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

The use of recombinant human erythropoietin (rhuEPO) has revolutionized the treatment of renal anemia, but the dose regimens have not been established. We studied the effects of subcutaneous rhuEPO given 4,000U (1 vial) every 5-10 days in 9 patients on continuous ambulatory peritoneal dialysis (CAPD). Ten stable CAPD patients (6 females and 4 males; mean age +/- SEM, 54.4 +/- 5.6 years; mean baseline hemoglobin concentration 7.3 +/- 1.2g/dL) were commenced on s.c. rhuEPO. None of the patients had a history of gastrointestinal bleeding, aluminum overload, sepsis nor receiving androgens. Seven patients were receiving 4,000 U rhuEPO weekly, one patient each was receiving 4,000 U every 5 and 10 days (range, 66.7-89.3 U/kg/week). The dose was adjusted every 4 weeks according to response by altering the dose interval. The mean hemoglobin concentration increased from 7.3 +/- 1.2 g/dL to 10.3 +/- 1.1 g/dL over 8 weeks. There was no significant changes in the serum ferritin, urea, creatinine and potassium levels. One patient required an increase in antihypertensive therapy. We feel that s.c. rhuEPO 4,000 U given on an intermittent basis is effective in the treatment of anemia in CAPD patients. The administration of a single vial each time is convenient and cost sparing. The gradual rise in hematocrit avoids complications.
Adv Perit Dial 1991
PMID:Subcutaneous recombinant human erythropoietin in patients on CAPD. 168 Apr 47

The efficacy of once weekly subcutaneous erythropoietin (SC EPO) was evaluated by reviewing records of twelve continuous ambulatory peritoneal dialysis (CAPD) patients age 27-66 years after achieving a goal hematocrit (hct) greater than 30%. Patients had a mean hct of 22.8% (range: 19.1-29.5) and were placed on a thrice weekly SC EPO dose of 4000 international units (IU) (37-74 IU/KG, [mean of 57 IU/kg]) until a goal hct greater than 30% was achieved. This hct ranged from 30.8-37% (mean 33.2%) and was achieved in a mean of 11.5 weeks (range: 4.1-29 weeks). Patients were then maintained on the same SC EPO dose given only once weekly. 11/12 (92%) patients have maintained a mean hct of 34% (range: 29-38.4%) on once weekly SC EPO over a mean period of 14 weeks (range: 1.4-36 weeks). The mean serum ferritin was 484; only two patients required parenteral iron dextran therapy. One patient did not reach the goal hct due to poor compliance. There was no significant increase in blood pressure or in serum potassium level. We conclude that SC EPO is effective in treating anemia in these patients and can be given once weekly to maintain a hct greater than 30%.
Adv Perit Dial 1991
PMID:Once weekly subcutaneous erythropoietin is an effective maintenance therapy in the treatment of anemia of end stage renal disease in patients on CAPD. 168 Apr 48

Anemia of CRF has been corrected by use of H-R-EPO both in hemodialysis and CAPD patients. Long term response to subcutaneous EPO and its relationship with serum EPO levels remain to be established. Twenty-five CAPD patients treated with CAPD during 30 +/- 28 (mean +/- SD) months were included in this study. The follow-up period was 6-24 months. All patients have been on CAPD at least 6 months and their Hemoglobin (Hb) level was lower than 8.5 g/dl. Twelve patients received EPO by subcutaneous route, at doses of 20 u./Kg daily and 13 other patients at doses of 2000 units twice a week. Thereafter, these doses were adjusted to obtain a Hemoglobin level ranging 10.5-13 g/dl. In conclusion, our results suggest that the subcutaneous route for H-R-Erythropoietin can be considered as the best choice for CAPD patients. Low doses twice a week seem to improve anemia in 2 months. Later, dose adjustment should be done according to the patient's response. The improvement in nutritional status we observed suggests a new positive aspect for EPO therapy. Our data did not show changes in peritoneal function.
Adv Perit Dial 1991
PMID:Medium term response to H-R erythropoietin in CAPD patients: the influence of erythropoietin plasmatic levels and the effects on peritoneal transport capacity. 168 Apr 50

