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)

Erythropoietin, a naturally occurring human protein that stimulates red blood cell production, is secreted by the kidney in direct response to anemia and hypoxia. This mechanism is absent in those with impaired renal function; thus, those suffering from chronic renal failure may develop anemia evidenced by very low hemoglobin and hematocrit, low red blood cell count, and low reticulocyte count. Commercially available epoetin alfa recombinant may be administered intravenously or subcutaneously to reverse this deficiency.
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PMID:Clinical administration of epoetin alfa recombinant. 156 6

Recombinant human erythropoietin (r-HuEPO) represents the therapy of choice in anaemia of chronic renal failure. A number of studies have analysed the relative effectiveness of r-HuEPO administered subcutaneously (s.c.) or intravenously (i.v.) in haemodialysis patients. The bioavailability of s.c. r-HuEPO appears to be low and the absorption of r-HuEPO variable. Nevertheless, s.c. administration of r-HuEPO is more efficacious than i.v. administration, probably due to the better time-averaged plasma concentrations. Patients on haemodialysis who were on i.v. r-HuEPO 3 times weekly for 9 months were subsequently successfully maintained on a self-administered s.c. dosage which was 50% of the i.v. maintenance dosage and which was later reduced further to 30% of the weekly i.v. maintenance dosage. An ongoing European multicentre study has confirmed these findings and demonstrated that s.c. administration 3 times weekly and once daily was as effective as i.v. administration 3 times weekly. Both these s.c. regimens resulted in a significant dosage reduction (30%) compared with the i.v. regimen. The study also found that once weekly s.c. dosing was as effective as 3 times weekly i.v. dosing but did not result in a dosage reduction. Other studies on the optimization of s.c. r-HuEPO in patients on continuous ambulatory peritoneal dialysis demonstrated that haemoglobin levels following s.c. r-HuEPO administration (60 U/kg twice weekly) can be further increased by 2 ml iron dextran (containing 50 mg/ml iron) administered i.v. 7-9 weeks after the start of therapy. Studies on the site of s.c. injection reveal that injection into the thigh results in more rapid absorption, higher peak concentrations and greater bioavailability than injection into the arm or abdomen. Data also demonstrate the economic advantage of s.c. r-HuEPO in high-risk patients.
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PMID:Optimal route of administration of erythropoietin in chronic renal failure patients: intravenous versus subcutaneous. 157 61

Erythropoietin (EPO) adjusts the red cell mass to the optimal size in order to satisfy the oxygen requirement of the body. The amount of circulating EPO is regulated by oxygen sensors in the kidney, which control the secretion of EPO through feedback signals. EPO stimulates the erythroid progenitor cells at different levels to develop into mature red blood cells. In anaemia, the serum EPO concentration, which is normally around 15 U/l, can increase 100-fold, or more. Patients with severe renal failure are unable to adapt the production of EPO in response to low haematocrit levels, and anaemia is due to a relative EPO deficiency. Studies have shown that recombinant human erythropoietin (r-HuEPO) could quickly correct anaemia in chronic renal failure by inducing a dose-dependent rise in haemoglobin and in the haematocrit level. r-HuEPO is now the standard treatment to correct severe anaemia in chronic renal failure. In recent years, r-HuEPO has been tested in other types of anaemia, some of which are fully discussed in this supplement together with various dosage regimens and routes of administration.
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PMID:Current and potential applications for erythropoietin. 157 62

Chronic renal failure is almost invariably accompanied by symptomatic anemia. It has been demonstrated that the primary cause of this anemia is inadequate production of erythropoietin by the diseased kidneys. The isolation of erythropoietin, followed by the cloning and expression of the human erythropoietin gene, made possible clinical trials of rHuEPO in uremic patients. rHuEPO produced dramatic increases in the hematocrit in almost all patients treated and also ameliorated many symptoms, such as lethargy, dizziness, and poor appetite, that had long been attributed to the effect of uremic toxins. Adverse effects of treatment with rHuEPO noted in the early clinical trials included hypertension, seizures, arteriovenous fistula or shunt thrombosis, and hyperkalemia. Further study of rHuEPO has shown that many of these side effects may be no more frequent in patients receiving rHuEPO than in other uremic patients not receiving rHuEPO. Reduction of the rHuEPO dosage and subcutaneous administration produce less rapid increases in the hematocrit and may lessen the incidence and severity of these side effects. rHuEPO therapy places great demands on both the body's iron stores and the capacity to rapidly transfer iron from storage sites to the erythroid progenitor cells. Thus, almost all patients treated with rHuEPO become iron deficient and require oral or parenteral iron replacement. Response to rHuEPO in uremic patients is diminished if the anemia is complicated by iron deficiency, inflammatory disorders, aluminum overload, or deficiency of folate or vitamin B12. rHuEPO therapy is safe and effective in the treatment of the anemia of chronic renal failure. The use of rHuEPO leads to enhanced quality of life and eliminates the need for red cell transfusions. In addition to hemodialysis patients, predialysis patients and those on CAPD benefit from and are candidates for rHuEPO therapy.
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PMID:Anemia of renal failure. Use of erythropoietin. 157 66

