Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0002962 (angina)
 21,142 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The objective of this study was to determine the probabilities of specific morbid events or death among patients with end-stage renal disease (ESRD) treated by hemodialysis. A prospective cohort study was performed between March 1988 and September 1989 in 18 hemodialysis centers in 13 Canadian cities, representing about one third of the hemodialysis population in Canada. The inception cohort consisted of 496 patients entering hemodialysis who had survived 1 month. The few new hemodialysis patients who received erythropoietin (EPO) in the last 3 months of the study were excluded. Survival curves were compared using the Cox proportional hazards regression model. Older age and history of cardiovascular disease were independently associated with a greater probability of death. Age and history of cardiovascular disease were also associated with a greater probability of nonfatal circulatory events (myocardial infarction, angina requiring hospitalization, or stroke), while a serum albumin level less than or equal to 30 g/L (3.0 g dL) was associated with an increased probability of pulmonary edema. The probability of surviving 12 months without receiving a blood transfusion was 47.2% for males and 27.5% for females. The incidence of non-A, non-B hepatitis, as estimated by unexplained elevations in serum aspartate aminotransferase (AST) values, was not different between patients receiving and not receiving blood transfusions. The probability of hospitalization for any cause was greater for patients with grafts for vascular access than for those with fistulae, for those with a history of cardiovascular disease, for those with a serum albumin level less than or equal to 30 g/L, and for those with renal disease due to diabetes or vascular disease. Hospitalization due to circulatory disease was more likely among those with a history of cardiovascular disease and among those with a lower serum albumin level. Hospitalization for infectious disease was more likely among those with a lower serum albumin level and less likely among those with a fistula for vascular access. Among all patients receiving hemodialysis treatment for more than 6 months, there were 14.8 hospital days per year.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Canadian Hemodialysis Morbidity Study. 155 66

Human recombinant erythropoietin (r-HuEPO) improves quality of life in patients on maintenance haemodialysis, but the haemoglobin (Hb) level necessary to achieve this improvement is unknown. In this study, quality of life, functional capacity and symptoms of 28 haemodialysis patients with an initial Hb of 67 +/- 2 (mean +/- SEM) g/L were assessed after 0, 6 and 12 months of r-HuEPO, the dose of which was titrated to achieve a stable Hb of between 90 and 100 g/L. At six and 12 months Hb was 97 +/- 2 and 93 +/- 2 g/L, and mean r-HuEPO dose between three and six, and between nine and 12 months was 88 +/- 6 and 62 +/- 9 U/kg/week intravenously respectively. There was a significant improvement in level of activity and satisfaction with various aspects of life, and a reduction in fatigue, weakness, dyspnoea, angina and restless legs. Patients were able to walk 50% further in six minutes. The improvement in quality of life and function was similar to that reported from other centres whose target Hb was between 100 and 120 g/L, and where the r-HuEPO dose was 75% higher than in this study. Costs of r-HuEPO therapy were assessed. The drug itself costs +A3681/yr/patient, to which was added the estimated cost of additional dialyses and medications, bringing the total to +A5177/yr/patient. There was, however, a reduction in both hospitalisation by 8.3 days/yr/patient and medical consultation by 3.9 hours/yr/patient. Five patients commenced full-time work, one took up full-time study aimed at finding work, three transferred to home haemodialysis and six fewer patients drew social security benefits. The net cost saving from using low dose r-HuEPO was more than +A1,000/yr/patient.
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PMID:Low dose erythropoietin in maintenance haemodialysis: improvement in quality of life and reduction in true cost of haemodialysis. 175 17

We studied the effects of recombinant human erythropoietin (rEPO) on angina pectoris in patients with chronic maintenance hemodialysis. We evaluated hemodynamic changes and exercise tolerance in 6 patients underwent symptom-limited treadmill exercise tests, before and 3-months after treatment with rEPO. Hemoglobin concentration and hematocrit increased significantly from 8.1 +/- 1.0 to 10.3 +/- 1.1 g/dl, from 25.7 +/- 2.7 to 31.5 +/- 2.5%, respectively. Exercise duration increased significantly from 291 +/- 68 to 396 +/- 77 sec. Maximal oxygen uptake (VO2max) also increased significantly from 18.3 +/- 3.3 to 24.2 +/- 3.4 ml/kg/min during correction of anemia. Systolic blood pressure (SBP) and pressure rate product (PRP) at rest, and at maximal exercise showed no significant changes, on the other hand ischemic ST change at maximal exercise decreased significantly from 1.2 +/- 0.7 to 0.2 +/- 0.3 mm under 3-months treatment. Our results suggest that improvement of exercise capacity and ST depression in patients with chronic hemodialysis is the outcome of increased coronary oxygen supply with unchanged cardiac oxygen demand after correction of renal anemia treated with rEPO.
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PMID:[Effect of recombinant human erythropoietin (rEPO) on angina pectoris in patients with chronic maintenance hemodialysis]. 187 59

