-KTx and serum glucose concentration at 6 months post-KTx were significantly higher, and pre- and posttransplantation Hb concentrations were higher. The need for post-KTx transfusions was comparable between groups. Pretransplantation Hb concentration did not affect outcome except for longer initial hospital stay and 1-year creatinine concentration.

5 citations

Journal ArticleDOI
TL;DR: Two ongoing randomized controlled trials have been designed to study early initiation of epoetin treatment in pre-dialysis patients and will provide much needed information in this area.
Abstract: Current guidelines give evidence-based advice on how best to manage anaemia in patients with renal disease, but these guidelines do not consider individual patient needs, so tailoring anaemia management to each patient still remains a challenge for the treating physician. Two case studies are described that illustrate some of the key factors that need to be considered. The first case emphasizes that haemoglobin (Hb) targets recommended in current guidelines may not suit all patients. The patient had been stably maintained on subcutaneous epoetin therapy with an average Hb concentration of >13.0g/dl because he developed angina symptoms when his Hb level fell to 12.2 g/dl. Iron deficiency was identified as the likely cause of falling Hb in this patient. After the patient's iron supplementation was increased, his Hb level was normalized back to >13.0 g/dl without increasing the epoetin dose, and the angina symptoms were resolved. The second case involved a pre-dialysis patient with diabetes, who required a higher dose of epoetin after beginning concomitant antihypertensive treatment with an angiotensin-converting enzyme inhibitor. Previously, the treatment of renal anaemia in pre-dialysis patients has not been the focus of attention. Two ongoing randomized controlled trials have been designed to study early initiation of epoetin treatment in pre-dialysis patients and will provide much needed information in this area.

4 citations


Cites background from "Effects of haemoglobin normalizatio..."

  • ...In recent studies, higher Hb levels produced significant clinical benefits in patients with cardiomyopathy [3] as well as in healthier patient groups [4,5,10]....

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  • ...The Australian and Spanish normalization studies showed significant improvements in echocardiographic parameters, quality of life, exercise performance and hospitalization rates in these patients [4,5,10]....

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Journal Article
TL;DR: Los resultados de los ensayos clínicos fueron tan claros que the rHuEPO fue aceptada by las agencias regulatorias sanitarias como agente terapéutico en 1988, sólo 3 años después oficialmente ofreciendo su descubrimiento.
Abstract: Correspondencia: ÁLM de Francisco Servicio de Nefrología. Hospital Universitario Valdecilla. Santander. martinal@unican.es Uno de los avances terapéuticos más importantes para el control de la anemia del paciente con enfermedad renal crónica (ERC) fue la síntesis de la eritopoyetina humana recombinante (rHuEPO) en 1985. Para quienes en aquellos momentos tratábamos a pacientes en diálisis con hemoglobinas de 5 a 7 g/dl únicamente nos quedaba la posibilidad de realizar múltiples transfusiones que no sólo aumentaban la posibilidad de infecciones virales sino que también sensibilizaban a los pacientes ante un eventual trasplante renal o producían sobrecarga de hierro. Los resultados de los ensayos clínicos fueron tan claros que la rHuEPO fue aceptada por las agencias regulatorias sanitarias como agente terapéutico en 1988, sólo 3 años después de su descubrimiento.

4 citations

Book ChapterDOI
01 Jan 2003
TL;DR: This chapter deals with erythropoietin, which is the gene that is highly conserved between species, and there is a 80%–82% amino acid identity between the human sequence, and that of pig, sheep, mouse, and rat erythroid progenitor cells.
Abstract: This chapter deals with erythropoietin, which is the gene that is highly conserved between species. There is a 80%–82% amino acid identity between the human sequence, and that of pig, sheep, mouse, and rat erythropoietin genes. Erythropoietin was the first hematopoietic growth hormone to be cloned. The identification of the amino acid sequence of the pure urinary protein isolated and purified from the urine of severely anemic patients enabled it to synthesize erythropoietin DNA probes for isolation and cloning of the erythropoietin gene. Chinese hamster ovary (CHO) cells transfected with the erythropoietin gene linked to an expression vector were shown to produce biologically active recombinant human erythropoietin, and hence, recombinant human erythropoietin became available for clinical use. Erythropoietin is the primary regulator of erythropoiesis, and promotes the survival, proliferation, and differentiation of erythroid progenitor cells.

