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

OBJECTIVETo evaluate the efficacy and safety of iron protein succinylate (IPS) oral solution in preventing and treating anemia of prematurity (AOP).

METHODSSixty premature infants less than 35 weeks of gestation were randomly divided into IPS (n=30) and polysaccharide iron complex (PIC) groups(n=30). Treatment began at two weeks after birth. The infants received IPS or PIC in addition to recombinant human erythropoietin. On days 14, 28, 42, and 60 after treatment, hemoglobin (Hb), red blood cell count(RBC), hematocrit (HCT), percentage of reticulocytes, serum iron, and serum ferritin were determined. Liver and renal functions were evaluated before and after treatment.

RESULTSThere were significant differences in the changing trends of RBC and HCT between the two groups (P<0.05). In the IPS group, RBC and HCT gradually decreased after birth, but began to rise gradually on days 28 and 42 of treatment; in the PIC group, RBC and HCT kept decreasing from birth to day 60 of treatment. On day 60 of treatment, the IPS group had significantly higher levels of Hb, RBC, HCT, serum iron, and serum ferritin than the PIC group (P<0.05). No notable adverse events occurred in either group.

CONCLUSIONSIPS oral solution has good efficacy and tolerability in preventing and treating AOP.

Administration, Oral ; Anemia, Neonatal ; blood ; drug therapy ; prevention & control ; Erythrocyte Count ; Female ; Hematinics ; therapeutic use ; Hematocrit ; Humans ; Infant, Premature ; Iron ; metabolism ; Male ; Metalloproteins ; adverse effects ; therapeutic use ; Solutions ; Succinates ; adverse effects ; therapeutic use

Anti-erythropoietin antibodies usually cross-react with all kinds of recombinant erythropoietins; therefore, erythropoiesis-stimulating agent (ESA)-induced pure red-cell aplasia (PRCA) is not rescued by different ESAs. Here, we present a case of ESA-induced PRCA in a 36-yr-old woman with chronic kidney disease, whose anemic condition improved following reintroduction of darbepoetin-alpha. The patient developed progressive, severe anemia after the use of erythropoietin-alpha. As the anemia did not improve after the administration of either other erythropoietin-alpha products or erythropoietin-beta, all ESAs were discontinued. Oxymetholone therapy failed to improve the transfusion-dependent anemia and a rechallenge with ESAs continuously failed to obtain a sustained response. However, her anemia improved following reintroduction of darbepoetin-alpha at 3 yr after the initial diagnosis. Interestingly, anti-erythropoietin antibodies were still detectable, although their concentration was too low for titration. In conclusion, darbepoetin-alpha can improve ESA-induced PRCA when the anti-erythropoietin antibody titer declines and its neutralizing capacity is lost.
Adult ; Anemia/drug therapy/etiology ; Antibodies/*blood/immunology ; Bone Marrow Cells/pathology ; Drug Hypersensitivity/immunology ; Erythropoietin/*analogs & derivatives/therapeutic use ; Erythropoietin, Recombinant/adverse effects/*immunology/therapeutic use ; Female ; Glomerulonephritis, IGA/complications ; Hematinics/adverse effects/immunology/*therapeutic use ; Humans ; Kidney Failure, Chronic/complications ; Oxymetholone/therapeutic use ; Red-Cell Aplasia, Pure/chemically induced/*drug therapy/immunology