Risk factors for heart disease in patients with chronic renal failure (CRF) are the same as in general population; moreover CRF and renal replacement therapies (dialysis, immunosuppressive drugs for kidney transplantation) induce further specific cardiac risks. In practice, the commonest heart diseases associated with CRF are coronary artery diseases, myocardiopathies from various aetiologies, valve diseases and arrhythmias. Uremic pericarditis are quite unusual nowadays. Advances in therapy authorize easier control of congestive heart failure, the major complication of heart disease in CRF patients. Furthermore, it was observed that correction of anemia with erythropoietin therapy or kidney transplantation can ameliorate or reverse partially some cardiac diseases.
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PMID:[The heart in chronic kidney failure patients]. 160 61

Although recombinant human erythropoietin (rHuEPO) has only been approved for clinical use since 1989, its beneficial effects in the treatment of anemia in patients with chronic renal failure has been clearly demonstrated. Bolstered by this success, clinical investigators are now turning to other types of anemia that might benefit from such therapy. Part II of this article will continue to discuss some of the potential areas of clinical application for rHuEPO. Part I was published last month in NN&I.
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PMID:Future trends and issues in erythropoietin. Part II. 160 77

We examined the conditions necessary for performing a reliable erythropoietin (EPO) assay based on CFU-E colony formation in fetal mouse liver cell (FMLC) microcultures using 96-well microtiter plates. Both linearity of colony numbers with the number of cells plated and comparison among the colony ratios at various densities of seeding cells indicated that the colonies originated from a single progenitor cell when 7500 or fewer cells were plated into individual microtiter wells. About a twofold CFU-E enrichment in 12- to 13-day FMLC was achieved by Ficoll-Paque centrifugation. Plasma treated with acid-boiling stimulated the colony formation most and contained no colony inhibitor. Dose-response curve for the plasma was parallel to the EPO standard curve. The "erythroid colony-stimulating activity" in the plasma was additive to that in the standard EPO, and was completely neutralized by a monoclonal antibody against recombinant human EPO. Using the assay procedure thus established, plasma EPO titer was determined in normal subjects, in patients with nonuremic anemia and polycythemia vera, and in dialysis patients with chronic renal failure. The use of different preparations of standard EPO resulted in a significant difference in the titers because their dose-response curves differed from one another. An inverse relationship was found between EPO titers and hemoglobin concentrations in the nonuremic anemic patients, but not in the dialysis patients with about one half the normal EPO level.
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PMID:Improved microbioassay for plasma erythropoietin based on CFU-E colony formation. 162 57

Erythropoietin has been proved extremely effective in ameliorating the anemia of chronic renal failure and is currently under intensive investigation. We describe a patient with severe anemia and secondary hemochromatosis due to prosthetic valves, who has been successfully treated with erythropoietin. During 12 months' follow-up, an acceptable hemoglobin level was maintained without any need for blood transfusions; in addition, there was evidence indicating regression of hemochromatosis. This patient illustrates that erythropoietin therapy might prove beneficial for similar cases.
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PMID:Erythropoietin therapy obviates the need for recurrent transfusions in a patient with severe hemolysis due to prosthetic valves. 162 82

As the anemia that accompanies chronic renal failure (CRF) is successfully treated with recombinant human erythropoietin (epoetin), striking improvements in overall quality of life have been noted in several clinical studies of patients receiving chronic hemodialysis. A review of available clinical data has shown that, following epoetin therapy, peak oxygen consumption, a principal indicator of exercise ability, increased by approximately 50% as the hematocrit level increased. Following epoetin therapy in pediatric patients with end-stage renal disease (ESRD), the ventilatory anaerobic threshold (VAT) increased significantly and correlated well with increases in hemoglobin concentrations. Increased exercise capacity associated with the reversal of anemia appeared to positively effect many quality-of-life parameters. Analysis of questionnaires incorporating both subjective and objective quality-of-life indicators showed significant improvements between baseline and follow-up periods. Many patients experienced relief from some of the debilitating symptoms of anemia and many had significantly improved functional ability. Higher activity and energy levels were reflected in enhanced emotional and social well-being, with improvements noted in appetite, sleeping behavior, and sexual function. There was no change in the employment status of most patients. The extent of improvement in overall quality of life may be a function of the baseline level of impairment and the potential for reversal. However, baseline capabilities at rest may not be appropriate for physiologic studies.
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PMID:Quality of life and hematocrit level. 162 52

The uremia of chronic renal failure (CRF) can alter brain electrophysiology and cognitive function, even in the well-dialyzed patient. The effect of uremia on brain function can be assessed by electrophysiologic techniques such as electroencephalogram (EEG), sensory-evoked potentials (EPs), and cognitive event-related potentials (ERPs), and through a series of neuropsychologic tests. Five tests have been used clinically to measure the speed and efficiency of cognitive functioning and include the following: Number Cancellation, Trailmaking Test, Symbol Digit Modalities Test, Rey Auditory Verbal Learning Test, and Controlled Oral Word Association Test. Test performance by patients with CRF is often below that of healthy controls. Auditory ERPs, a sensitive indicator of subtle changes in central nervous system (CNS) function in uremia, result in the generation of a P300 component wave that varies in amplitude and latency with patient variables such as attention and effort. Although dialysis tends to normalize P300 latencies, the waves remain somewhat prolonged in most patients. The anemia often observed in patients receiving chronic dialysis appears to aggravate uremic encephalopathy. This effect can be reversed when anemia is corrected following administration of recombinant human erythropoietin (epoetin). Improvement in P300 amplitudes, and, in some cases, decreases in P300 latencies correlated well with epoetin-induced increases in hematocrit levels. With the correction of anemia, that component of brain dysfunction not attributable to retention of uremic toxins can largely be reversed.
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PMID:Epoetin and cognitive function. 162 53


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