3 citations

References
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Journal ArticleDOI
TL;DR: In this article, the authors developed the Sickness Impact Profile (SIP), a behaviorally based measure of health status, and evaluated its reliability and validity using multitrait-multimethod technique.
Abstract: The final development of the Sickness Impact Profile (SIP), a behaviorally based measure of health status, is presented. A large field trial on a random sample of prepaid group practice enrollees and smaller trials on samples of patients with hyperthyroidism, rheumatoid arthritis and hip replacements were undertaken to assess reliability and validity of the SIP and provide data for category and item analyses. Test-retest reliability (r = 0.92) and internal consistency (r - 0.94) were high. Convergent and discriminant validity was evaluated using the multitrait--multimethod technique. Clinical validity was assessed by determining the relationship between clinical measures of disease and the SIP scores. The relationship between the SIP and criterion measures were moderate to high and in the direction hypothesized. A technique for describing and assessing similarities and differences among groups was developed using profile and pattern analysis. The final SIP contains 136 items in 12 categories. Overall, category, and dimension scores may be calculated.

4,283 citations

Book
01 Feb 1994
TL;DR: In this paper, the principles of exercise testing and interpretation are presented for exercise testing in the Libros de Medicina (Patologia) 5/e - Patologia - 139,00
Abstract: Principles of Exercise Testing and Interpretation, 5/e - Libros de Medicina - Patologia - 139,00

2,331 citations

Journal ArticleDOI
TL;DR: In patients with clinically evident congestive heart failure or ischemic heart disease who are receiving hemodialysis, administration of epoetin to raise their hematocrit to 42 percent is not recommended.
Abstract: Background In patients with end-stage renal disease, anemia develops as a result of erythropoietin deficiency, and recombinant human erythropoietin (epoetin) is prescribed to correct the anemia partially. We examined the risks and benefits of normalizing the hematocrit in patients with cardiac disease who were undergoing hemodialysis. Methods We studied 1233 patients with clinical evidence of congestive heart failure or ischemic heart disease who were undergoing hemodialysis: 618 patients were assigned to receive increasing doses of epoetin to achieve and maintain a hematocrit of 42 percent, and 615 were assigned to receive doses of epoetin sufficient to maintain a hematocrit of 30 percent throughout the study. The median duration of treatment was 14 months. The primary end point was the length of time to death or a first nonfatal myocardial infarction. Results After 29 months, there were 183 deaths and 19 first nonfatal myocardial infarctions among the patients in the normal-hematocrit group and 150 deat...

1,944 citations

Journal ArticleDOI
TL;DR: It is concluded that clinical and echocardiographic cardiovascular disease are already present in a very high proportion of patients starting ESRD therapy and are independent mortality factors.

1,255 citations

Journal ArticleDOI
TL;DR: Overstretching appears to be coupled with oxidant stress, expression of Fas, programmed cell death, architectural rearrangement of myocytes, and impairment in force development of the myocardium.
Abstract: To determine the effects of loading on active and passive tensions, programmed cell death, superoxide anion formation, the expression of Fas on myocytes, and side-to-side slippage of myocytes, papillary muscles were exposed to 7-8 and 50 mN/mm2 and these parameters were measured over a 3-h period. Overstretching produced a 21- and a 2.4-fold increase in apoptotic myocyte and nonmyocyte cell death, respectively. Concurrently, the generation of reactive oxygen species increased 2.4-fold and the number of myocytes labeled by Fas protein 21-fold. Moreover, a 15% decrease in the number of myocytes included in the thickness of the papillary muscle was found in combination with a 7% decrease in sarcomere length and the inability of muscles to maintain stable levels of passive and active tensions. The addition of the NO-releasing drug, C87-3754, prevented superoxide anion formation, programmed cell death, and the alterations in active and passive tensions with time of overloaded papillary muscles. In conclusion, overstretching appears to be coupled with oxidant stress, expression of Fas, programmed cell death, architectural rearrangement of myocytes, and impairment in force development of the myocardium.

642 citations

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