No abstract available.
Erythropoiesis ; Hematinics ; Hemoglobins

From 1995 to 2002, 364 courses of chemotherapy with different regimens, almost gave various side effects such as leucopenia, thrombocytopenia, hypohemoglobin, increase of liver enzymes (SGOT, SGPT,…), enhance urea, creatinine level, nausea, alopecia… with different severity and incidence. The common regimans with more significant side effects were Doxorubicin + AraC (P3), MOPP (P2), CHDP (P1) and VAD (P4); the regimens AraC + Depersolon (P7), Hydrea + AraC (P6) and particularly Hydrea alone (P5) gave usually less side effects
drug therapy ; Hematinics ; Diseases ; Therapeutics ; adverse effects

PURPOSE: This study was undertaken to examine whether differences exist in the hemoglobin variability according to the types of erythropoiesis stimulating agent (ESA) in hemodialysis (HD) patients. METHODS: Clinical data were retrospectively analyzed from 72 patients on maintenance hemodialysis who were using darbepoetin alfa (n=27), epoetin beta (n=27), and epoetin alpha (n=18). As parameters of hemoglobin variability, hemoglobin cycling, the variance of hemoglobin and the SD/mean of hemoglobin were analyzed. Hemoglobin cycling was defined as the presence of cycles with an amplitude >1.5 g/dL and lasting more than 2 months. RESULTS: Hemoglobin cycling was present in 53 (73.6%) out of 72 HD patients. Hemoglobin cycling in patients receiving darbepoetin alfa had greater frequency (1.63+/-0.93 vs. 1.00+/-0.88 times/year, p<0.05), amplitude (2.88+/-1.48 vs. 1.88+/-1.60 g/dL, p<0.05), and velocity (1.21+/-0.74 vs. 0.73+/-0.66 g/dL/month, p<0.05) than that in patients receiving epoetin beta. The variance of hemoglobin in patients receiving epoetin beta (0.79+/-0.53 g/dL) was smaller than that in patients receiving darbepoetin alfa (1.29+/-0.70 g/dL, p<0.05) and epoetin alfa (1.08+/-0.52 g/dL, p<0.05). Also, the ratio of SD/mean of hemoglobin in patients receiving epoetin beta (8.20+/-2.59%) was lower than that in patients receiving darbepoetin alfa (10.81+/-2.10%, p<0.05) and epoetin alfa (10.30+/-2.10%, p<0.05). CONCLUSION: Hemoglobin variability is differential according to various ESAs, and it may be less with epoetin beta compared with darbepoetin alpha and epoetin alpha.
Anemia ; Erythropoiesis ; Erythropoietin ; Hematinics ; Hemoglobins ; Humans ; Recombinant Proteins ; Renal Dialysis ; Retrospective Studies ; Darbepoetin alfa ; Epoetin Alfa

Blood transfusions were once believed to the most potent and cost-effective method of improving patients' survival outcomes, but accumulating evidence over the past thirty years strongly suggests allogeneic transfusions as independent prognosticators of complications, prolonged hospital stay, and higher costs. A growing body of health care providers in Korea and throughout the world recognize a causal relationship between these adverse outcomes with liberal transfusion policies and call for a universal paradigm shift regarding the management of blood. Currently, the most promising contender is Patient Blood Management (PBM), which has been found to improve patient outcomes by conserving or optimizing the patient's own blood and physiologic reserves and advocating for restrictive transfusion policies. PBM incorporates evidence-based transfusion replacements to address anemia, bleeding, and blood disorders. These various methods–such as intravenous iron, erythropoiesis stimulating agents, coagulating factors, and topical hemostatic agents–are gaining recognition because of their ability to preclude the need for allogenic transfusions while effectively managing the patient's blood.
Anemia ; Blood Transfusion ; Health Personnel ; Hematinics ; Hemorrhage ; Humans ; Iron ; Korea ; Length of Stay ; Methods