In this study we have evaluated the haematological consequences of chronic aluminium (Al) overload. We have also investigated 'in vivo' whether aluminium overload may modulate gastrointestinal iron (Fe) absorption and 'in vitro' whether the presence of aluminium may influence the cellular uptake of iron. The in vivo studies were performed in rats with normal renal function and the in vitro experiments were done using the rat intestinal epithelial cell line RIE-1. The results demonstrate that aluminium deposit in tissues even with normal renal function. The intraperitoneal aluminium loading resulted in serum and tissue aluminium increases comparable with concentrations found in aluminium-intoxicated renal patients. The aluminium intoxication was accompanied by a microcytic anaemia with a haematological pattern similar to that observed in iron-deficiency anaemia. Nevertheless, iron absorption was significantly reduced despite an increased total iron binding capacity (TIBC). In addition, aluminium was also able to reduce in vitro cellular uptake of iron in the RIE-1 intestinal cell line. These experimental results demonstrate that aluminium interferes with iron absorption and iron transfer, and suggest that these mechanisms may be responsible for maintaining and even increasing the anaemia observed in aluminium overload.
Nephrol Dial Transplant 1991
PMID:Iron uptake in aluminium overload: in vivo and in vitro studies. 174 87

Human recombinant erythropoietin is of proven value in the treatment of the anaemia of renal failure. The aluminium content of 36 ampoules of water for injection supplied for use with recombinant erythropoietin has been measured and ranged from 24 to 450 micrograms/l, with a median of 251 micrograms/l. In three samples, which may have been contaminated on opening, the range was from 1770 to 6160 micrograms/l. In Water for Injection BP, values ranged from 66 to 140 micrograms/l with a median of 99 micrograms/l. Reconstituted erythropoietin did not contain any more aluminium than could be accounted for by the water. Ampoules of a second brand of erythropoietin, supplied already in solution, contained from 506 to 837 micrograms/l aluminium (median 682 micrograms/l). In view of the lifelong duration of erythropoietin therapy clinicians and pharmaceutical companies should be aware of this potential problem. Although the amount of aluminium delivered with each injection is usually less than 4 micrograms, it is suggested that active steps are taken to establish a British Pharmacopoeia limit on the aluminium content of injections.
Nephrol Dial Transplant 1991
PMID:Aluminium content of water for injection used with recombinant human erythropoietin. 177 51

To clarify the role of chronic anaemia in the pathogenesis of the left ventricular hypertrophy (LVH) of chronic uraemia, nine normotensive dialysed patients were studied before and 3 and 6 months after start of intravenous treatment with recombinant human erythropoietin (rHuEpo). M-Mode echocardiographic estimations of left ventricular mass indices (LVMi) and plasma noradrenaline determinations were made at 3 and 6 months, and total blood volume (TBV) only at 6 months. Resting haemoglobin values were 5.9 +/- 1.3 (SD) g/dl, increased within 3 months to 10.2 +/- 1.2 (P less than 0.001), then remained unchanged. Baseline LVMi was 115 +/- 18 g/m2 body surface area (b.s.a.) and decreased significantly (P less than 0.0025) over the entire period to a final value of 78 +/- 13 g, which did not differ from the average value for 19 healthy controls. Resting plasma noradrenaline was 1.45 +/- 0.44 pmol/ml and did not change significantly, although values were reduced at the 3rd month, when decreased heart rates and slightly and non-significantly increased blood pressures were recorded. TBV did not vary because the increased erythrocyte mass was compensated for by parallel decreases in plasma volume. These data demonstrate the existence of a cause-effect relationship between uraemic anaemia and LVH, although the precise mechanism remains unknown. Amelioration of anaemia with rHuEpo, by allowing recovery from the attendant LVH, might improve long-term cardiovascular prognosis in some dialysed uraemic patients.
Nephrol Dial Transplant 1991
PMID:Reversal of left ventricular hypertrophy following recombinant human erythropoietin treatment of anaemic dialysed uraemic patients. 182 46

Recombinant human erythropoietin (rHuEpo) is an effective therapy for anaemia in most patients with end-stage renal disease (ESRD). However, there remain a minority of patients with ESRD who are resistant to the effects of rHuEpo. The present study examined the role of aluminium overload and hyperparathyroidism of the biological effects of rHuEpo. Twenty-two patients aged 26-74 (mean 53 +/- SD 15.5) received rHuEpo 50-200 U/kg per week for 16.5 +/- 8.0 months (range 3-27). Haemoglobin was maintained at 11.5-13.0 g/dl by appropriate dose adjustment. Iron supplements were provided to maintain serum ferritin greater than 200 ng/ml. The mean time to rHuEpo response (Hb greater than 2 g/dl over baseline) was 6.1 +/- 2.6 weeks. Mean pretreatment serum aluminium correlated with time to Hb response (r = 0.48; P less than 0.05) and pretreatment mean corpuscular volume (r = 0.43; P less than 0.05) but not with eventual rHuEpo maintenance dose. PTH did not correlate with either Hb response or eventual maintenance rHuEpo dose. In summary, elevated serum aluminium concentrations were associated with an initial resistance to the biological effects of rHuEpo but had no effect on long-term dose requirements. In contrast, no impact of PTH on either immediate or long-term rHuEpo dose was evident.
Nephrol Dial Transplant 1991
PMID:The role of aluminium and parathyroid hormone in erythropoietin resistance in haemodialysis patients. 187 Jul 50

