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1.
Transfusion and recombinant human erythropoietin requirements differ between dialysis modalities 总被引:2,自引:0,他引:2
Background: Before the routine use of recombinant
human erythropoietin (rHuEpo), patients dialysed by peritoneal dialysis
(PD) received fewer blood transfusions than patients on haemodialysis (HD).
We compared transfusion practices in these groups now that the use of
rHuEpo has become standard, while controlling for variables known to
influence anaemia of end-stage renal disease (ESRD). Maintenance rHuEpo
doses were also compared. Methods: Data were examined
for 157 HD and 126 PD patients during a 2-year period. Potential
confounders included age, gender, albumin, iron deficiency, parathyroid
hormone (PTH), underlying renal disease, cormorbid illness, renal
transplant, dialysis adequacy and duration. An intent-to-treat analysis was
used, with sensitivity analyses to account for change in treatment and
transplant. Results: Mean haemoglobin (Hb) was not
different (10.47 g/dl for HD, 10.71 G/DL for PD; P=0.45). Mean monthly
transfusion rate was higher for HD (0.47 units per month
vs 0.19; P<0.01). More HD patients received at
least one transfusion (52.9 vs 40.9%; P<0.01).
The maintenance rHuEpo dose was higher for HD (7370 U/week
vs 5790 U/week; P=0.01). The only factors associated
with risk of being transfused were dialysis duration and mode of dialysis
(less risk for PD, odds-ratio 0.57; 95% confidence interval 0.35-0.92).
Conclusions: Despite the routine use of rHuEpo, HD
patients received more blood and rHuEpo than PD patients to achieve the
same Hb. No patient factors were identified to account for this difference.
The use of fewer transfusions and less rHuEpo in PD represents an advantage
over HD in terms of both cost and safety. 相似文献
2.
Does long-term treatment of renal anaemia with recombinant erythropoietin influence oxidative stress in haemodialysed patients? 总被引:3,自引:3,他引:0
Sommerburg O; Grune T; Hampl H; Riedel E; van Kuijk P; Ehrich J; Siems W 《Nephrology, dialysis, transplantation》1998,13(10):2583-2587
Background. Patients with end-stage renal failure
undergoing haemodialysis (HD) are exposed to oxidative stress. Increased
levels of malondialdehyde (MDA) were demonstrated in plasma of uraemic
patients, indicating accelerated lipid peroxidation (LPO) as a consequence
of multiple pathogenetic factors. The aim of our investigation was to
examine the role of renal anaemia in oxidative stress in HD patients.
Methods. MDA and 4-hydroxynonenal (HNE) were measured
in three groups of patients undergoing HD: group I comprised eight patients
with a blood haemoglobin (Hb) <10 g/dl (mean Hb=8.1±1.3
g/dl), and group II were eight patients with a Hb <10 g/dl (mean
Hb=12.4±1.9 g/dl); none of these 16 patients had been treated
with human recombinant erythropoietin (rHuEpo). Group III comprised 27
patients with a mean Hb of 10.5±1.6 g/dl after long-term rHuEpo
treatment. Results. Mean plasma concentrations of both
MDA and HNE were significantly higher
(P<0.0001) in all 43 HD patients than in 20
healthy controls (MDA 2.85±0.25 vs
0.37± &mgr;M, HNE 0.32± vs
0.10±0.01 &mgr;M). Comprising the three groups, it was shown
that HD patients with a Hb <10 g/dl had significantly higher plasma
levels of LPO products (MDA 3.81±0.86 &mgr;M, HNE
0.45±0.07 &mgr;M) than HD patients with a Hb > 10
g/dl (MDA 2.77±0.58 &mgr;M, HNE 0.25±0.05
&mgr;M), and than HD patients treated with rHuEpo (MDA
2.50±0.12 &mgr;M, HNE 0.29±0.03 &mgr;M).
Furthermore, an inverse correlation between plasma concentration of LPO
products and haemoglobin levels was seen (r=0.62,
P<0.0001). Conclusion.
Radical generation in HD patients might be caused in part by
renal anemia itself. Treatment with rHuEpo may decrease radical generation
effectively in HD patients due to the increase in the number of red blood
cells and blood haemoglobin concentration. Keywords:
erythropoietin; haemodialysis; HNE; lipid peroxidation; MDA;
renal anaemia
相似文献
3.