PURPOSE: It is frequently observed that the level of hemoglobin (Hb) widely fluctuates during treatment of erythropoiesis stimulating agents (ESAs) in hemodialysis (HD) patients, known as Hb cycling. The purpose of this study was to describe the frequencies and the characteristics of Hb cycling in Korean HD patients treated with ESA. METHODS: Data were analyzed for 49 patients on maintenance HD at our unit between August, 2005 and July, 2006. The patients treated with ESA and oral iron > or =6 months before study period were eligible. Only Hb cycles of duration > or =8 weeks and amplitude >1.5 g/dL were included in the analysis. RESULTS: Forty-seven of patients (96%) had experienced Hb cycling. The mean number of Hb excursions (a half of Hb cycle) was 2.5+/-1.3 times/year/person. The mean amplitude and duration of Hb excursions was 2.4+/-0.7 g/dL and 10.0+/-4.2 weeks, respectively. The mean nadir Hb level of excursions was 9.2+/-0.8 g/dL which was quite lower than 10 g/dL, the lower limit of Hb range recommended in Korea. Down Hb excursions were associated with ESA withdrawal in 78.3%. Patients who were frequent cyclers (> or =2 times/year/person) significantly had a higher prevalence of diabetes mellitus than others (57.1% vs. 28.6%, p=0.047). CONCLUSION: Hb cycling is a common and a serious feature in HD patients treated with ESA. It is primarily a result of anemia treatment practices, especially holding of ESA and, in part, underlying diabetes.
Anemia ; Diabetes Mellitus ; Erythropoiesis* ; Hematinics ; Humans ; Iron ; Korea ; Prevalence ; Renal Dialysis*

PURPOSE: It is very important to correct renal anemia by erythropoiesis stimulating agents (ESA) because anemia is associated with poor outcomes in chronic kidney disease (CKD) patients. We investigated whether once-biweekly (Q2W) treatment with epoetin-alpha (EPO-alpha) is as effective as Q2W darbepoetin-alpha (DA-alpha) in CKD patients who are not on dialysis. METHODS: Fifteen CKD patients not receiving dialysis with renal anemia (M:F 6:9, age 60.1+/-7.2 years, eGFR-MDRD 15.7+/-6.4 mL/min/1.73m2, DM 46.7%) were enrolled. All patients received Q2W subcutaneous DA-alpha (40 microgram) for 10 weeks. After 6 weeks of wash-out period, patients were switched to Q2W subcutaneous EPO-alpha (10,000 IU) for 10 weeks. RESULTS: There were no significant differences in baseline parameters, such as hemoglobin (Hb), serum ferritin, and transferrin saturation, between before DA-alpha therapy and before EPO-alpha therapy. Hb levels significantly increased after completion of ESA therapy (DA-alpha, 9.8+/-0.4 vs. 10.4+/-0.6 g/dL, p=0.001; EPO-alpha, 9.6+/-0.7 vs. 10.2+/-0.4 g/dL, p=0.003). After completion of ESA therapy, Hb levels did not reveal significant differences between two groups (p=0.123). Erythropoietin resistance index (8.2+/-1.6 vs. 8.4+/- 1.5 IU/kg weight/g hemoglobin/week, p=0.136) and % increase of Hb (106.7+/-5.5 vs. 106.8+/-6.4%, p=0.776) were not significantly different between DA-alpha therapy and EPO-alpha therapy. There were no significant adverse effects observed during study periods. CONCLUSION: These findings indicate that Q2W high dose (10,000 IU) of EPO-alpha therapy in CKD patients who are not on dialysis may be effective in maintaining Hb levels as Q2W DA-alpha therapy.
Anemia ; Dialysis ; Erythropoietin ; Ferritins ; Hematinics ; Hemoglobins ; Humans ; Kidney Failure, Chronic ; Renal Insufficiency, Chronic ; Transferrin

Anemia and malnutrition are common complications of end-stage renal disease. They increase the morbidity and mortality of end-stage renal disease patients and affect their quality of life. However, the mechanisms of anemia and malnutrition are already known, and their therapeutic guidelines are being established. Appropriate iron supplementation and the development of erythropoiesis-stimulating agents have made anemia easier to manage than in the past. In addition, adequate protein and calorie intake have allowed end-stage renal disease patients to maintain a neutral or positive nitrogen balance. These therapeutic approaches have decreased the morbidity and mortality of these end-stage renal disease patients. This review is a summary of the treatment of anemia and nutrition in end-stage renal disease, based on the Kidney Disease Outcomes Quality Initiative (KDOQI) guideline on anemia and other anemia guidelines, and also on the KDOQI guideline on nutrition and European Best Practice Guideline (EBPG) on nutrition.
Anemia ; Hematinics ; Humans ; Iron ; Kidney Diseases ; Kidney Failure, Chronic ; Malnutrition ; Nitrogen ; Practice Guidelines as Topic ; Protein-Energy Malnutrition ; Quality of Life