Previous studies reported the beneficial effect of erythropoietin (EPO) in acute injuries. We followed patients with and without acute kidney injury (AKI) after coronary artery bypass grafting (CABG) and evaluated the effect of EPO on long-term outcome. We also assessed the efficacy of urinary neutrophil gelatinase-associated lipocalin (uNGAL) as a predictive marker of AKI. Seventy-one patients scheduled for elective CABG were randomly given either 300 U/kg of EPO or saline before CABG. The primary outcome was AKI, and the secondary outcome was the all-cause-mortality and composite of all-cause-mortality and end stage renal disease (ESRD). Twenty-one patients had AKI, 14 (66.7%) in the placebo group and 7 (33.3%) in the EPO group (P = 0.05). Also, uNGAL was higher in the patients with AKI than in those without AKI at baseline, 2, 4, 24, and 72 hr after CABG (P = 0.011). Among patients with AKI, 2-week creatinine (Cr) was not different from baseline Cr in the EPO group, but 2-week Cr was significantly higher than baseline Cr in the placebo group (P = 0.009). All-cause-mortality (P = 0.022) and the composite of all-cause-mortality and ESRD (P = 0.003) were reduced by EPO. EPO reduces all-cause-mortality and ESRD in patients with AKI, largely due to the beneficial effect of EPO on recovery after AKI.
Acute Kidney Injury/etiology/mortality/*prevention & control ; Acute-Phase Proteins/urine ; Aged ; Aged, 80 and over ; Biological Markers/urine ; Coronary Artery Bypass/*adverse effects ; Creatinine/analysis ; Double-Blind Method ; Erythropoietin/*therapeutic use ; Female ; Hematinics/*therapeutic use ; Humans ; Kaplan-Meier Estimate ; Lipocalins/urine ; Male ; Middle Aged ; Placebo Effect ; Prospective Studies ; Proto-Oncogene Proteins/urine ; ROC Curve ; Recombinant Proteins/therapeutic use ; Risk Factors ; Treatment Outcome

Child ; Folic Acid ; administration & dosage ; therapeutic use ; Folic Acid Antagonists ; adverse effects ; Hematinics ; administration & dosage ; therapeutic use ; Humans ; Hypesthesia ; chemically induced ; drug therapy ; Injections, Spinal ; Leukoencephalopathies ; chemically induced ; Male ; Methotrexate ; adverse effects ; Quadriplegia ; chemically induced ; drug therapy ; Time Factors ; Vitamin B Complex ; administration & dosage ; therapeutic use

The number of patients with end-stage renal disease (ESRD) is rising very rapidly as the number of elderly and patients with diabetes increases in Korea. ESRD Registry Committee of the Korean Society of Nephrology (KSN) collected dialysis therapy data in Korea through an online registry program on the KSN website. The status of renal replacement therapy in Korea at the end of 2009 was as follows. First, total number of patients with ESRD was 56,396 (hemodialysis [HD], 37,391; peritoneal dialysis [PD], 7,618; functioning kidney transplant [KT], 11,387). The prevalence of ESRD was 1,113.6 patients per million population (PMP). Proportion of patients undergoing renal replacement therapy was 66.3% with HD, 13.5% with PD, and 20.2% with KT. Second, a total of 8,906 (HD, 6,540; PD, 1,125; KT, 1,241; incidence rate of 175.9 PMP) patients developed ESRD in 2009. Third, the most common primary causes of ESRD were diabetic nephropathy (45.4%), hypertensive nephrosclerosis (18.3%), and chronic glomerulonephritis (11.1%). Fourth, mean urea reduction rate was 67.5% and 73.8% in male and female patients, respectively, undergoing HD. Mean Kt/V was 1.38 in male patients and 1.65 in female patients. Fifth, the overall 5-year survival rate of male patients undergoing dialysis was 65.4% and that of female patients was 67.4%.
Adult ; Aged ; Anemia/drug therapy/etiology ; Comorbidity ; Erythropoietin, Recombinant/therapeutic use ; Female ; Hematinics/therapeutic use ; Humans ; Incidence ; Kidney Failure, Chronic/mortality/*therapy ; Male ; Middle Aged ; Prevalence ; Registries ; *Renal Dialysis/adverse effects/mortality ; Republic of Korea/epidemiology ; Risk Factors ; Survival Rate ; Time Factors ; Treatment Outcome