S Ertürk G Nergizo?lu K Ate? N Duman B Erbay O Karatan A E Ertu? 《Nephrology, dialysis, transplantation》1999,14(8):1912-1916
BACKGROUND: Angiotensin-converting enzyme (ACE) inhibitors have the capability of decreasing left ventricular mass index (LVMI) in chronic haemodialysis (HD) patients. On the other hand, recent reports provide conflicting information regarding the impact of ACE inhibitors on responsiveness to recombinant human erythropoietin (rHuEpo), and there are no data about the effect of withdrawing ACE inhibitors both on rHuEpo response and LVMI in HD patients. METHODS: ACE inhibitors were switched to another antihypertensive medication in 23 out of 68 patients in our HD unit who were receiving both rHuEpo and an ACE inhibitor for more than 1 year. Blood pressure at the pre- and post-dialysis phases, haematocrit levels and rHuEpo doses were determined at the end of the first and of the third years, and the LVMI was determined at the end of the third year. Statistical analyses were done in 15 patients in whom the study could be completed. RESULTS: The mean (+/-SD) haematocrit level was increased from 26.3+6.4% to 29.8+/-6.3% at the first year (P<0.05), and to 29.4+/-6.5% at the third year (P<0.05 vs before), while the mean dose of rHuEpo was decreased from 208.3+/-99.0 UI/kg/week to 141.0+/-91.8 at the first year (P=0.01), and to 141.4+/-81.0 at the third year (P=0.01 vs before). Administration of rHuEpo had been stopped in two patients at the end of the first year. The mean blood pressure level and the mean LVMI were not changed (P>0.05 vs before). There were no significant changes in dialysis parameters, iron status, plasma renin activities, and levels of aldosterone, intact parathyroid hormone, aluminum and erythropoietin. CONCLUSION: The findings of this small uncontrolled study indicate that withdrawal of ACE inhibitors in hypertensive chronic HD patients receiving rHuEpo may result in an increase in haematocrit level, and a decrease in dose of rHuEpo without any significant changes in the blood pressure level and LVMI. Controlled prospective studies are needed to clarify this issue. 相似文献
4.
Aucella F; Vigilante M; Scalzulli P; Musto P; Crisetti A; Modoni S; Carotenuto M; Stallone C 《Nephrology, dialysis, transplantation》1998,13(5):1194-1199
Background: In chronic renal failure, desferrioxamine
(DFO) may improve erythropoiesis independent from its aluminium (Al)
chelating effect. The mechanism of this action is still unknown.
Methods: To verify whether DFO influences
proliferation of erythropoietic precursors, we studied 10 patients on
chronic haemodialysis, free from malignancies or other haematological
diseases, iron deficiency, bone marrow fibrosis, and Al toxicity. Al
accumulation was excluded by the DFO test. Peripheral blood samples were
drawn for basal burst-forming unit-erythroid (BFU-E) assay. Mononuclear
cells were isolated by density gradient centrifugation with Ficoll-Hypaque,
and incubated for 15 days with three different experimental conditions: (a)
low-dose recombinant human erythropoietin (rHuEpo) (3 U/ml); (b) high dose
rHuEpo, (30 U/ml); (c) both DFO (167 &mgr;g/ml) and rHuEpo (3 U/ml). We
determined TIBC, transferrin, ferritin, reticulocytes, hypochromic
erythrocytes, soluble transferrin receptor (sTR), haemoglobin (Hb), and
haematocrit (Hct) at baseline and then every 14 days. Patients received 5
mg/kg DFO infused during the last hour of each dialysis session for 6
weeks; six patients remained in the study for an additional 6 more weeks.
BFU-E assays were set up after 6 and 12 weeks of DFO therapy.
Results: At baseline DFO had small effect on BFU-E
proliferation (33.9±25 vs
30.4±25.9) and high-dose rHuEpo had a significant effect
(45.15±27 vs 30.4±25.9,
P<0.01). After 6 weeks of DFO therapy a significant increase in
BFU-E proliferation was observed in all culture conditions
(78.25±32 vs 30.45±25.9 standard
culture, P<0.01; 110.9±30
vs45.15±27 high dose rHuEpo, P<0.01;
98.75±32 vs 45.15±27 DFO
culture, P<0.01). Moreover, the increase in BFU-E proliferation was
significant greater with DFO culture than standard culture (P<0.01).
The same trend was found at the third BFU-E assay, performed in only six
patients, when all culture conditions showed a further increase of
erythroid precursor proliferation. However, the DFO culture was not
significantly greater than the standard culture, while the high-dose rHuEpo
was significantly greater than the DFO culture. Patients in group 1 (n=10),
had a significant increase in reticulocytes (1.5±0.6
vs 1.72±0.3, P<0.01) and of
hypochromic erythrocytes (HE) (5.6±5.1 vs
14.4±12.7, P<0.01), while sTR, Epo, Hb, and Hct were only
minimally increased. Ferritin decreased significantly (448±224
vs 196±215, P<0.01) and TIBC and
transferrin were unchanged. Conclusions: Thus DFO
increases erythroid activity by BFU-E proliferation and increases
reticulocytes in haemodialysis patients. Such an effect may be related to
increased iron utilization. DFO may be a useful tool for anaemic patients
with good iron stores and without Al overload. Key
words: desferrioxamine; erythroid progenitors; erythropoiesis;
haemodialysis
相似文献
5.
Acute effects of recombinant human erythropoietin on plasma levels of proendothelin-1 and endothelin-1 in haemodialysis patients 总被引:2,自引:0,他引:2
Background: The pathogenesis of rHuEpo-induced
hypertension in haemodialysis (HD) patients still remains uncertain.
