Hemoglobin Variability and Hyporesponsiveness: Much Ado About Something or Nothing?

Yee, Jerry; Zasuwa, Gerard; Frinak, Stanley; Besarab, Anatole

doi:10.1053/j.ackd.2008.12.003

Cited by 14 publications

(14 citation statements)

References 62 publications

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“…Optimizing anemia treatment in hemodialysis (HD) patients remains a priority worldwide as it has significant health and financial implications. One of the main factors hindering the achievement of this therapeutic goal is the variability of individual responses to erythropoiesis-stimulating agents (ESAs), which has been attributed to patient-related factors such as iron deficiency, malnutrition and inflammation [1][2][3][4], hyperparathyroidism and the accumulation of uremic toxins inhibiting erythropoiesis [5][6][7], as well as to factors related to HD technique, such as dialysis adequacy [8,9] and the microbiological purity of dialysis fluid [10,11]. There is good evidence that intravenous iron therapy should be administered as a standard therapy for iron deficiency [ferritin\100 ng/ml, transferrin saturation (TSAT) \20 %] in conjunction with or before therapy with ESAs in anemia in CKD and to maintain adequate stores in dialysis patients [12][13][14].…”

Section: Introductionmentioning

confidence: 99%

Cumulative iron dose and resistance to erythropoietin

Rosati¹,

Tetta

Merello³

et al. 2014

J Nephrol

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Section: Introductionmentioning

confidence: 99%

Cumulative iron dose and resistance to erythropoietin

Rosati¹,

Tetta

Merello³

et al. 2014

J Nephrol

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“…Iron homeostasis also plays an important role in anemia management [29]. If the etiology of Hb variability is not easily discerned, erythropoietic hyporesponsiveness must be envisaged and evaluated, and all efforts brought to reaching stability [30,31]. …”

Section: Discussionmentioning

confidence: 99%

Stable hemoglobin in hemodialysis patients: forest for the trees – a 12-week pilot observational study

Rottembourg¹,

Kpade²,

Tebibel³

et al. 2013

BMC Nephrol

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BackgroundHemoglobin (Hb) variability is a common occurrence in hemodialysis patients treated with erythropoiesis-stimulating agents. High amplitude fluctuations have been associated with greater risk of morbidity and mortality.MethodsThis prospective, single centre pilot observational study was conducted over a 3-month period in daily practice patterns, to assess per-dialysis events and inter-dialysis complications that could interfere with erythropoiesis in patients undergoing hemodialysis.ResultsMean Hb levels remained stable in the 78 evaluable patients, as did darbepoetin alfa (DA) doses, including in patients suffering from diabetes or cardiac affections. In total, an average of 7.7 events / patient / month occurred, but no significant relationship with Hb excursions was shown.ConclusionThe observation of 7.7 events per patient per month suggests a careful monitoring of Hb and DA dosing every other week, in order to maintain Hb level within the target.

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“…Yee et al have reported that in large studies in the general population such as the National Health and Nutrition Examination Survey (NHANES) and the Scripps-Kaiser Database, Hgb levels ranged from 13 to 15 g/dL with an SD of 0.8 to 1.2 g/dL. 11 Thus, Hgb variability seen in our analyses of 2 trials of EPO in CKD patients was similar to or lower than the variability seen in the general population (SD: 0.59-0.75 g/dL).…”

Section: Discussionmentioning

confidence: 99%

Hemoglobin Variability with Extended Dosing of Epoetin Alfa in Patients with Chronic Kidney Disease and Not on Dialysis

Bailey

McGowan

Tang

et al. 2009

Dialysis & Transplantation

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OBJECTIVES Hemoglobin (Hgb) variability when treating anemia in pre‐dialysis chronic kidney disease (CKD) patients with erythropoietin stimulating agents (ESAs) may be an important safety consideration, as significant Hgb fluctuations over time appear to be associated with worse outcomes, especially cardiovascular‐related outcomes. We analyzed Hgb variability in subjects receiving epoetin alfa (EPO) with extended dosing regimens. METHODS We conducted a post‐hoc analysis to evaluate Hgb variability in 2 trials of EPO in CKD anemia; both examined Hgb response during dosing intervals up to 4 weeks. Study 1 examined 4 EPO maintenance regimens of every 1 to 4 weeks for 16 weeks. Study 2 examined EPO initiation and maintenance dosing of every 2 weeks for 28 weeks. RESULTS During the maintenance periods evaluated, Hgb variability (mean within‐subject standard deviations) was 0.75 (0.32), 0.66 (0.29), 0.65 (0.30), and 0.74 (0.36) g/dL, with 10KQW, 20KQ2W, 30KQ3W, and 40KQ4W regimens in study 1 (10,000 IU [10K] once weekly [QW], 20,000 IU [20K] every 2 weeks [Q2W], 30,000 IU [30K] every 3 weeks [Q3W], or 40,000 IU [40K] every 4 weeks [Q4W]), and was 0.59 (0.27) g/dL with 20KQ2W in study 2. Serious thrombovascular events were seen in 4 patients in study 1 and in 3 patients in study 2. CONCLUSIONS Our analysis of CKD patients treated with extended dosing of EPO revealed no relationships between Hgb variability and administered dose or dose interval, comparable with published results of other ESAs.

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Hemoglobin Variability and Hyporesponsiveness: Much Ado About Something or Nothing?

Cited by 14 publications

References 62 publications

Cumulative iron dose and resistance to erythropoietin

Cumulative iron dose and resistance to erythropoietin

Stable hemoglobin in hemodialysis patients: forest for the trees – a 12-week pilot observational study

Hemoglobin Variability with Extended Dosing of Epoetin Alfa in Patients with Chronic Kidney Disease and Not on Dialysis

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