Iron absorption in erythropoietin-treated haemodialysis patients: effects of iron availability, inflammation and aluminium

Kooistra, Menno P.; Niemantsverdriet, E.C.; Es, Ad van; Mol-Beermann, Noor M.; Struyvenberg, A; Marx, Joannes J.M.

doi:10.1093/ndt/13.1.82

Cited by 93 publications

(62 citation statements)

References 14 publications

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“…Subjects in the control arm of this study were prescribed 200 mg/d for 21 d, resulting in a total cumulative dose of 4200 mg. Given that the absorption of oral iron is incomplete (approximately 40%) (6), and patients may not be fully compliant with daily oral iron dosing, this cumulative dose would ensure that at least 1 g of iron would be absorbed; this would represent a comparable dose of bioavailable iron to that administered in the ferumoxytol treatment arm. Despite most oral iron-treated patients being at least 80% compliant, the hemoglobin increase with ferumoxytol was twice as high as with oral iron, and twice as many patients achieved a hemoglobin increase of 1 g/dl or greater with ferumoxytol compared with oral iron.…”

Section: Discussionmentioning

confidence: 99%

“…Iron deficiency is a common cause of anemia in CKD patients (3,4) and may be the result of poor iron absorption, blood loss, and increased erythropoiesis after use of erythropoiesis-stimulating agents (ESAs) (5,6). The intravenous (IV) route is recommended for iron replacement therapy in HD patients because oral iron is associated with intolerance and limited efficacy (7)(8)(9), since oral iron may be poorly absorbed (10).…”

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confidence: 99%

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Ferumoxytol as an Intravenous Iron Replacement Therapy in Hemodialysis Patients

Provenzano¹,

Schiller²,

Madhumathi³

et al. 2009

Clinical Journal of the American Society of Nephrology

169

126

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Background and objectives: Intravenous iron is a key component of anemia management for chronic kidney disease (CKD).Ferumoxytol is a unique intravenous iron product that can be administered as a rapid injection in doses up to 510 mg. Results: Ferumoxytol resulted in a mean increase in hemoglobin of 1.02 ؎ 1.13 g/dl at day 35 compared with 0.46 ؎ 1.06 g/dl with oral iron (P ‫؍‬ 0.0002). Twice as many ferumoxytol-treated patients than oral iron-treated patients achieved a >1 g/dl hemoglobin increase at day 35 (P ‫؍‬ 0.0002). There was a greater mean increase in transferrin saturation (TSAT) with ferumoxytol compared with oral iron at day 35 (P < 0.0001). The larger hemoglobin increase after ferumoxytol compared with oral iron at day 35 persisted after adjustment for baseline hemoglobin, TSAT, and serum ferritin. Overall adverse event rates were comparable between groups.Conclusions: In patients on hemodialysis, rapid intravenous injection of 510 mg of ferumoxytol led to significantly greater hemoglobin increases compared with oral iron, with comparable tolerability.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Ferumoxytol as an Intravenous Iron Replacement Therapy in Hemodialysis Patients

Provenzano¹,

Schiller²,

Madhumathi³

et al. 2009

Clinical Journal of the American Society of Nephrology

169

126

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“…Cytokines, including IL-1, IL-6 and TNF-α, suppress and affect precursor cells at different stages of erythropoiesis [47]. Inflammation may also impair iron availability for erythropoiesis: HD patients with high CRP levels (>8 mg/l) have lower iron absorption than patients with lower CRP levels [48]. Significantly, inflammation regulates hepcidin expression and production in response to liver iron levels, hypoxia and anemia [49] (fig.…”

Section: Impact Of Dialysis On Amplification Of Anemia By Inflammationmentioning

confidence: 99%

Impact of Hemodialysis Therapy on Anemia of Chronic Kidney Disease: The Potential Mechanisms

Bowry

Gatti

2011

Blood Purif

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A significant and increasing number of chronic kidney disease (CKD) patients are treated with online hemodiafiltration (OL-HDF), even in the absence of more conclusive survival data. OL-HDF affords several clinical benefits including control of anemia of CKD, a common affliction in dialysis patients. In efforts to understand the underlying mechanisms that contribute to the purported benefits of OL-HDF, we examined the potential role and impact of OL-HDF on key stages of anemia and its correction: erythropoiesis of bone marrow, circulating erythrocytes and on anemia therapy. We review evidence that indicates OL-HDF may modulate key processes of anemia and its therapy, including underlying conditions and responses of uremic toxicity and inflammation that aggravate anemia. Our assessment indicates that OL-HDF favorably impacts anemia by not only eliminating putative uremic inhibitors that suppress erythropoiesis, reducing red cell destruction and increasing iron availability, but also by mechanisms restricting underlying inflammation and endothelial dysfunction that are crucial to both CKD and anemia.

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“…A absorção desse micronutriente aumenta acentuadamente, em resposta a um quadro de deficiência. No entanto, em estudo conduzido por Kooistra et al 38 , ficou evidenciado que, tanto a captação pela mucosa, quanto a retenção de ferro, foram significativamente diminuídas em pacientes submetidos a hemodiálise, quando comparados a indivíduos não-urêmicos deficientes em ferro.…”

Section: A R a C T E R í S T I C A S D O C O N S U M O A L I M E N unclassified

Avaliação nutricional de pacientes em hemodiálise

2005

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ObjetivoO objetivo deste estudo foi o de avaliar o estado nutricional e a ingestão de energia e de nutrientes de uma população em hemodiálise no Hospital das Clínicas, Universidade Federal de Pernambuco. MétodosDe um total de 47 pacientes em hemodiálise de manutenção, 37 indivíduos (18 homens e 19 mulheres, idade 50,4 ± 16,3 anos) foram selecionados. O índice de massa corporal foi utilizado para a classificação do estado nutricional e a dieta foi investigada por meio do método do diário alimentar de 4 dias. ResultadosOs resultados evidenciaram um predomínio de indivíduos eutróficos (62,2%) e igual prevalência de baixo peso e excesso de peso (18,9% de pacientes em cada caso). Com relação à dieta, os achados desta pesquisa revelaram um adequado consumo energético-protéico. De uma forma geral, a ingestão média diária de nutrientes foi considerada adequada, exceto pelo cálcio e pela vitamina A, que apresentaram <50,0% e <70,0% da ingestão diária recomendada, respectivamente. ConclusãoEsses resultados indicam que se deve dar atenção cuidadosa às diferenças regionais e nacionais que influenciam o estado nutricional e a ingestão dietética de pacientes em hemodiálise.Termos de indexação: antropometria, consumo de alimentos, diálise renal, dietética, doença renal crônica.

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Iron absorption in erythropoietin-treated haemodialysis patients: effects of iron availability, inflammation and aluminium

Abstract: The absorption of iron in dialysis patients is decreased in haemodialysis patients, which may, at least in part, be due to inflammation. Aluminium ingestion further reduces absorption in functional iron-deficient patients.

Cited by 93 publications

References 14 publications

Ferumoxytol as an Intravenous Iron Replacement Therapy in Hemodialysis Patients

Ferumoxytol as an Intravenous Iron Replacement Therapy in Hemodialysis Patients

Impact of Hemodialysis Therapy on Anemia of Chronic Kidney Disease: The Potential Mechanisms

Avaliação nutricional de pacientes em hemodiálise

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