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Your search term(s) "anemia and kidney and dialysis" returned 17 results.

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Adequacy of Dialysis and Differences in Hematocrit Among Dialysis Facilities. American Journal of Kidney Diseases. 36(6): 1166-1174. December 2000.

Despite the clearly established relationship between adequacy of dialysis and response to erythropoietin, recent guidelines on anemia management in end stage renal disease (ESRD) omit mention of dialysis adequacy while advocating the use of large amounts of intravenous iron. This article reports on a study undertaken to determine the relative effects of adequacy of dialysis and intravenous iron on hematocrit (levels of oxygen carrying blood components, lower levels indicate anemia). The authors studied 309 hemodialysis patients and analyzed data from 141 hemodialysis facilities in New York state (ESRD Network 2), as well as data from all 18 ESRD Networks in the United States, for the last quarter of 1997. Among the 309 subjects, mean hematocrit differed between quartiles of urea reduction ratio (URR, a measure used to indicate adequacy of dialysis). Patients with URRs greater than 70 percent were 2.6 times more likely to have hematocrits greater than 33 percent, after adjustment for other factors. Mean dialysis facility hematocrits correlated directly with mean URRs. Facilities with a mean URR greater than 70 percent were three times more likely to have a mean hematocrit greater than 33 percent. The percentage of patients in each of the 18 ESRD Networks with hematocrits of 33 percent or greater correlated inversely with the percentage of patients administered intravenous iron, after adjustment for dose of erythropoietin. The authors conclude that adequacy of dialysis predicts the response to erythropoietin at both patient and dialysis facility levels. Patients with low hematocrits primarily because of inadequate dialysis may inappropriately be administered excess intravenous iron intended as a corrective measure. 2 figures. 5 tables. 48 references.

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Current Concepts of Anemia Management in Chronic Renal Failure: Impact of NKF-DOQI. Seminars in Nephrology. 20(4): 320-329. July 2000.

Since the introduction of recombinant human erythropoietin (rHuEPO) into clinical nephrology practice 10 years ago, there has been a slow increase in hemoglobin (Hgb) levels. However, most patients with the anemia of chronic renal (kidney) failure (CRF) are still moderately anemic and have not achieved the target Hgb (11 to 12 grams per dL) recommended by the National Kidney Foundation Dialysis Outcomes Quality Initiative (NKF DOQI) anemia guidelines. This article reviews current concepts for anemia management in patients with CRF. The author notes that functional iron deficiency, insufficient rHuEPO doses, and comorbid factors such as inflammation or infection have been the major reasons for not achieving this target. By optimizing iron stores with regular infusions of intravenous iron in the hemodialysis patient (who has significant blood iron losses related to the hemodialysis procedure) and giving adequate amounts of rHuEPO, preferably subcutaneously instead of intravenously, the NKF DOQI recommended target Hgb can be achieved in the majority of patients so treated. The author comments that the role of 'underdialysis' (dialysis inadequacy) as a cause of less than optimal responsiveness to rHuEPO remains controversial. Other unresolved issues include the role of ACE inhibitors and carnitine in the management of patients using rHuEPO. Periodic monitoring of Hgb (e.g., every 2 to 4 weeks) and of iron parameters (e.g., every 3 months) is essential to optimize anemia management. 2 figures. 2 tables. 47 references.

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Impact of Anemia Correction on Cardiovascular Disease in End-Stage Renal Disease. Seminars in Nephrology. 20(4): 350-355. July 2000.

Cardiovascular disease (CVD) is a major cause of mortality and morbidity in patients with end stage renal disease (ESRD). This article explores the impact of anemia correction on CVD in patients with ESRD. Anemia, a result of erythropoietin deficiency, is associated with increased all cause and cardiovascular mortality in this population, and predisposes patients to the development of symptomatic heart disease. Anemia is also associated with the development and progression of left ventricular echocardiographic disorders, which strongly predict cardiac failure and death. Left ventricular dilatation with compensatory hypertrophy, the major pattern of echocardiographic disease progression in hemodialysis patients, is a particularly strong predictor of late mortality. Partial correction of anemia with recombinant human erythropoietin likely reduces left ventricular mass and volume. Complete correction of anemia may prevent progressive left ventricular dilatation in patients with normal left ventricular volumes. A recent trial, however, reports excess mortality and vascular access loss in patients with preexisting symptomatic heart disease when anemia was completely corrected. Consequently, hematocrit (red blood cells) target ranges above 32 to 36 percent cannot be recommended in this population. Despite improvements seen in echocardiographic disease in patients without symptomatic heart disease, it is not yet possible to conclude that potential benefits derived from a normalized hematocrit will outweigh potential risks in this subgroup of dialysis patients. 1 figure. 5 tables. 34 references.

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Impact of Hematocrit on Morbidity and Mortality. Seminars in Nephrology. 20(4): 345-349. July 2000.

