Poor response to treatment of renal anaemia with erythropoietin corrected by iron given intravenously.

Macdougall, Iain C.; Hutton, Richard D.; Cavill, I.; Coles, Gerald A.; Williams, J. D.

doi:10.1136/bmj.299.6692.157

Cited by 185 publications

(107 citation statements)

References 3 publications

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“…Adequate iron supply, which is achieved mainly by administration of parenteral iron, is a prerequesite for successful stimulation of erythropoiesis with rhEPO [22][23][24]. We have already reported on several studies using rhEPO in combination with oral iron for the treatment of postpartum anaemia [25,27,36].…”

Section: Introductionmentioning

confidence: 99%

Use of recombinant human erythropoietin in combination with parenteral iron in the treatment of postpartum anaemia

Breymann

Zimmermann

Huch

et al. 1996

Eur J Clin Investigation

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Abstract. The authors compared the effect of recombinant human erythropoietin (rhEPO) in combination with iron with that of iron therapy only in the treatment of postpartum anaemia. Ninety patients (30 patients/ group) received either rhEPO (300 U kg ÿ 1 , i.v. or s.c., once) and iron (parenteral and oral), or iron therapy only. Erythropoiesis was assessed by haemoglobin and haematocrit increase, absolute reticulocyte counting and reticulocyte flow cytometry. Ferrokinetics was assessed by serum ferritin, transferrin and transferrin saturation measurements. There was no difference before therapy for baseline haematological values or iron status. Patients with endogenous EPO levels below 145 mU mL ÿ 1 had a significant benefit from intravenous rhEPO administration with highest haematocrit and haemoglobin levels 4 and 14 days after therapy. rhEPO-treated groups showed a higher absolute reticulocyte count 1 and 4 days after therapy and an elevated percentage of high fluorescent reticulocytes (HFRs). Parenteral iron therapy caused a significant increase of ferritin and transferrin saturation, while transferrin concentration decreased. Ferritin and transferrin levels were lowest after i.v. administration of rhEPO, 1 and 4 days after therapy. C-reactive protein concentration was highest in patients who underwent caesarean section until the end of the observation period. A single dose of rhEPO in combination with iron was more effective in treating postpartum anaemia than iron therapy only, in patients who had low EPO levels despite peripartal blood loss. Postpartum low endogenous EPO levels might be a consequence of inhibiting inflammatory cytokines that are released after spontaneous or operative deliveries.

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Section: Introductionmentioning

confidence: 99%

Use of recombinant human erythropoietin in combination with parenteral iron in the treatment of postpartum anaemia

Breymann

Zimmermann

Huch

et al. 1996

Eur J Clin Investigation

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“…13 Iron deficiency has been identified as a major factor for anaemia in CKD patients, with a 43-90% prevalence in different series. 6,[14][15][16] Hence the periodical monitoring of iron status is crucial in ESRD.…”

Section: Discussionmentioning

confidence: 99%

“…1,5 Resistance to erythropoietin most commonly is due to iron deficiency but chronic inflammation, infection, and/or hyperparathyroidism also contribute. 6,7 Iron deficiency in ESRD is primarily due to impaired dietary intake and impaired gastrointestinal absorption but blood loss during haemodialysis and increased iron demands from ESA use also contribute. 8 Management of iron deficit is crucial in haemodialysis patients.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of iron status in patients with end stage renal disease

et al. 2017

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Background: Anaemia is almost universal in haemodialysis patients. Here, we evaluated the utility and clinical implications of the commonly employed tests in assessing iron status in haemodialysis patients.Methods: In this prospective observational study, we enrolled 100 prevalent haemodialysis patients, and measured transferrin saturation (TSAT) and serum ferritin at enrolment. Patients were categorized to have normal, deficient, overload, or indeterminate status of iron based on KDOQI guidelines. To study anaemia trend, haemoglobin (Hb) level at time of enrolment, as well as levels 3-months before and 3-months after enrolment, were collected. Patient survival outcomes were also obtained till October 2016.Results: Using serum ferritin and TSAT, iron status was determinable in 48% of the patients ie 20%-normal iron status, 25% - iron deficiency, 3% - iron overload. Fifty-two percent of the patients’ iron status was indeterminate by current parameters. In spite of being on standard-of-care treatment in our centre, we observed that mean-Hb level of patients in the indeterminate group showed insignificant increases compared to normal- and deficient-groups. Mean delta-Hb levels over 6-months were 0.80±1.54 g/dl in the indeterminate group, compared to 1.87±1.95 g/dl in the deficient group (P=0.03). In our cohort, 57% had died and 5 lost follow-ups during the study (P=0.30 between groups).Conclusions: Serum ferritin and TSAT accurately categorized the iron status of 48% haemodialysis patients in our study. Divergent serum ferritin and TSAT values, or an iron indeterminate state was prevalent in 52% of our urban dialysis cohort. The indeterminate group had inferior increases in Hb over time with current treatment, showing clinical relevance of this finding. Our data suggests the need for more sensitive indices to accurately assess iron status, and improve anaemia management.

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“…This situation arises in the treatment of patients undergoing renal dialysis with erythropoietin in order to cure their anaemia. Sometimes a failure to respond is due to the fact that although there is apparently sufficient storage Fe available, this Fe cannot be mobilized rapidly enough to regenerate haemoglobin (Macdougal et al 1989). A more rapid response is assured by injecting Fe.…”

Section: Iron Dejiciencymentioning

confidence: 99%

Influence of disease on iron status

Worwood

1997

Proc. Nutr. Soc.

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Poor response to treatment of renal anaemia with erythropoietin corrected by iron given intravenously.

Cited by 185 publications

References 3 publications

Use of recombinant human erythropoietin in combination with parenteral iron in the treatment of postpartum anaemia

Use of recombinant human erythropoietin in combination with parenteral iron in the treatment of postpartum anaemia

Evaluation of iron status in patients with end stage renal disease

Influence of disease on iron status

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