The Intensity of Hemodialysis and the Response to Erythropoietin in Patients with End-Stage Renal Disease
15 Feb 1996-The New England Journal of Medicine (Massachusetts Medical Society)-Vol. 334, Iss: 7, pp 420-425
TL;DR: In patients with end-stage renal disease, inadequate hemodialysis is associated with a suboptimal response to erythropoietin therapy and increasing the intensity of dialysis in patients with anemia who are receiving inadequate dialysis results in a significant increase in the hematocrit.
Abstract: Background Anemia (characterized by a hematocrit of 30 percent or lower) persists in 40 to 60 percent of patients treated for end-stage renal disease with maintenance hemodialysis, despite concomitant erythropoietin (epoetin) therapy. We tested the hypothesis that inadequate dialysis is a key reason for the insufficient response to erythropoietin in patients with end-stage renal disease who are receiving hemodialysis. Methods we prospectively studied 135 randomly selected patients undergoing hemodialysis who had been receiving intravenous erythropoietin for at least four months. The adequacy of dialysis was assessed by measuring the percent reduction in the blood urea nitrogen concentration and the serum albumin concentration. The hematocrit was measured weekly for four weeks, transferrin saturation was measured, and coexisting illnesses were documented. To determine the effect of an increased level of dialysis on the hematocrit, the thrice-weekly schedule of dialysis was increased to raise the mean urea-...
Citations
More filters
TL;DR: Serum albumin concentration is an independent predictor of mortality risk and could be useful in the quantification of risk in a broad range of clinical and research settings and a direct protective effect of the albumin molecule is suggested.
552 citations
TL;DR: The re-establishment of EV is associated with healing, improved life quality, and exercise capabilities for these injured/sick persons, and the influence of several perturbations on adaptations of blood volume, erythrocyte volume, and plasma volume is reviewed.
Abstract: This paper reviews the influence of several perturbations (physical exercise, heat stress, terrestrial altitude, microgravity, and trauma/sickness) on adaptations of blood volume (BV), erythrocyte volume (EV), and plasma volume (PV). Exercise training can induced BV expansion; PV expansion usually occurs immediately, but EV expansion takes weeks. EV and PV expansion contribute to aerobic power improvements associated with exercise training. Repeated heat exposure induces PV expansion but does not alter EV. PV expansion does not improve thermoregulation, but EV expansion improves thermoregulation during exercise in the heat. Dehydration decreases PV (and increases plasma tonicity) which elevates heat strain and reduces exercise performance. High altitude exposure causes rapid (hours) plasma loss. During initial weeks at altitude, EV is unaffected, but a gradual expansion occurs with extended acclimatization. BV adjustments contribute, but are not key, to altitude acclimatization. Microgravity decreases PV and EV which contribute to orthostatic intolerance and decreased exercise capacity in astronauts. PV decreases may result from lower set points for total body water and central venous pressure, which EV decrease bay result form increased erythrocyte destruction. Trauma, renal disease, and chronic diseases cause anemia from hemorrhage and immune activation, which suppressions erythropoiesis. The re-establishment of EV is associated with healing, improved life quality, and exercise capabilities for these injured/sick persons.
440 citations
Cites background from "The Intensity of Hemodialysis and t..."
...PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) United States Army Institute of Surgical Research, JBSA Fort Sam Houston, TX 78234 8....
[...]
...The news is that anemia persists despite rhEpo therapy in about 50% of patients on hemodiaysis in the United States (77)....
[...]
...The social implication is that some dialysis centers shortchange patients to save money (77)....
[...]
TL;DR: A logistic regression analysis performed using the laboratory variables revealed a strong, independent, and inverse relationships between the serum albumin and creatinine concentrations, total lymphocyte count, and the odds risk of death.
360 citations
TL;DR: Nocturnal hemodialysis represents the most efficient form of dialysis at low cost and should be considered as an option for patients who can be trained for home he modialysis.
Abstract: There is evidence that high frequency, as well as long duration, hemodialysis provides better clinical outcomes. We developed nocturnal hemodialysis, a new innovative form of renal replacement therapy, which is performed six to seven nights per week for 8 to 10 h during sleep at home. Blood flow was set at 300 ml/min and dialysate flow at 100 ml/min. An internal jugular catheter was used as the vascular access. Special precautions were taken to prevent accidental disconnection during sleep, as well as air embolization. Dialysis functions from the patient9s home were monitored continuously via a modem at the nocturnal hemodialysis center. Twelve patients have completed training and have been successfully performing nocturnal hemodialysis for up to 34 mo. This study represents 170 patient months of experience accumulated over 3 yr. There was hemodynamic stability and significant subjective improvement in patient well being. Nightly Kt/V was 0.99. Weekly removal of phosphate was twice as high and beta2 microglobulin 4 times as high as conventional hemodialysis. All patients have discontinued their phosphate binders and have increased dietary phosphate and protein intake. BP control was achieved with fewer medications. Dialyzer reuse has decreased the operating costs to the level of the other form of home dialysis. Complications were infrequent and were related primarily to the dialysis access. Nocturnal hemodialysis represents the most efficient form of dialysis at low cost and should be considered as an option for patients who can be trained for home hemodialysis.
358 citations
TL;DR: In well-dialyzed patients who were iron replete, the acute-phase response was the most important predictor of EPO resistance, and EPO/Hct was independent of PTH and aluminum levels, PCRn, and Kt/V.
302 citations
References
More filters
TL;DR: The anemia of hemodialysis patients is corrected by rHuEpo resulting in the elimination of transfusions, reduction in iron overload, and improved quality of life.
Abstract: Study Objective:To determine the effectiveness and safety of recombinant human erythropoietin (rHuEpo). Patients:Hemodialysis patients (333) with uncomplicated anemia (hematocrit < 0.30). ...
768 citations
TL;DR: It is concluded that increasing the dose of delivered dialysis decreases the hospitalization and mortality rates of hemodialysis-dependent patients.
423 citations
TL;DR: A 40-year-old man has undergone chronic hemodialysis for 7 years and had nephrotic syndrome from age 2 to 5 years but was apparently well until age 18, when proteinuria was detected again.
371 citations
TL;DR: In patients with uremia, the dose of erythropoietin needed to achieve an adequate hematocrit response may depend on the severity of secondary hyperparathyroidism and the extent of bone marrow fibrosis.
Abstract: Background and Methods Anemia is common in patients with chronic renal insufficiency and secondary hyperparathyroidism. Erythropoietin therapy is effective, but the dose required varies greatly. One possible determinant of the efficacy of erythropoietin therapy is the extent of marrow fibrosis caused by hyperparathyroidism. We examined the relation between the erythropoietic response to erythropoietin and hyperparathyroidism in a cross-sectional study of 18 patients undergoing hemodialysis who had received erythropoietin therapy for one to three years. In 7 patients (the poor-response group) the dose of intravenous erythropoietin needed to maintain a mean (±SD) target hematocrit of 35 ±3 percent was >100 units per kilogram of body weight three times a week, and in 11 patients (the good-response group) it was ≤ 100 units per kilogram. In all patients, indexes of the adequacy of dialysis and the extent of hyperparathyroidism and aluminum toxicity were determined monthly, and bone histomorphometry was perfor...
370 citations