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

Epoetin alfa has been in use for over a decade to increase hemoglobin in patients with cancer who develop chemotherapy-associated anemia. Early placebo-controlled, randomized studies, as well as recent large, community-based trials in thousands of patients, have consistently shown recombinant human erythropoietin (rHuEPO, epoetin alfa) to be effective and safe in the treatment of chemotherapy-associated anemia. Patients experienced an improved quality of life (QOL) related to the magnitude of the hemoglobin increase. As measured by a Linear Analog Scale Assessment, mean energy level, ability to do daily activities, and overall QOL improved significantly in patients who received epoetin alfa. The improvement in QOL was similar when anemia-specific instruments (Functional Assessment of Cancer Therapy-Anemia) were used. A large community-based trial has demonstrated that the more convenient once-weekly dosing schedule resulted in good efficacy and safety profiles. A recent double-blind placebo-controlled study that compared the efficacy of epoetin alfa versus placebo in patients receiving nonplatinum-based chemotherapy has confirmed epoetin alfa's efficacy, safety, and beneficial QOL effects. These findings should challenge current anemia management practices and encourage aggressive treatment of anemia in cancer patients receiving chemotherapy.
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PMID:The use of epoetin alfa in chemotherapy patients: a consistent profile of efficacy and safety. 1208 59

The National Kidney Foundation's Kidney Disease Outcomes Quality Initiative recommends a target hemoglobin (Hb) level of 11 to 12 g/dL (hematocrit [Hct] of 33% to 36%) for both peritoneal dialysis and hemodialysis patients. However, national tracking data indicate that peritoneal dialysis patients have consistently lower Hb/Hct levels. This article focuses on anemia management challenges that are unique to the peritoneal dialysis population. Nursing knowledge and management of Epoetin alfa dosing and administration techniques, peritonitis and other infections, and iron supplementation may help improve anemia-related outcomes in peritoneal dialysis patients.
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PMID:Anemia management practices in peritoneal dialysis patients. Case study of the anemic patient. 1214 66

Anemia management protocols provide a consistent, standardized, therapeutic approach that can help nurses and other members of the nephrology team achieve more stable Hb levels within the target range of 11 to 12 g/dL recommended by the NKF-K/DOQI. This article provides an overview of Winthrop University Hospital's anemia management protocol, with a focus on an Epoetin alfa algorithm that was developed to guide therapeutic interventions.
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PMID:Anemia management protocols and epoetin alfa administration: an algorithm approach. Case study of the anemic patient. 1216 81

Novel approaches to anemia associated with cancer and chemotherapy are reviewed. Anemia in cancer patients is usually related to treatment with antineoplastic agents or to the disease itself. The normal concentration of endogenous erythropoietin ranges from 0.1 to 0.2 microU/mL and may increase to 2-10 microU/mL in patients with severe anemia. Many cancer patients with anemia do not have an increase in erythropoietin levels, however. Recombinant human erythropoietin (epoetin alfa), the standard for treating anemia caused by chronic renal failure, is also used to treat cancer chemotherapy-related anemia. It resolves anemia, decreases the need for transfusions, and may improve a patient's quality of life. A newer erythropoiesis-stimulating protein, darbepoetin alfa, was initially evaluated in patients with chronic renal disease. In patients who had never taken epoetin alfa, darbepoetin alfa was able to achieve a hemoglobin concentration of 11 g/dL by four weeks in most patients, and 97% of patients maintained on epoetin alfa were successfully switched to the other drug. Similar positive results were achieved in patients with solid tumors receiving chemotherapy, patients with anemia of chronic disease associated with cancer, and patients with lymphoproliferative malignancies. Darbepoetin alfa has a longer half-life than epoetin alfa, enabling less frequent administration. No difference in toxicity between the two agents has been reported. Epoetin alfa and darbepoetin alfa are effective in the treatment of anemia in patients with cancer.
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PMID:Novel approaches to anemia associated with cancer and chemotherapy. 1216 35

Cancer-related anemia commonly is associated with fatigue and decreased quality of life (QOL). Treatment to achieve optimal hemoglobin levels in patients receiving chemotherapy can alleviate common symptoms of anemia and may allow patients to have more meaningful survival time while on chemotherapy. New studies have suggested that epoetin alfa (Procrit, Ortho Biotech Products, LP, Raritan, NJ) can be administered safely and effectively once a week in patients with anemia other than those patients with cancer receiving concomitant chemotherapy. Preclinical studies and pilot clinical studies also have suggested a new application for epoetin alfa in improving cognitive function. Oncology nurses skilled at anticipating, assessing, and managing anemia and its symptoms can be instrumental in improving the QOL of patients with cancer. They should be aware of clinical trials that have suggested advantages of improved dosing schedules and new applications for epoetin alfa.
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PMID:Epoetin alfa: current and future indications and nursing implications. 1224 Apr 85

New patients starting dialysis typically have hemoglobin (Hb) and hematocrit (Hct) levels well below the target range of 11 to 12 g/dL (33% to 36%) recommended by the NKF-K/DOQI. Despite the emphasis on anemia as a quality indicator, low Hb levels often persist for months after dialysis is initiated. Several factors can help promote timely correction of anemia. (a) proactively assessing anemia-related laboratory indicators, (b) calculating weight-based Epoetin alfa starting doses, (c) starting Epoetin alfa therapy on the first day of dialysis for all eligible patients, and (d) proactively assessing patients for conditions that may affect the erythropoietic response. Through proactive, protocol-mandated interventions, nurses can help ensure that anemia is corrected promptly.
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PMID:Timely correction of anemia at the initiation of dialysis. Case study of the anemic patient. 1243 53