Endothelin-1 (ET-1) is produced from proendothelin-1 (proET-1) by an
endothelin-converting enzyme. Since proET-1 is known to have approximately
1/100 the potency of ET-1 for contracting an isolated blood vessel, the
change in the activity of endothelin-converting enzyme (ECE) has been
proposed as an important factor in the pathophysiology of various
hypertensive diseases. However there is no report on whether a change in
the rate of conversion of proET-1 to ET-1 may be involved in the
pathogenesis of rHuEpo-induced hypertension. The purpose of this study was
to ascertain the potential role of ECE in the development of rHuEpo-induced
hypertension. Methods: The levels of plasma
erythropoietin, proET-1, ET-1, and mean arterial blood pressure (MAP) were
measured following a single dose of rHuEpo (100 U/kg) in HD patients with
24-h ambulatory blood pressure monitoring. Different routes of
administration (19 intravenous group, 10 subcutaneous group) were compared
to a placebo-injected control group (10 HD patients).
Results: Plasma erythropoietin levels reached maximal
value 5 min after i.v injection of rHuEpo (13.1±2.4
vs 2780.9±290.1 mU/ml, P<0.01),
whereas it was 6h in the s.c. group (14.7±3.8
vs 38.8±17.7 mU/ml, P<0.05). A
significant increase in MAP was noted 30 min after rHuEpo injection, which
lasted for 3 h in the i.v. group. However, no significant changes in MAP
were noted in patients given rHuEpo subcutaneously. Both the plasma
concentrations of proET-1 and ET-1 started to increase from 10 min after
i.v. rHuEpo administration, with the pro-ET-1 reaching a peak level at 30
min (13.5±7.4 vs 21.6±3.8 pg/ml,
P<0.05) and the ET-1 at 1 h (4.2±2.6
vs 9.9±4.8 pg/ml, P<0.05). In
patients with significant interdialysis hypertension following a single
i.v. injection of rHuEpo, the molar ratio of ET-1 over proET-1
(ET-1/proET-1) was significantly higher than in patients without
hypertension. In addition, the increase in ET-1 levels was significantly
greater in patients with interdialysis hypertension, while changes in
proET-1 level were similar in both hypertensive and non-hypertensive
groups. Changes in interdialysis MAP (Dgr;IDMAP) was significantly
correlated with &Dgr;ET-1 during the interdialysis period, but not with
&Dgr;proET-1. Conclusion: Differences in
ET-1/proET-1 ratio in relation to changes in MAP after a single intravenous
administration of rHuEpo suggest a potential role for ECE in the
pathogenesis of rHuEpo-induced hypertension. Key
words: endothelin-1; endothelin-converting enzyme;
haemodialysis; proendothelin-1; rHuEpo-induced hypertension
相似文献
6.
Iron absorption in erythropoietin-treated haemodialysis patients; effects of iron availability, inflammation and aluminium 总被引:3,自引:3,他引:0
Kooistra M; Niemantsverdriet E; van Es A; Mol-Beermann N; Struyenberg A; Marx J 《Nephrology, dialysis, transplantation》1998,13(1):82-88
Background: The response to recombinant human
erythropoietin (rHuEpo) is determined primarily by the availability of
iron. In contrast to i.v. iron, oral iron supplementation is often
insufficient for an optimal response. Method: We
studied iron absorption and the effects of iron status, aluminium status
and inflammation in 19 chronic haemodialysis patients on maintenance rHuEpo
therapy. Iron mucosal uptake after 24 h, iron retention after 2 weeks and
mucosal transfer of iron were determined with a whole-body counter using an
oral dose 59Fe. Iron absorption was measured once
without, and once after the ingestion of 2 g aluminium hydroxide.
Results: On the basis of transferring saturation, two
groups of dialysis patients were distinguished: a group with a functional
iron deficiency (n=9), and an iron-deficient dialysis patients group,
mucosal uptake, mucosal transfer, and iron retention were
49.9%±29.4, 0.73±0.29, and 41.6%±32.2,
being significantly lower than in a non-uraemic iron deficient population
(P <0.01, P <0.05, P <0.01 respectively). In the
iron-replete dialysis patients group, mucosal uptake, mucosal transfer, and
iron retention were 20.0±12.3, 0.59±0.18, and
11.1±6.7, mucosal uptake and iron retention being lower than in
a normal iron-replete population (P <0.0005 and P <0.003
respectively). Dialysis patients with high C-reactive protein (CRP) values
showed lower iron absorption. Iron absorption data correlated significantly
with transferrin saturation and CRP in the iron-deficient group, and with
serum ferritin in the iron-replete group. Iron absorption decreased after
an aluminium hydroxide challenge in the iron-deficient patients to the
lower levels of the iron-replete subjects. Body aluminium stores, estimated
by the desferrioxamine test, did not correlate with parameters of iron
absorption. Conclusion: 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. Key
words: anaemia; erythropoietin; iron absorption; haemodialysis
相似文献
7.
8.
