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Query: UMLS:C0002871 (anemia)
 52,094 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

As the use of Epoetin alfa to treat the anemia of chronic renal failure (CRF) expands, nurses play an ever-increasing role in patient monitoring and control. One area that relies heavily on nurses is blood pressure monitoring. Clinical trials with Epoetin alfa in hemodialysis patients indicate that its use may be associated with the onset or aggravation of elevated blood pressure as the hematocrit level increases. Because high blood pressure is a risk factor for left ventricular hypertrophy and cardiovascular mortality in this patient population, use of an agent that may cause high blood pressure requires careful monitoring. As the following two cases reports illustrate, sufficient data to provide better insight into the clinical aspects of this potential problem have now been accumulated.
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PMID:Case management of the anemic patient. Focus on blood pressure and rHuEPO therapy. 231 7

Epoetin alfa (recombinant human erythropoietin) effectively diminishes the anemia associated with end-stage renal disease (ESRD). Although many clinical manifestations of ESRD have been attributed to uremic toxins, the ability of epoetin alfa therapy to improve several of these conditions, such as diminished energy levels, appetite, cold tolerance, sexual function, and cognitive abilities, suggests that anemia may be an important factor in uremia-associated symptoms. Correction of this anemia results in improvements in the patient's quality of life. These improvements can be measured by objective criteria such as exercise tolerance tests, or by subjective standards such as patient response to questionnaires. In studies to date, both subjective and objective data show that epoetin alfa therapy significantly improves the quality of life of patients with ESRD.
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PMID:Perspectives on the improvement of quality of life with epoetin alfa therapy. 234 8

The emergence of the Epoetin alfa as an effective therapy in the treatment of the anemia of chronic renal failure has reemphasized the importance of nursing monitoring and intervention in the treatment of these patients. This article examines the role of nurses in monitoring and managing patients receiving Epoetin alfa and the development of medications, such as Epoetin alfa, with recombinant DNA technology.
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PMID:Epoetin alfa: patient management issues and development through recombinant DNA technology. Part 1: Focus on Epoetin alfa patient management and recombinant DNA technology. 239 57

The characteristics and uses of epoetin alfa (recombinant human erythropoietin) are described, and the issues associated with its use are discussed. The use of epoetin alfa was recently approved by FDA for the treatment of anemia associated with end-stage renal disease. Epoetin alfa acts on burst-forming and colony-stimulating units in the blood to raise hemoglobin and hematocrit levels, thus correcting the patient's anemia. It has a relatively short half-life and may be given either i.v. or s.c. Doses vary and must be adjusted according to the individual patient response. Clinical trials have involved doses ranging from 15 to 500 units/kg three times per week. Treatment causes a dose-related rise in the hematocrit, with subsequent improvement in the quality of life of dialysis patients. Adverse effects include hypertension, iron deficiency, and thrombocytosis. Additional research indicates that epoetin alfa may be effective in the correction of other uncomplicated anemias, such as those related to antineoplastic therapy. Issues facing hospital pharmacists and other health-care professionals include cost (the estimated cost of therapy is $4000 to $8000 per patient per year), appropriate use and potential misuse, use and reimbursement for indications not included in FDA-approved labeling, and restriction to particular prescribers. Because epoetin alfa does not produce therapeutic effects for at least 7 to 14 days, it is an ideal agent for formulary restriction. Epoetin alfa, like other products of biotechnology, will have substantial impact, both therapeutic and economic, on the practice of pharmacy. Hospital pharmacists need to be aware of these new therapies so that they may act quickly and decisively when issues associated with their use arise.
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PMID:Recombinant human erythropoietin. 269 Jun 6