The objectives of this study were to assess the safety and efficacy of darbepoetin alfa (Aranesp) administered every 2 weeks in anemic patients with solid tumors receiving chemotherapy. This was an open-label, randomized, active-controlled, multicenter dose-finding study evaluating a range of every-2-week darbepoetin alfa doses. The active control arm received epoetin alfa (Epogen, Procrit) at 40,000 U weekly with a dose increase to 60,000 U weekly for subjects with an inadequate response. The lowest clinically effective doses of darbepoetin alfa in this study were 3.0 and 5.0 microg/kg every 2 weeks, with no additional benefit observed at higher doses. The percentage of patients who achieved a hematopoietic response in the 3.0- and 5.0-microg/kg groups was 66% (95% confidence interval [CI] = 46%-86%) and 84% (95% CI = 67%-100%), respectively, compared with 63% (95% CI = 46%-81%) in the epoetin alfa group. Darbepoetin alfa administered at a dose of 3.0 microg/kg every 2 weeks is safe and effective for treating anemia in patients with solid tumors on chemotherapy, and is comparable to epoetin alfa. A dose increase to 5.0 microg/kg of darbepoetin alfa administered every 2 weeks may be appropriate in patients with an inadequate initial response.
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PMID:Darbepoetin alfa administered every 2 weeks alleviates anemia in cancer patients receiving chemotherapy. 1243 70

Anemia management programs typically strive to maintain hemoglobin (Hb) levels in the target range of 11 to 12 g/dL recommended by the National Kidney Foundation's Kidney Disease Outcomes Quality Initiative (NKF-K/DOQI). Although nephrology clinicians are constantly alert for conditions that cause hyporesponse to Epoetin alfa therapy, management protocols generally focus on assessing and managing acute disorders that affect the production of red blood cells. A more difficult clinical challenge is how to systematically manage patients with conditions that chronically affect the erythropoietic response and are intractable to routine therapies. This article addresses the etiology and management of chronic conditions that require a specialized anemia management approach to ensure that patients can achieve targeted Hb levels and associated clinical and quality of life benefits. Examples include chronic inflammatory disorders, severe secondary hyperparathyroidism, malignancies, human immunodeficiency virus (HIV), and kidney transplant failure.
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PMID:Anemia management in patients with chronic conditions that affect erythropoiesis. Case study of the anemic patients. 1259 7

Recombinant human erythropoietin (epoetin) is widely used for correction of anaemia in patients with chronic renal disease and its efficacy has been confirmed in numerous studies. Disturbances in carnitine metabolism may also contribute to the development of renal anaemia. Although increases in erythrocyte count (RBC) and changes in RBC metabolism during L-carnitine administration have been observed, supplementation with L-carnitine in anaemic hemodialysis patients is not routine. The aim of our study was to determine the influence of epoetin on hematological parameters and plasma carnitine profile in anaemic hemodialysis patients. 36 hemodialysis patients (22 men, 14 female, aged from 17 to 64 years, mean 43) and 30 healthy volunteers (12 men, 18 female, aged from 25 to 65 years, mean 40) were studied. Epoetin (Eprex, Janssen-Cilag) was administered subcutaneously for twelve months with the starting dose 2000 IU three times per week (range from 75 to 133, mean 102 +/- 21 IU/kg/week). The target hemoglobin (Hb) range at the time of the study was between 10-11 g/dL. Laboratory markers of hematological response, carnitine and iron status, were measured before epoetin administration and then controlled every three months. During epoetin treatment a significant increase in Hb concentration was observed (100% of patients responded to epoetin). In the third and six month of epoetin treatment, along with a significant increase in mean reticulocyte count and the highest increment of RBC count and Hb levels, probably due to increased erythropoiesis, a significant, transient decrease of mean total and free plasma carnitine levels was observed. This may suggest the utilisation of carnitine by a new RBC population. It also indicates that there is a need for L-carnitine in carnitine deficient maintenance hemodialysis patients particularily during erythropoiesis induced by epoetin treatment.
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PMID:Plasma carnitine profile during chronic renal anemia treatment with recombinant human erythropoietin. 1260 67

The ongoing Cardiovascular risk Reduction by Early Anaemia Treatment with Epoetin beta (CREATE) trial is investigating the effect of early anaemia correction in around 600 patients with moderate anaemia [haemoglobin (Hb) 11.0-12.5 g/dl] and chronic kidney disease (CKD) not yet requiring renal replacement therapy (creatinine clearance 15-35 ml/min). Patients are being randomized to early treatment or late treatment with epoetin beta (NeoRecormon) administered subcutaneously. The early treatment group starts epoetin beta therapy immediately, aiming for a target Hb level of 13-15 g/dl. The late treatment group only starts epoetin beta therapy once the Hb level has declined to below 10.5 g/dl (target Hb level 10.5-11.5 g/dl). The objective of the study is to examine the impact of an early anaemia treatment strategy on cardiovascular risk in this patient population. Preliminary baseline data from patients recruited so far indicate there are no clinically relevant differences between treatment groups in terms of their baseline characteristics. The baseline data also confirm the heavy burden in terms of cardiovascular disease present in these patients. The CREATE trial is anticipated to provide important new data that could have an impact on new strategies for management of patients with moderate anaemia and CKD not yet requiring renal replacement therapy.
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PMID:CREATE: new strategies for early anaemia management in renal insufficiency. 1281 95


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