Determinants of circulating soluble transferrin receptor level in chronic haemodialysis patients. 总被引:1,自引:1,他引:0
BACKGROUND: The aim of this study was to identify the factors determining the circulating soluble transferrin receptor (sTfR) concentrations in haemodialysis (HD) patients on maintenance recombinant human erythropoietin (rHuEpo) treatment. METHODS: In a prospective cross-sectional study, 91 chronic HD patients and 18 anaemic controls with normal renal function were recruited. For each subject, blood samples were measured for complete blood count, reticulocyte count, percentage of hypochromic red cells (% HRC), serum ferritin, serum iron, transferrin saturation (TS), serum erythropoietin (sEpo), C-reactive protein (CRP), and sTfR. HD patients received constant rHuEpo doses and basal sEpo was measured > or = 86 h after the last injection. The age, gender, dialysis vintage, and the above-mentioned parameters were used as independent variables and logarithmic sTfR (log(10)sTfR) as a dependent variable in the forward stepwise multiple regression model. RESULTS: HD patients were similar to controls regarding haematocrit, serum ferritin, TS, and % HRC, but had significantly lower sTfR, sEpo, and reticulocyte index. Univariate analyses showed that the sTfR level strongly correlated with sEpo (r=0.60, P<0.001) and % HRC (r=0.60, P<0.001), and significantly with serum ferritin (r=-0.29, P<0.01), TS (r=-0.27, P<0.05), and dose of rHuEpo administered (r=0.27, P<0.05) in HD patients. sTfR also had a positive correlation with haematocrit (r=0.26, P<0.05), red blood cell (RBC) count (r=0.23, P<0.05), and reticulocyte count (r=0.24, P<0.05), but not with CRP (r=0.16, P>0.05). Multivariate regression analysis disclosed that sEpo, HRC, and serum ferritin were the independent predictors of sTfR level. Overall, the model explained 58.8% of the variability in sTfR (R(2)=0.588, P<0.001). CONCLUSIONS: Circulating sTfR is a good index of marrow erythropoietic activity in HD patients during rHuEpo treatment. Its level is also independently up-regulated by functional iron deficiency in the process of enhanced erythropoiesis. Our study showed that sTfR levels quantitatively reflect the integrated effects of iron availability, iron reserves, and erythropoietic stimulation. 相似文献
9.
Rocha J; Gentil M; Gili M; Gil L; Cabello V; Bernal G 《Nephrology, dialysis, transplantation》1998,13(1):89-92
Background: Subcutaneous recombinant human
erythropoietin seems to be more effective than intravenous administration.
Local pain, however, may diminish patient compliance with the subcutaneous
route. Recently continuous intravenous intradialysis administration of
rHuEpo has been reported to be more efficacious in stimulating
erythropoiesis than the usual postdialysis intravenous bolus.
Methods: We conducted a randomized, controlled,
crossover study on stable chronic haemodialysis patients to compare the
efficacy of continuous intradialysis rHuEpo therapy with intravenous
postdialysis administration. Twenty patients were selected and randomly
assigned to receive rHuEpo either postdialysis (control phase) or by
continuous intradialysis perfusion (slow Epo phase) for 12 weeks. After
this period, patients were switched to the alternative method for 12
additional weeks. The erythropoietin dose remained unchanged during the
study. Haematocrit was monitored weekly and iron metabolism, serum Epo, and
vitamins were measured monthly. Urea kinetics and iPTH measurements were
performed every 3 months. Results: Three patients were
excluded because of unrelated problems. The final mean haematocrit was
unchanged from previous basal values in both phases and no statistical
differences were found for any parameter between the groups. No differences
were found in iron metabolism nor in urea kinetic parameters.
Conclusions: Continuous intravenous intradialysis
administration of rHuEpo is no more effective than an intravenous
postdialysis bolus as rHuEpo maintenance therapy in stable chronic
haemodialysis patients. 相似文献
10.
《Renal failure》2013,35(10):1399-1403
AbstractBackground: Studies detected an association between visfatin and markers of iron metabolism in patients with insulin resistance. In this study, such a relation was evaluated in hemodialysis (HD) patients. Also relations between visfatin and hepcidin, demands for recombinant human erythropoietin (rHuEpo), inflammation, and situations characterized by insulin resistance were evaluated. Methods: After a four-week washout period from iron treatment, 33 HD patients and 20 healthy volunteers enrolled in the study. Serum visfatin, hepcidin, and interleukin-6 (IL-6) were assessed by means of enzyme-linked immunosorbent assay. Hemoglobin, serum iron, ferritin, and transferrin saturation (TSAT) were also measured. Results: Visfatin was markedly increased in HD patients. Visfatin levels did not differ between diabetics and non-diabetics. No relation was detected between visfatin and body mass index or IL-6 in HD patients. From the markers of iron metabolism, the hepcidin included, visfatin was related only to TSAT. A strong positive relation was revealed between visfatin and hemoglobin, whereas visfatin was inversely related to rHuEpo dose. Resistance to rHuEpo index was inversely and independently of TSAT related to visfatin. Conclusion: Visfatin is increased in HD patients and it is associated with decreased demands for rHuEpo. 相似文献
11.