Epoetin alfa is a recombinant form of erythropoietin, a glycoprotein hormone which stimulates red blood cell production by stimulating the activity of erythroid progenitor cells. This review discusses the use of the drug in the management of anaemia in diseases often associated with advancing age [renal failure, cancer, rheumatoid arthritis (RA) and other chronic diseases, and the myelodysplastic syndromes (MDS)] and in surgical patients. Intravenous and subcutaneous therapy with epoetin alfa raises haematocrit and haemoglobin levels, and reduces transfusion requirements, in anaemic patients with end-stage renal failure undergoing haemodialysis or peritoneal dialysis. The drug is also effective in the correction of anaemia in patients with chronic renal failure not yet requiring dialysis and does not appear to affect renal haemodynamics adversely or to precipitate the onset of end-stage renal failure. Response rates of 32 to 82% with epoetin alfa therapy have been reported in patients with anaemia associated with cancer or cytotoxic chemotherapy. Limited data in patients with anaemia associated with RA show correction of anaemia after epoetin alfa treatment. Response rates to the drug of 0 to 56% have been noted in patients with MDS. Epoetin alfa also reduces anaemia, increases the capacity for autologous blood donation and reduces the need for allogeneic blood transfusion in patients scheduled to undergo surgery. Hypertension occurs in 30 to 35% of patients with end-stage renal failure who receive epoetin alfa, but this can be managed successfully with correction of fluid status and antihypertensive medication where necessary, and is minimised by avoiding rapid increases in haematocrit. Although vascular access thrombosis has not been conclusively linked to therapy with the drug, increased heparinisation may be required when it is administered to patients on haemodialysis. Epoetin alfa does not appear to exert any direct cerebrovascular adverse effects. Thus, epoetin alfa is a well established and effective therapy for the management of anaemia associated with renal failure. It also improves haematocrit and quality of life in patients with anaemia associated with cancer or chemotherapy. Epoetin alfa increases the capacity for blood donation and reduces the decrease in haematocrit seen in patients donating autologous blood prior to surgery. It also reduces, but may not eliminate, the need for allogeneic blood transfusion.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Epoetin alfa. A review of its clinical efficacy in the management of anaemia associated with renal failure and chronic disease and its use in surgical patients. 757 84

Recombinant human erythropoietin (epoetin) therapy had a significant impact on the practice of nephrology before its widespread use in the dialysis arena. Since then, a number of long-term studies have provided physicians with parameters for optimizing therapeutic response and patient outcomes with epoetin therapy. Fears of accelerated hypertension syndromes or increased fistula clotting are recognized as largely unfounded. There is a marked improvement in well-being, as measured by both subjective and objective parameters, as the level of anemia is reduced. Fortunately, epoetin was recognized early as essential therapy in patients on dialysis and thus was reimbursed by the Health Care Financing Administration (HCFA) and other payers, albeit through various methods of payment. Why is it, then, that hematocrit levels are still averaging approximately 30%? Perhaps the basic concern that all practitioners share is the potential for increased morbidity at "higher" hematocrit levels. Increased access clotting was not reported in the recently completed Epogen (Epoetin alfa; Amgen Inc, Thousand Oaks, CA) phase IV postmarketing study. Needle size, however, needs to be considered, because higher blood flow rates accompanied by higher hematocrit levels may lead to increased hemolysis. The venous needle size is especially important in patients who experience large weight gains. It is important to keep these issues in mind as one decides on an appropriate hematocrit level for a given patient. Hull and Eschbach reviewed postdialysis data from patients with naturally occurring high hematocrit levels and found no major changes in hematocrit level, thus alleviating the concern of significant postdialysis inspissation as a common cause for fistula clotting.
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PMID:Adapting the dialysis unit to increased hematocrit levels. 770 70

