Recombinant Erythropoietin Improves Exercise Capacity in Anemic Hemodialysis Patients

Robertson, H. Thomas; Haley, Nancy; Guthrie, Mark R.; Cardenas, Diana D.; Eschbach, Joseph W.; Adamson, John W.

doi:10.1016/s0272-6386(12)80079-5

Cited by 128 publications

(60 citation statements)

References 20 publications

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“…EPO often causes a large increase in hemoglobin, while the corresponding increase in peak oxygen uptake is disproportionately low (6,7). Furthermore, peak oxygen uptake is better predicted by skeletal muscle strength than by hemoglobin (7,8). These findings suggest skeletal muscle oxygen extraction, not oxygen delivery to muscle, limits exercise tolerance in many renal failure patients.…”

Section: Introductionmentioning

confidence: 97%

“…improvement mechanisms are obscure, and some patients enigmatically fail to improve after exercise training or EPO (4,5). EPO often causes a large increase in hemoglobin, while the corresponding increase in peak oxygen uptake is disproportionately low (6,7). Furthermore, peak oxygen uptake is better predicted by skeletal muscle strength than by hemoglobin (7,8).…”

Section: Introductionmentioning

confidence: 99%

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31P-magnetic resonance spectroscopy assessment of subnormal oxidative metabolism in skeletal muscle of renal failure patients.

1993

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In hemodialysis patients, erythropoietin increases hemoglobin, but often the corresponding increase in peak oxygen uptake is low. The disproportionality may be caused by impaired energy metabolism. 3"P-magnetic resonance spectroscopy was used to study muscle energy metabolism in 11 hemodialysis patients, 11 renal transplant recipients, and 9 controls. Measurements were obtained during rest, static hand-grip, and rhythmic handgrip; recoveries were followed to baseline. During static handgrip, there were no between-group differences in phosphocreatine (PCr), inorganic phosphate (Pi), or PCr/(PCr + Pi), although intracellular pH was higher in hemodialysis patients than transplant recipients. During rhythmic hand-grip, hemodialysis patients exhibited greater fatigue than transplant recipients or controls, and more reduction in PCr/(PCr + Pi) than transplant recipients. Intracellular pH was higher in controls than either hemodialysis patients or transplant recipients. Recoveries from both exercises were similar in all groups, indicating that subnormal oxidative metabolism was not caused by inability to make ATP. The rhythmic data suggest transplantation normalizes PCr/(PCr + Pi), but not pH. In hemodialysis patients, subnormal oxidative metabolism is apparently caused by limited exchange of metabolites between blood and muscle, rather than intrinsic oxidative defects in skeletal muscle. (J.

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Section: Introductionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

31P-magnetic resonance spectroscopy assessment of subnormal oxidative metabolism in skeletal muscle of renal failure patients.

1993

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“…11 Untreated anemia contributes to the increased CVD burden in CKD populations. 7 Timely treatment of anemia with an emphasis on raising hematocrit to at least 36% can improve patient's quality of life, 12 decrease the need of blood transfusions, 13,14 improve cognitive function 15 and muscle strength, 16 and decrease hospitalizations and mortality. 17,18 This study aimed at estimating the prevalence and severity of anemia in adult pre-dialysis patients.…”

Section: Introductionmentioning

confidence: 99%

Prevalence and management of anemia in pre-dialysis Malaysian patients: A hospital-based study

Salman

Khan

Adnan

et al. 2016

Rev. Assoc. Med. Bras.

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Summary Objective: Anemia, a common complication of chronic kidney diseases (CKD), is involved in significant cardiovascular morbidity. Therefore, the objective of our study was to investigate the prevalence and severity of anemia in pre-dialysis patients, as well as to determine the predictors of anti-anemic therapy. Method: A retrospective, observational study was conducted on adult pre-dialysis patients receiving treatment at the Hospital Universiti Sains Malaysia from January 2009 to December 2013. Results: A total of 615 eligible cases were included. The mean age of patients was 64.1±12.0 years. The prevalence of anemia was 75.8%, and the severity of anemia was mild in 47.7% of the patients, moderate in 32.2%, and severe in 20%. Based on morphological classification of anemia, 76.9% of our patients had normochromic-normocytic anemia whereas 21.8 and 1.3% had hypochromic-microcytic anemia and macrocytic anemia, respectively. Oral iron supplements were prescribed to 38.0% of the patients and none of the patients was given erythropoietin stabilizing agents (ESA) or intravenous iron preparations. In logistic regression, significant predictors of anti-anemic preparation use were decreased hemoglobin and hematocrit, and advanced stages of CKD. Conclusion: The results of the present study suggest that the prevalence of anemia in pre-dialysis patients is higher than currently accepted and it is found to be correlated with renal function; prevalence increases with declined renal function. An earlier identification as well as appropriate management of anemia will not only have a positive impact on quality of life but also reduce hospitalizations of CKD patients due to cardiovascular events.

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“…The primary cause in patients with end-stage renal disease is insufficient production of erythropoietin by the kidneys. [2][3][4] Currently, recombinant human erythropoietin is the standard treatment for renal anemia in end-stage renal disease patients and has been shown to improve quality of life, 5) increase exercise tolerance, 6) and improve cardiac function. 7,8) Furthermore, managing renal anemia with erythropoietin and iron replacement in hemodialysis patients poses several clinical challenges, including the maintenance of stable hemoglobin levels within narrow target ranges, balancing iron and erythropoietin dosages, and optimizing the response to erythropoietin to achieve the lowest possible effective erythropoietin dose.…”

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confidence: 99%

Effect of Pharmacist Management on Serum Hemoglobin Levels with Renal Anemia in Hemodialysis Outpatients

Kuwatsuka

Onoue

et al. 2011

Biological & Pharmaceutical Bulletin

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Recombinant Erythropoietin Improves Exercise Capacity in Anemic Hemodialysis Patients

Cited by 128 publications

References 20 publications

31P-magnetic resonance spectroscopy assessment of subnormal oxidative metabolism in skeletal muscle of renal failure patients.

31P-magnetic resonance spectroscopy assessment of subnormal oxidative metabolism in skeletal muscle of renal failure patients.

Prevalence and management of anemia in pre-dialysis Malaysian patients: A hospital-based study

Effect of Pharmacist Management on Serum Hemoglobin Levels with Renal Anemia in Hemodialysis Outpatients

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