Cardiac valve calcification in haemodialysis patients: role of calcium-phosphate metabolism 总被引:14,自引:5,他引:9
Ribeiro S; Ramos A; Brandao A; Rebelo J; Guerra A; Resina C; Vila-Lobos A; Carvalho F; Remedio F; Ribeiro F 《Nephrology, dialysis, transplantation》1998,13(8):2037-2040
Background. Cardiac valve calcification (VC) has been
detected with increased frequency in haemodialysis (HD) patients, making it
necessary to determine the potential pathogenic factors in uraemic
patients. Methods. A total of 92 chronic HD patients
(39 female, 53 male) and 92 age and gender-matched non-dialysis control
subjects were evaluated by echocardiography and a severity score for VC was
determined. Calcium-phosphate metabolism was evaluated at the beginning of
haemodialysis. Results. We found a greater prevalence
of VC in dialysis patients than in normal patients (mitral annulus 44.5%
vs 10%, P = 0.02; aortic annulus
52% vs 4.3%, P = 0.01). HD
patients with mitral calcification were found to be older than patients
without calcification, were on long-term renal replacement therapy, had
longer duration of predialysis arterial hypertension, had greater values of
the highest value of mean calcium-phosphate product in 6 successive months
(CaxP) and the highest absolute value of calcium-phosphate product
(CaxPmax). We also found a positive correlation between calcification
score, age, and CaxP. No correlation was found between actual VC and
arterial hypertension or parathyroid hormone. Multiple stepwise regression
analysis selected age and CaxP as the most predictive parameters for mitral
calcification (r = 0.47). Mitral calcification was
associated more frequently with rhythm and cardiac conduction defects,
valvular insufficiency and with peripheral vascular calcification. Aortic
calcification was correlated with age (r = 0.42) and
longer duration or pre-dialysis arterial hypertension.
Conclusion. Our study confirmed an increased
prevalence of VC in HD patients and selected age and calcium-phosphate
product as the most predictive parameters. These finding support careful
monitoring of calcium metabolism beginning at the early stages of end-stage
renal failure to reduce the risk of heart disease. Keywords:
calcium; echocardiography; haemodialysis; mitral annulus
calcification; parathyroid hormone; valvular calcification
相似文献
12.
Recombinant human erythropoietin(rHuEpo) is effective for the treatment of renal anemia associated with chronic renal failure(CRF). However, we have encountered some patients with CRF who have sometimes developed a resistance to rHuEpo. This resistance can be due to iron or folate deficiency, aluminum toxicity, hyperparathyroidism, or auto-antibodies for rHuEpo. In this study, we focused on the soluble erythropoietin receptor(sEpoR), which can bind to rHuEpo. To demonstrate the possibility that the sweeping of rHuEpo by sEpoR results in resistance to rHuEpo, we performed a bioassay using the rHuEpo-dependent cell line, UT7/EPO. The results showed that recombinant mouse sEpoR(rmsEpoR) can reduce the proliferation of UT7/EPO induced by rHuEpo in a dose-dependent manner. We consider that this cell line could be a useful tool in a bioassay to detect the inhibitory factor(s) against Epo. We selected sera from three groups of patients with renal anemia associated with CRF who were receiving hemodialysis three times a week: the first was a patient group that needed a high dose of rHuEpo(7,500-9,000 unit/dialysis), the second was a patient group that needed an intermediate dose of rHuEpo (4,500 unit/dialysis), the third was a patient group that needed a low dose of rHuEpo(below 1,500 unit/dialysis). Interestingly, the proliferation of UT7/EPO determined with [3H]-thymidine incorporation was reduced by the addition of sera from the first group, but not by the addition of sera from the third group. These results suggested that serum sEpoR may play an important role in signal transduction via EpoR on erythroid progenitor in CRF patients. 相似文献
13.
Ambuhl P; Wuthrich R; Korte W; Schmid L; Krapf R 《Nephrology, dialysis, transplantation》1997,12(11):2355-2364
Background: Thrombotic complications are common in
patients with endstage renal disease and contribute substantially to the
morbidity and mortality in this population. The aim of the present study
was to: I) determine the prevalence and the extent of hypercoagulability in
patients undergoing dialysis treatment by measuring parameters that
directly reflect thrombin concentrations, ii) assess changes in coagulation
status during haemodialysis (HD); iii) quantify the relative impact of
heparin, dialysis and their combined effects on coagulation status and iv)
detect factors that modify coagulation haemostasis in dialysis patients.
Method: A total of 39 patients (HD: n=29, CAPD: n=10)
was analysed for procoagulatory and fibrinolytic activity determined by
measurements of partial thromboplastin time, prothrombin fragments F1+2,
thrombin-antithrombin complexes and D-dimer concentrations. HD patients
were investigated prior to and during dialysis. A subgroup of patients was
infused heparin alone without dialysis or was dialysed without heparin
administration. Furthermore, subgroup and correlation analyses were
performed for the type of dialysis (HD vs CAPD), dialyzer and shunt, Kt/V,
underlying disease and treatment with recombinant erythropoietin (rhEPO).