Sixteen anaemic CAPD patients (Hb less than 9 g/dl) were treated with thrice-weekly subcutaneous recombinant erythropoietin, epoetin-alfa. The dose was adjusted to induce a stepwise increase in haemoglobin. Fourteen patients reached a first target haemoglobin of 11.0-11.5 g/dl and eight of these a second of 13.0-13.5 g/dl, but one could not be maintained at this level. Failure to reach or maintain the second target in nine subjects was accounted for by incomplete responses associated with infection in one, extreme shortening of red-cell survival in another, and was unexplained in one subject. These three received the maximum dose studied of 450 IU/kg per week. Six other subjects were withdrawn from the study for reasons unrelated to treatment with erythropoietin. The median dose required to maintain the haemoglobin at 11.0-11.5 g/dl was 75 IU/kg per week and at 13.0-13.5 g/dl was 150 IU/kg per week. Quality of life, assessed in 12 patients at haemoglobin 11.0-11.5 g/dl, showed significant improvement in energy, and at 13.0-13.5 g/dl improvements in sleep and emotional wellbeing became significant. Twelve subjects required either institution of, or an increase in, treatment for hypertension. The thrice-weekly subcutaneous doses of erythropoietin were well tolerated and were a convenient and effective treatment for anaemia in patients on CAPD.
Nephrol Dial Transplant 1991
PMID:Stepwise correction of anaemia by subcutaneous administration of human recombinant erythropoietin in patients with chronic renal failure maintained by continuous ambulatory peritoneal dialysis. 192 10

Recombinant erythropoietin (R-EPO) administered i.v. is effective in correcting anemia in patients on hemodialysis (HD). As subcutaneous (s.c.) or intraperitoneal (i.p.) dosing would be preferable in CAPD patients, we have evaluated its efficacy when given by these routes. Sixteen CAPD patients (mean Hb 7.3 +/- 1.6 g/dl) have been divided into two groups: group A received s.c. self-administered R-EPO (starting dose 92 +/- 35 U/kg/week) two times a week; in group B R-EPO was given i.p. (170 +/- 42 U/kg/week) thrice weekly. The observation period lasted about 12 months. All patients reached a target Hb greater than 10 g/dl. Group A achieved a full response within 9 +/- 2 weeks, group B within 13 +/- 1.7 (p less than 0.005). In group A the starting R-EPO dose was not changed; in group B it was increased to 225 +/- 45 U/kg/week. We observed no differences in the incidence of peritonitis in the two groups. Our findings show that both R-EPO administration routes are safe and efficient in correcting anemia in patients on CAPD. A shorter period of treatment and lower doses of R-EPO seem to be required to achieve the same target Hb level when using the s.c. rather than the i.p. application route.
Adv Perit Dial 1990
PMID:Efficacy of recombinant erythropoietin after subcutaneous or intraperitoneal administration to patients on CAPD. 198 30

After 6 months of (recombinant human erythropoietin) rHuEPO treatment we recently observed an increased peritoneal ultrafiltration (UF) (Nephron 53: 91, 1989). The aim of the present study was to investigate the long term effect of subcutaneous (SC) on dialysis efficiency in CAPD. Fourteen patients (11 female, 3 male, mean age 42.6, range 18-65 years) with renal anemia (HCT less than 28%) took part in the study. rHuEPO was administered s.c. twice weekly in an initial dose of 50 U/kg body weight. This dose was increased by 25 U/kg body weight every 4 weeks till the target HKT of 35% had been achieved. After 12 months of mean time of treatment (range 8-14 months) hematocrits had increased from 23.3 +/- 3.2 (x +/- SD) to 36.6 +/- 5.3% (p less than 0.005). UF improved from 0.70 +/- 0.22 to 1.03 +/- 0.47 ml/min (4 hr dwell time, 1.5% glucose monohydrate) (p less than 0.03). Increased UF resulted in an augmented creatinine clearance (p less than 0.05). No changes were observed in serum chemistries, body weight, pulse rate or cardiothoracic index. The observed increase in peritoneal ultrafiltration might be due to augmented mesenteric perfusion resulting from improved cardiac function. The sustained increase in UF after rHuEPO-induced correction of renal anemia may improve the fluid balance on CAPD patients.
Adv Perit Dial 1990
PMID:One year experience with subcutaneous human erythropoietin in CAPD: correction of renal anemia and increased ultrafiltration. 198 33


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