A 78-year-old man on hemodialysis presented to our hospital with erythrocytosis. He had started hemodialysis 4 years previously, with a hemoglobin level of 9.8 g/dL, and was administered erythropoiesis stimulating agents and ferrous sulfate. Two years previously, his hemoglobin level increased to 14.5 g/dL and the treatment for anemia was discontinued. He continued hemodialysis thrice weekly; however, the hemoglobin level had increased to 17.0 g/dL at the time of presenting to our hospital. His serum erythropoietin level was 31.4 mIU/mL (range, 3.7-31.5 mIU/mL), carboxyhemoglobin level was 0.6% (range, 0-1.5%), and oxygen saturation in ambient air was 95.4%. The JAK2 V617F mutation was not observed and other bone marrow abnormalities were not identified. The patient was diagnosed with bladder cancer and a transurethral resection was performed. Eight months after the treatment of bladder cancer, his hemoglobin level was 15.1 g/dL, and he was diagnosed with idiopathic erythrocytosis.
Aged ; Anemia ; Bone Marrow ; Carboxyhemoglobin ; Erythropoietin ; Hematinics ; Humans ; Kidney Failure, Chronic ; Oxygen ; Polycythemia* ; Renal Dialysis* ; Urinary Bladder Neoplasms

Hypoxia inducible factor (HIF)-stabilizers are being developed for the renal anemia treatment. This small molecules inhibit prolyl hydroxylase domain (PHD)-containing enzymes, causing HIF activation instead of degradation under the state of normoxia, finally increase production of intrinsic erythropoiesis. Current treatment guidelines suggest that renal anemia should be treated mainly with iron and erythropoiesis stimulating agents (ESAs). But there are several complications and concerns such as hypertension, ESA refractory anemia and increased cardiovascular mortality in using ESAs. Advantages of HIF stabilizers over ESAs are orally available, no dose-up requirement for inflammation. So far new HIF stabilizers showed efficacy and safety in renal anemia treatment. This new therapeutic agent may emerge as a standard treatment option for renal anmia treatment.
Anemia ; Anemia, Refractory ; Anoxia ; Erythropoiesis ; Hematinics ; Hepcidins ; Humans ; Hypertension ; Inflammation ; Iron ; Mortality ; Prolyl Hydroxylases ; Renal Insufficiency, Chronic

OBJECTIVETo investigate the mechanism of Zishen Shengxue Recipe (ZSR) in treating renal anemia by observing its effect on serum level of endogenous erythropoietin in patients undergoing long-term hemodialysis.

METHODSSixty renal anemia patients undergoing long-term hemodialysis were randomly and equally assigned to two groups. The treated group was treated with subcutaneous injection of erythropoiesis stimulating factor (rHuEpo) combined with oral intake of ZSR, and the control group treated with rHuEpo alone. They were observed for eight weeks, and the blood levels of endogenous human erythropoietin (Epo), hemoglobin (Hgb), hematocrit (Hct), as well as the residual renal function (RRF) in the two groups were compared.

RESULTSSerum Epo level in the control group was unchanged after treatment (P>0.05), while that in the treated group increased significantly, and showed significant difference in comparing with that in the control group (P<0.05). Levels of Hgb and Hct increased and RRF decreased in both groups (P<0.01), but the treated group showed higher increments and lesser decrement than those in the control group (P<0.05).

CONCLUSIONSZSR can enhance the blood levels of Hgb, Hct and Epo, postpone the descent of RRF, and correct the anemic status in patients. Its mechanism of action is possibly through alleviating the inhibition of uremic toxin on erythropoiesis, in the meanwhile of promoting the secretion of Epo.

Adult ; Anemia ; blood ; therapy ; Drugs, Chinese Herbal ; therapeutic use ; Erythropoiesis ; drug effects ; Erythropoietin ; blood ; Female ; Hematinics ; therapeutic use ; Hematocrit ; Hemoglobins ; analysis ; Humans ; Male ; Middle Aged ; Renal Dialysis