Results: Baseline levels of all
parameters-procoagulatory and fibrinolytic- were substantially elevated in
all patients, but to a higher degree among those on CAPD. Moreover,
haemodialysis treatment increased procoagulatory markers even further,
suggesting stimulated coagulation and/or insufficient anticoagulation
during dialysis. However, after 3 h of dialysis thrombin concentrations,
determined by quantification of prothrombin fragments, were inversely
correlated with Kt/V. Selective heparin infusion diminished procoagulatory
activity only slightly and incompletely, whereas HD without heparin
resulted in excess thrombin accumulation. Finally, subgroup analyses
revealed more pronounced thrombin formation among patients treated with
polysulfon dialyzers, whereas erythropoietin dosage was positively related
with lower procoagulatory activity. Conclusion: A
majority of patients on dialysis are in a hypercoagulable state, which is
further aggravated by the haemodialysis procedure itself and may not be
sufficiently controlled with current anticoagulation regimens. Intensified
heparin treatment and the use of rhEPO are likely to improve coagulation
haemostasis, whereas the type of dialyzer should be considered as a
relevant procoagulatory factor. 相似文献
14.
Vella J; O'Neill D; Atkins N; Donohoe J; Walshe J 《Nephrology, dialysis, transplantation》1998,13(8):2027-2032
Introduction. Antibodies directed against human
leukocyte antigens (HLAs) impact adversely on renal transplantation.
Measures aimed at preventing such antibody formation are thus important.
The introduction of recombinant human erythropoietin (rHuEpo) has permitted
the reduction of blood transfusion in patients with chronic renal failure.
The impact of rHuEpo on the incidence of sensitization in patients awaiting
transplantation was therefore studied. Methods. A
retrospective analysis of the patients awaiting transplantation before
(group A) and 4 years after (group B) the introduction of rHuEpo was
performed in order to ascertain changing patterns in the use of blood
transfusion and causes of sensitization. Results. The
total number of transfusions administered to haemodialysis patients
decreased by 34% during the study period. This was accompanied by a
significant reduction in the ratio of blood transfusion to haemodialysis
treatment episodes (0.095 in group A to 0.06 in group B,
P = 0.001). The number of patients sensitized as a
consequence of blood transfusion decreased from 63% in group A to 28% in
group B (P = 0.0004). The overall incidence of
sensitization decreased from 50% in group A to 36.5% in group B
(P = 0.008). This decrement was associated with a
significant reduction in the mean waiting time for transplantation (42.1
± 1.1 vs 15.4 ± 2.4 months,
P <0.0001). The incidence of sensitization due
to previous transplantation increased during the study period from 41% in
group A to 77% in group B (P = 0.0004). There was no
change in the number of patients sensitized due to pregnancy.
Conclusion. The introduction of rHuEpo has resulted in
a significant decrease in the requirements for blood transfusion among
patients awaiting transplantation and is associated with a significant
reduction in transfusion-related sensitization and mean waiting time for
transplantation. 相似文献
15.
Importance of iron supply for erythropoietin therapy 总被引:10,自引:5,他引:5
BACKGROUND.: rHuEpo and iron therapy corrects renal anaemia. However, dosage,route of administration, and monitoring of iron and rHuEpo therapyin uraemic patients remains controversial. METHODS.: Therefore a 22-month i.v. iron substitution trial, subdividedinto four study periods, was initiated in 64 iron-depleted chronichaemodialysis (HD) patients receiving i.v. rHuEpo therapy. Withinthe first period (6 months) patients were treated with high-doseiron (100mg at the end of HD treatment, mean cumulative i.v.iron saccharate dosage was 2538±810 mg per patient) inorder to replete the iron stores. During the 2nd period (6 months)the available iron pool was maintained with low-dose iron byadministration of 10, 20, or 40 mg iron at each HD, dependingon haemoglobin, serum ferritin and transferrin saturation levels.During the 3rd period (4 months), the iron-replete patientswere randomized to i.v. or s.c. route of rHuEpo administration.During the 4th period (3 months) iron substitution was omittedto exclude severe iron overload. RESULTS.: In the first study period, high-dose iron therapy dramaticallyreduced the weekly rHuEpo requirement by 70% of the initialdose (from 217±179 to 62.6±70.2 U/kg/week). Inthe 2nd period iron storage pools were easily maintained. Serumferritin and transferrin saturation levels remained stable duringthis study period. Randomization for thrice-weekly i.v. or s.c.administration of rHuEpo in the 3rd study period revealed comparableefficacy for both administration routes in iron-replete patients.In well-nourished patients (serum albumin >40 g/1) withouthyperparathyroidism (parathyroid hormone levels < 100 pg/ml),5060 U/kg/week rHuEpo were required in contrast to >100 U/kg/week in patients with hyperparathyroidism. In the 4thstudy period, withdrawal of iron administration led to a rapiddecrease of serum ferritin and transferrin saturation levels,indicating the absence of severe iron overload. CONCLUSIONS.: Long-term thrice-weekly i.v. low-dose iron therapy (1020mg per HD treatment) proved to be a very effective, economicaland safe treatment schedule for iron-replete HD patients. Intravenousand s.c. rHuEpo therapy was equally efficacious in iron-replete,well-nourished patients. HD patients with increased parathyroidhormone levels require significantly more rHuEpo than HD patientswith parathyroid hormone levels values <100 pg/ml). 相似文献
16.