In the 10 years since epoetin alpha (human recombinant erythropoietin, rHuEPO) was approved by the FDA for use in patients with end stage renal disease (ESRD), clinical studies have shown a relationship between the correction of anemia and improved cardiac function, cognitive ability, sexual function, and exercise capacity. This article reviews studies of the impact of hematocrit (a measure of red blood cells) level on morbidity and mortality. Recent large epidemiological studies have shown that mortality and morbidity are reduced when the hematocrit (Hct) level is in the range 33 to 36 percent. The National Kidney Foundation's Dialysis Outcomes Quality Initiative (NKF DOQI) guidelines recommend a target Hct of 33 to 36 percent to enhance patient outcomes. The most recent mortality studies who that Hcts less than 30 percent are associated with an 18 percent to 40 percent increased associated risk of death and hospitalizations. Higher Hcts in the 33 to 36 percent range appear to be associated with a 7 percent reduced risk of death and hospitalizations compared with patients with Hcts of 30 percent to less than 33 percent. Patients with sustained Hcts of 33 to 36 percent over 1 year appear to have the best outcome compared with patients with Hcts that fall. These studies suggest that the factors that may influence patients' ability to move into higher Hct ranges need to be determined to enhance patient outcomes. Dramatic improvement in hemodialysis patient Hct levels has occurred since 1989. Mortality and hospitalization studies support the NKF DOQI target Hct range of 33 to 36 percent as providing the best associated outcomes. 25 references.

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Lessons from NKF-DOQI: Iron Management. Seminars in Nephrology. 20(4): 330-334. July 2000.

The introduction of rHuEPO (recombinant human erythropoietin) throughout the United States in 1989 dramatically changed the spectrum of iron disorders in patients with dialysis associated anemia. RHuEPO exposed a propensity for negative iron balance among hemodialysis patients by dramatically curtailing red cell transfusions. This article reviews the current thinking on iron management in these patients, focusing on guidelines from the National Kidney Foundation Dialysis Outcomes Quality Initiative (NKF DOQI) Anemia Work Group. These guidelines acknowledge that iron is prescribed to patients with chronic renal (kidney) failure (CRF) not merely to correct iron depletion, which is harmless and asymptomatic, but to forestall iron deficiency erythropoiesis, a hematologic (blood) consequence that is potentially both deleterious and expensive. The author discusses the need to define iron efficacy, the use of oral iron, iron safety, optimum body iron status, the use of the iron dextran test dose, and future challenges. The author calls for further research on the clinical utility of test doses before intravenous (IV) iron administration, the comparative efficacy and safety of maintenance compared with period iron treatment, and the relationship between IV iron administration, body iron status, and risk of infection, heart disease, and death. More information is also needed on iron management in nonhemodialysis CRF patient groups, particularly pediatric patients, peritoneal dialysis patients, and predialysis patients. 1 table. 27 references.

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NKF-DOQI Clinical Practice Guidelines: A Guide for Dialysis Patients In Interpreting the NKF-DOQI Clinical Practice Guidelines. For Patients Only. 13(3): 22-24. May-June 2000.

In late 1997, the National Kidney Foundation (NKF) released the Dialysis Outcomes Quality Initiative (DOQI) Clinical Practice Guidelines (CPGs) to help improve outcomes and reduce complications and deaths among dialysis patients. This article offers a guide for dialysis patients in interpreting these NKF DOQI guidelines. The author briefly reviews the process that was used in establishing the guidelines and then discusses some of the opinion based CPGs about which dialysis patients should inform themselves. Guidelines are discussed in the areas of hemodialysis adequacy, peritoneal dialysis adequacy, vascular access (VA), treatment of anemia, and nutrition. Guidelines include the need to routinely measure and monitor the delivered dose of dialysis, to measure blood urea nitrogen (BUN), to assess the nutritional status of both adult and pediatric patients, to strive to achieve a hematocrit level of 33 to 36 percent, to preserve any veins in the arm that may be needed for VA, to use erythropoietin (EPO) therapy appropriately, to monitor response to EPO therapy, to monitor blood pressure levels regularly, and to insure adequate protein and energy intake. The author concludes by encouraging readers to learn about the guidelines and participate actively in their own health care.

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Trends in Erythropoietin Therapy in the U.S. Dialysis Population: 1995-1998. Seminars in Nephrology. 20(4): 335-344. July 2000.

Anemia is an important cause of morbidity, and may be associated with increased mortality in patients with end stage renal disease (ESRD) receiving dialysis. Therapy with recombinant human erythropoietin (rHuEPO) has revolutionized the care of ESRD patients, but this is a costly medication and concerns have been expressed about whether the outcome, as measured by achieved hematocrit (Hct), could be improved. This article reviews trends in erythropoietin therapy in the United States dialysis population from 1995 to 1998. The number and proportion of ESRD patients receiving rHuEPO increased steadily from 1995 to 1998, as did the dose of rHuEPO per patient. The amount of intravenous iron administered to patients increased markedly over the study period. The increase in both the amounts of payments per patient for rHuEPO and the number of patients receiving rHuEPO over this time has resulted in a marked increase in the total costs to Medicare for this therapy. The authors suggest that a combination of payment regulations, provider financial opportunities and disincentives, and patient resistance to the effects of rHuEPO, as a result of both iron deficiency and inflammation, largely explain the findings. 6 figures. 18 references.

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