Epoetin alfa is a recombinant form of the principal hormone responsible for erythrogenesis, erythropoietin. Already an established treatment for anaemia associated with renal failure, epoetin alfa may also be used to correct anaemia in other patient groups. The drug increases the capacity for autologous blood donation in patients scheduled to undergo surgery and attenuates the decrease in haematocrit often seen in untreated autologous donors. However, transfusion requirements did not significantly decrease in many trials. Epoetin alfa also accelerates red blood cell recovery after allogeneic--but not autologous--bone marrow transplant. Limited data in patients with adult rheumatoid arthritis suggest that while epoetin alfa increases haematocrit/haemoglobin levels, overall clinical rheumatological status may not improve. However, the drug did improve quality of life in a small cohort of children with juvenile rheumatoid arthritis in addition to correcting anaemia. Response rates to treatment with epoetin alfa in patients with anaemia associated with cancer range between 32 and 85%. Anaemia associated with cancer chemotherapy also responds well to treatment with the drug as does anaemia associated with zidovudine therapy in patients with acquired immune deficiency syndrome (AIDS). Studies evaluating the use of epoetin alfa as treatment for anaemia of prematurity have used different methodologies and dosages, making overall analysis difficult. Nevertheless, it appears that high dosages are necessary for response. Results from 1 study suggest that treatment with epoetin alfa appears to be more costly than transfusional support in this application; the relevance of this finding is questionable, however, given that the aim of treatment with epoetin alfa is elimination of transfusion requirements. The incidence of many adverse events associated with epoetin alfa treatment in patients with renal failure (hypertension, seizures and thromboembolic events) has been minimal in patients without renal failure. Adverse events occurred at a similar rate in placebo and epoetin alfa recipients in placebo-controlled trials evaluating the use of the drug as treatment for anaemia in patients with cancer receiving chemotherapy or patients with AIDS receiving zidovudine. In summary, epoetin alfa is an effective alternative to blood transfusion, reducing anaemia and producing consequent improvements in quality of life in many nonrenal applications. It was more effective than placebo in a number of double-blind trials and may be particularly useful as treatment for anaemia associated with other drugs such as cisplatin and zidovudine.
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PMID:Epoetin alfa. A review of its pharmacodynamic and pharmacokinetic properties and therapeutic use in nonrenal applications. 772 31

Multiple factors, including chronic anemia, can impair left ventricular function and lead to serious or fatal consequences. Correcting anemia with Epoetin alfa is an important step in improving compromised left ventricular function. Continuous management of fluid status, blood pressure, and hematocrit is the best way for nephrology nurses to help patients improve their cardiac function and quality of life.
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PMID:Case study of the anemic patient: epoetin alfa--focus on improving ventricular function. 778 83

Patients with chronic renal failure (c.r.f.) are at high risks of death from cardiovascular diseases. It was found that successful treatment of anemia could positively influence not only patients well being but also caused some unfavourable hemodynamic changes. The aim of the study was the estimation of some morphological and functional parameters of left ventricle (lv) in dialyzed and predialyzed patients treated with r-Epo. Two groups of patients with c.r.f. were studied. The I group of 10 dialyzed patients (6 W, 4 M, mean age 34 +/- 11, weight 55 +/- 9 kg), and the II group of 9 pre-dialyzed patients (6 W, 3 M, mean age 50.6 +/- 10, weight 63 +/- 14 kg). r-Epo (Eprex Cilag AG) was administered during 6 months s.c. The I group was given initial dose 3 x 2000 u per week (mean dose 24-46 u/kg b.w./per week, the II was on 3 x 2000 u per week (mean dose 24-46 u/kg b.w./per week) subcutaneously. The doses were adjusted by Hb level in order to keep it within limits (10-12 g/dl). Hematological parameters were monitored once a week by Technicon H1. Morphology and function of the lv were evaluated using echocardiographic measurements performed by Irex IIIA system. According to prescriptions of ASE the following parameters have been assessed: lv dimension, thickness of posterior wall in diastole and systole and thickness of interventricular septum in diastole.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Effect of treatment with erythropoietin (r-EPO) on hemodynamics of the cardiovascular system in patients with chronic renal failure (c.r.f.)]. 780 30

The complex task of managing the anemia caused by end-stage renal disease (ESRD) is more easily accomplished when the patient care team uses a protocol as a guide. The protocol outline presented in this article facilitates the management of patients with ESRD who are receiving Epoetin alfa. A case study is used to illustrate the clinical application of the protocol.
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PMID:Case study of the anemic patient: epoetin alfa--focus on protocols. 787 24


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