Background. Intravenous iron supplementation is often
necessary in recombinant human erythropoietin (r-HuEPO)-treated
haemodialysis (HD) patients, but rarely in r-HuEPO-treated peritoneal
dialysis (PD) patients. This may be due to differences in iron absorption
or blood loss. Method. Iron absorption (whole-body
counting after ingestion of a radiolabelled iron test dose) and iron
metabolism were compared in eight iron-replete r-HuEPO-treated PD patients
(serum ferritin 100-500 &mgr;g/l) and 68 healthy iron-replete controls
(sufficient iron in bone marrow specimen). Results.
Mucosal uptake (13.4±9.8), mucosal transfer
(0.34±0.18) and iron retention (4.9±4.0) in PD
patients was significantly lower than in controls (42.9±18.8%,
P<0.0001, 0.63±0.18,
P<0.0001, and 28.0±16.7%,
P<0.0001). Conclusion.
Iron absorption is impaired in PD patients, as we have shown
previously for HD patients. One reason for higher iron needs in HD patients
may be higher blood losses due to the dialysis procedure and blood sampling
for laboratory tests. 相似文献
17.
The haematopoietic effect of recombinant human erythropoietin in haemodialysis is independent of the mode of administration (i.v. or s.c.) 总被引:1,自引:1,他引:0
De Schoenmakere G; Lameire N; Dhondt A; Van Loo A; Van der Goten J; Duym P; Vanholder R 《Nephrology, dialysis, transplantation》1998,13(7):1770-1775
Background: Previous studies comparing intravenous
(i.v.) and subcutaneous (s.c.) administration of recombinant human
erythropoietin (rHuEpo) often did not achieve optimal iron reserve, were
restricted to a limited follow-up period (not allowing equilibration)
and/or did not exclude the role of other confounding factors. In addition
all papers focused on the conversion from i.v. to s.c.
Methods: In this study, 30 equilibrated patients on
s.c. rHuEpo were randomized into two groups, one converting to i.v. after 6
months of follow-up and one remaining on s.c. rHuEpo. In both groups rHuEpo
was administered three times weekly. Only patients completing a further 6
months follow-up were considered for statistical evaluation. Serum ferritin
was targeted at 200 ng/ml and haematocrits between 28 and 35% were pursued.
Results: The average haematocrit levels before
conversion were 31.9±1.1% in the conversion group and
31.4±1.6% at the same time point in the non-conversion group
(P-NS). After 6 months haematocrits were 31.5±0.5% in the
conversion group and 31.1±0.9% in the non-conversion group
(P=NS). Ferritin concentration in the conversion group was
219±49 ng/ml before and 230±83 mg/ml after the
conversion. For the non-conversion group ferritin was 224±25
ng/ml and 236±52 ng/ml respectively (P=NS). The
weight-standardized average rHuEpo dose per injection remained the same in
the conversion group before and after conversion (44.0±1.8
U/kg/injection vs 45.4±4.7 U/kg/injection)
P=NS). In the non-conversion group the corresponding rHuEpo doses were
32.9±4.2 U/kg/injection and 39.6±7.0 U/kg/injection
respectively (P=NS). There were no differences in serum PTH, aluminium,
vitamin B12, folic-acid levels, and intake of co-trimoxazole, ACE
inhibitors or theophylline. Conclusion: No changes in
rHuEpo dose wee observed after conversion from s.c. to i.v. There were no
significant differences between the conversion and non-conversion group.
These results are in contrast to some earlier studies suggesting lower
rHuEpo requirements in case of s.c. administration. Key
words: anaemia; erythropoietin; intravenous erythropoietin;
iron; subcutaneous erythropoietin
相似文献
18.
Recombinant erythropoietin reverses polymorphonuclear granulocyte dysfunction in iron-overloaded dialysis patients 总被引:1,自引:1,他引:0
J R Boelaert B F Cantinieaux C F Hariga P G Fondu 《Nephrology, dialysis, transplantation》1990,5(7):504-517
Iron overload increases the risk of bacterial infection in dialysis patients, partly by impairing functions of the polymorphonuclear granulocytes (PMNs). PMN defence was studied sequentially in haemodialysis patients with transfusional haemosiderosis, treated for 6 +/- 1.5 months (n = 8) to 13 +/- 1.7 months (n = 4) with recombinant human erythropoietin (rHuEpo). Over this period, signs of iron overload (increased serum ferritin and serum iron) improved, and stainable iron disappeared in PMNs. Simultaneously, phagocytosis of Yersinia enterocolitica by PMNs improved. The decrease in serum ferritin was significantly related to the improved phagocytosis. Killing of Y. enterocolitica by PMNs also improved. It is anticipated that rHuEpo therapy in iron-overloaded dialysis patients could decrease the incidence of bacterial infection by improving PMN functions in these patients. 相似文献
19.