BACKGROUND/AIMS: There are few data on the effects of low hemoglobin levels on the left ventricle (LV) in patients without heart disease. The objective of this study was to document changes in the echocardiographic variables of LV structure and function after the correction of anemia without significant cardiovascular disease. METHODS: In total, 34 iron-deficiency anemia patients (35 +/- 11 years old, 32 females) without traditional cardiovascular risk factors or cardiovascular disease and 34 age- and gender-matched controls were studied. Assessments included history, physical examination, and echocardiography. Of the 34 patients with anemia enrolled, 20 were followed and underwent echocardiography after correction of the anemia. RESULTS: There were significant differences between the anemia and control groups in LV diameter, left ventricular mass index (LVMI), left atrial volume index (LAVI), peak mitral early diastolic (E) velocity, peak mitral late diastolic (A) velocity, E/A ratio, the ratio of mitral to mitral annular early diastolic velocity (E/E'), stroke volume, and cardiac index. Twenty patients underwent follow-up echocardiography after treatment of anemia. The follow-up results showed significant decreases in the LV end-diastolic and end-systolic diameters and LVMI, compared with baseline levels. LAVI, E velocity, and E/E' also decreased, suggesting a decrease in LV filling pressure. CONCLUSIONS: Low hemoglobin level was associated with larger cardiac chambers, increased LV, mass and higher LV filling pressure even in the subjects without cardiovascular risk factors or overt cardiovascular disease. Appropriate correction of anemia decreased LV mass, LA volume, and E/E'.
Adult ; Anemia, Iron-Deficiency/blood/diagnosis/*drug therapy/physiopathology ; Biological Markers/metabolism ; Case-Control Studies ; Echocardiography, Doppler ; Female ; Heart Ventricles/*physiopathology/ultrasonography ; Hematinics/*therapeutic use ; Hemoglobins/metabolism ; Humans ; Male ; Middle Aged ; Prospective Studies ; Recovery of Function ; Time Factors ; Treatment Outcome ; *Ventricular Function, Left ; *Ventricular Pressure ; *Ventricular Remodeling ; Young Adult

Anemia is common in patients with advanced chronic kidney disease (CKD). Though erythropoiesis-stimulating agents (ESAs) have been strongly endorsed in guidelines, it is of particular financial interest. Recently, the reimbursement of ESAs in non-dialytic patients was started by the Korean National Health Insurance System. Thus, we investigated the impact of the reimbursement of ESAs on the anemia care in non-dialytic CKD patients. Medical records of patients with advanced CKD (estimated GFR <30 mL/min/1.73 m2) were reviewed. Use of ESAs, blood transfusion, and hemoglobin concentrations were analyzed from one year prior to reimbursement to three years following. We used multivariable modified Poisson regression to estimate the utilization prevalence ratio (PRs). A total of 1,791 medical records were analyzed. The proportion of patients receiving ESAs increased from 14.8% before reimbursement to a peak 33.6% in 1 yr after reimbursement; thereafter, ESA use decreased to 22.4% in 3 yr after reimbursement (compared with baseline; PR, 2.19 [95% CI, 1.40-3.42]). In patients with Hb <10 g/dL, the proportion of receiving ESAs increased from 32.1% before reimbursement to 66.7% in 3 yr after reimbursement (compared with baseline; PR, 2.04 [95% CI, 1.25-3.32]). Mean hemoglobin concentrations were 10.06±1.54 g/dL before reimbursement and increased to 10.78±1.51 g/dL in 3 yr after the reimbursement change (P=0.001). However, the requirement of blood transfusion was not changed over time. With the reimbursement of ESAs, the advanced CKD patients were more likely to be treated with ESAs, and the hemoglobin concentrations increased.
Adolescent ; Adult ; Aged ; Anemia/complications/*drug therapy/epidemiology ; Blood Transfusion ; Female ; Glomerular Filtration Rate ; Hematinics/*therapeutic use ; Hematocrit ; Hemoglobins/analysis ; Humans ; Male ; Middle Aged ; National Health Programs ; Poisson Distribution ; Prevalence ; Renal Insufficiency, Chronic/complications/*drug therapy/epidemiology ; Republic of Korea/epidemiology ; Retrospective Studies ; Young Adult