Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0002871 (anemia)
 52,094 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The availability of erythropoiesis-stimulating agents (ESAs) has revolutionized the treatment of anaemia in patients with chronic kidney disease. However, maintaining patients at haemoglobin (Hb) levels that are both safe and provide maximal benefit is a continuing challenge in the field. Based on emerging data on the potential risks of Hb treatment targets >13 g/dL, treatment targets have recently been lowered. In the latest revision (March 2008) of the European product labelling for the ESA class of drugs, the target treatment range was lowered to 10-12 g/dL. Fluctuation of Hb levels or 'Hb variability' during treatment with ESAs is a well-documented phenomenon. Hb levels that are either too high or too low may have an adverse effect on patient outcomes; thus, it is important to understand the causes of Hb variability in order to achieve optimal treatment. Several factors are believed to contribute to variation in the Hb level, including patient comorbidities and intercurrent events. Inflammation is also an important factor associated with Hb variability, and the consequences of persistent inflammatory activity are far-reaching in affected patients. This review addresses the complex role of inflammation in chronic kidney disease, as evidenced by the apparent state of deranged inflammatory markers. The mechanisms by which inflammatory cytokines may affect the response to ESAs, the development of anaemia and poor treatment outcomes are also examined. In addition, various options for intervention to enhance the response to ESAs in haemodialysis patients with inflammation are considered.
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PMID:Inflammation and its impact on anaemia in chronic kidney disease: from haemoglobin variability to hyporesponsiveness. 1946 56

Chronic kidney disease (CKD) is efined as a reduction in estimated glomerular filtration rate (eGFR) for three consecutive months, or evidence of kidney damage alone with preserved renal function. CKD affects 8.5% of the UK population. Early recognition allows intervention that may delay or avoid progression to end-stage disease and modify the cardiovascular risk associated with CKD. CKD is classified into five stages and the majority of individuals have stages 1-3, many of these will never progress to end-stage renal disease. A decline in with age is expected. The most frequent specific renal diseases resulting in progressive CKD in the UK are: diabetes mellitus, atheromatous renal vascular disease, glomerulonephritis, chronic pyelonephritis and inherited renal disease. Laboratories in the UK now routinely provide an eGFR with a serum creatinine value in all adult patients. This estimation is based on serum creatinine, age, gender, and ethnicity. Baseline assessment in a patient with newly diagnosed CKD should include: blood pressure, dipstick urinalysis, urine ACR or PCR, glucose, lipid profile and a full blood count. Fluctuation in renal function is common, particularly in elderly patients with CKD. A fall in eGFR can result from any intercurrent illness, medication, or volume depletion. Proteinuria is a very important prognostic marker in CKD, ACR is the preferred measure as it has greater sensitivity for lower levels of proteinuria and is the recommended method in those with diabetes. The potential health problems associated with CKD can be divided into two main categories: risk of progressive renal disease with the development of renal bone disease and renal anaemia, and risk of overt cardiovascular disease.
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PMID:Early recognition of CKD can delay progression. 2357 15

Background: Anaemia in pregnancy is typically due to iron deficiency (IDA) but remains a complex and pervasive problem, particularly in low resource settings. At clinics on the Myanmar-Thailand border, a protocol was developed to guide treatment by health workers in antenatal care (ANC). Objective: To evaluate the clinical use of a protocol to treat anaemia in pregnancy. Methods: The design was a descriptive retrospective analysis of antenatal data obtained during the use of a standard anaemia treatment protocol. Two consecutive haematocrits (HCT) <30% prompted a change from routine prophylaxis to treatment doses of haematinics. Endpoints were anaemia at delivery (most recent HCT before delivery <30%) and timeliness of treatment initiation. Women whose HCT failed to respond to the treatment were investigated. Results: From August 2007 to July 2012, a median [IQR] of five [4-11] HCT measurements per woman resulted in the treatment of anaemia in 20.7% (2,246/10,886) of pregnancies. Anaemia at delivery was present in 22.8% (511/2,246) of treated women and 1.4% (123/8,640) who remained on prophylaxis. Human error resulted in a failure to start treatment in 97 anaemic women (4.1%, denominator 2,343 (2,246 + 97)). Fluctuation of HCT around the cut-point of 30% was the major problem with the protocol accounting for half of the cases where treatment was delayed greater than 4 weeks. Delay in treatment was associated with a 1.5 fold higher odds of anaemia at delivery (95% CI 1.18, 1.97). Conclusion: There was high compliance to the protocol by the health workers. An important outcome of this evaluation was that the clinical definition of anaemia was changed to diminish missed opportunities for initiating treatment. Reduction of anaemia in pregnancy requires early ANC attendance, prompt treatment at the first HCT <30%, and support for health workers.
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PMID:Evaluation of a treatment protocol for anaemia in pregnancy nested in routine antenatal care in a limited-resource setting. 3120 91