I Kárpáti I Seres J Mátyus T Ben G Paragh Z Varga G Kakuk 《Nephrology, dialysis, transplantation》2001,16(7):1409-1415
BACKGROUND: Cytosolic free calcium ([Ca(2+)](i)) is an important second messenger during stimulation in a wide variety of cells, including polymorphonuclear leukocytes (PMNs). Its mobilization in PMNs is altered in various diseases such as atherosclerosis and ageing. In chronic haemodialysis (HD) patients, both atherosclerosis and accelerated ageing are well known. Therefore [Ca(2+)](i) in resting PMNs of HD patients was determined along with certain parameters which might affect it, such as recombinant human erythropoietin (rHuEpo) treatment, calcium-phosphate balance, and biocompatibility of dialysis membranes. METHODS: PMNs were separated by density centrifugation and [Ca(2+)](i) was determined by spectrofluorimetry using Quin 2/AM fluorescent dye. Laboratory parameters were determined by standard methods in clinical chemistry. RESULTS: It was found that [Ca(2+)](i) in resting PMNs of HD patients not undergoing rHuEpo therapy was higher than that of controls. After 12-weeks of rHuEpo therapy, [Ca(2+)](i) decreased to near normal level. The role of erythropoiesis in normalization of [Ca(2+)](i) in resting PMNs was supported by PMN [Ca(2+)](i) which was elevated in patients who had low haemoglobin (<100 g/l) or haematocrit (<0.30) values. In some patients, including those receiving rHuEpo treatment, [Ca(2+)](i) remained high, suggesting a role for other parameters in increasing [Ca(2+)](i). One possible parameter might be the disturbed calcium-phosphate metabolism of chronic renal failure, because we found a strong correlation between [Ca(2+)](i) and plasma iPTH levels in HD patients (r=0.743, P<0.001). [Ca(2+)](i) was also elevated in PMNs of those patients who had either low plasma calcium or high plasma phosphate levels. PMN [Ca(2+)](i) of HD patients correlated positively with the duration of HD (r=0.671, P<0.001). However, there was no correlation between [Ca(2+)](i) and patient age. The dialysis procedure itself also transiently increased PMN [Ca(2+)](i) HD patients, independently of the type of dialysis membrane. CONCLUSION: PMN [Ca(2+)](i) is modulated by various parameters in HD patients, including the degree of anaemia, disturbances of calcium metabolism, and duration of dialysis treatment. The elevated [Ca(2+)](i) of resting PMNs might contribute to altered functions in these cells. 相似文献
20.
Renal and haemodynamic effects of amlodipine and nifedipine in hypertensive renal transplant recipients 总被引:1,自引:1,他引:0
Venkat-Raman G; Feehally J; Elliott H; Griffin P; Moore R; Olubodun J; Wilkinson R 《Nephrology, dialysis, transplantation》1998,13(10):2612-2616
Background. Immunosuppressive treatment with
cyclosporin A (CsA) improves the survival of renal allografts, but is
associated with renal vasoconstriction and hypertension. Previous reports
suggest that the calcium-channel blockers nifedipine and amlodipine may
improve graft function in CsA-treated patients. We have compared the
effects of amlodipine (5-10 mg once daily) and nifedipine retard (10-40 mg
twice daily) on renal function and blood pressure in renal transplant
recipients treated with CsA. Methods. This was a
multicentre, two-way, crossover study in 27 evaluable hypertensive patients
with renal insufficiency following renal transplantation, who were
maintained on a stable dose of CsA. Patients received either amlodipine
(5-10 mg once daily) or nifedipine retard (10-40 mg twice daily) for 8
weeks, and were then crossed over to the other treatment for a further 8
weeks. Results. Trends were seen during amlodipine
treatment towards larger improvements, in serum creatinine (by 8% of
baseline on amlodipine vs 4% on nifedipine), lithium
clearance (13% vs 2%), and glomerular filtration rate
11% vs 7%). Effective renal plasma flow was increased
by 11% of baseline on nifedipine vs 9% on amlodipine.
There were no significant differences between treatments. Amlodipine and
nifedipine lowered systolic blood pressure to a similar extent (21 mmHg
vs 15 mmHg respectively, P=0.25),
but amlodipine was more effective than nifedipine in lowering diastolic
blood pressure (13 mmHg vs 8 mmHg,
P=0.006). Both treatments were well tolerated.
Conclusion. Once-daily amlodipine is at least
effective as twice-daily nifedipine retard in controlling blood pressure
and does not adversely affect graft function in hypertensive renal
allograft recipients. 相似文献