We treated 5 patients with rheumatoid arthritis (RA) with anemia of chronic disease with recombinant human erythropoietin (rHuEPO) for 11 weeks. An increase in hematocrit (Hct) greater than 5 was seen in 4 patients after 4 weeks of therapy. The 5th patient had a significant rise in Hct when the dosage of rHuEPO was increased to 150 units/kg from the 4th to 7th week. The subcutaneous administration of rHuEPO dose, reduced by one third with respect to initial dose, maintained an effective Hct value in all the 5 patients during the last 4 weeks of therapy. There was no change in disease activity. In one patient Hct normalization completely resolved symptoms of angina pectoris and permitted hip replacement surgery in another. No side effects occurred during rHuEPO therapy. We conclude that HuEPO is an effective, safe and well tolerated therapy for RA patients with severe anemia of chronic disease.
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PMID:Recombinant human erythropoietin therapy in patients with rheumatoid arthritis with the anemia of chronic disease. 194 17

The pathophysiology of anemia associated with renal failure and the major pharmacologic agents used in the treatment of this anemia are reviewed. Patients with renal failure are often anemic primarily because of diminished circulating erythropoietin and suppressed erythropoiesis in the bone marrow. The anemia may cause malaise, fatiguability, aggravated angina, and decreased exercise tolerance. Many patients require frequent red blood cell transfusions. Therapy has included anabolic androgen administration, iron and vitamin supplementation, and the administration of red blood cells. These approaches generally have not resulted in sustained improvement of the anemia. The recent development of recombinant human erythropoietin may represent a major therapeutic advance for the treatment of anemia associated with renal failure. Previously, erythropoietin therapy was not possible because of lack of sufficient quantities of the purified hormone. Clinical trials indicate, however, that recombinant human erythropoietin may improve erythropoiesis in most patients. Adverse effects have generally been mild and easily managed; however, increases in blood pressure and arteriovenous fistula clotting have been reported. Although initial reports are encouraging, larger and longer clinical trials are needed to determine proper dosing and to understand more completely the potential adverse effects of recombinant human erythropoietin. Previous pharmacologic attempts to improve the anemia associated with renal failure have been largely unsatisfactory; initial reports on the use of recombinant human erythropoietin are promising.
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PMID:Pathophysiology and treatment of the anemia of renal failure. 328 Feb 18

To examine the effects of recombinant human erythropoietin (rHuEPO) on hospital utilization, hospital costs, and Medicare reimbursements for hospital care, a longitudinal, matched cohort study was conducted using Medicare claims data of 23,806 Medicare-eligible, dialysis patients who received rHuEPO, did not have a transplant, and were alive for 18 mo or longer and 22,720 controls matched on age, sex, race, cause of ESRD, and dialysis modality. The relative odds (rHuEPO versus control) of admission for all causes and for specific causes over 9 mo, adjusted for admission in the prior 9 mo and the per patient change in total admissions, inpatient days, hospital costs, and Medicare hospital payments between the prior 9-mo period and the subsequent 9-mo period was examined. The adjusted relative odds (95% confidence interval) of admission (rHuEPO versus control) was: higher and statistically significant for all causes, 1.08 (1.03 to 1.14); seizure, 1.52 (1.28 to 1.75); vascular access revision, 1.11 (1.06 to 1.17), and heart failure, 1.17 (1.09 to 1.26); higher but not statistically significant for angina, 1.09 (0.99 to 1.20) and stroke, 1.08 (0.86 to 1.31); and lower but not statistically significant for myocardial infarction, 0.91 (0.72 to 1.10); peripheral vascular disease, 0.81 (0.60 to 1.02); anemia, 0.86 (0.56 to 1.17); and depression, 0.89 (0.37 to 1.40). The mean change per 1,000 patients in admissions was less by 38 (P = 0.03) because of fewer readmissions, and in days was 1,309 less (P < 0.001), for patients treated with rHuEPO versus controls. The mean change per patient in hospital costs was $371 less and was statistically significant (P = 0.03) and in Medicare hospital payments was $132 less but was not statistically significant (P = 0.43) for patients treated with rHuEPO versus controls. rHuEPO was associated with an increase in the probability of hospital admission (particularly admissions potentially related to adverse effects) but a decrease in readmissions, overall admissions, hospital days, and cost to hospitals in this cohort of patients surviving for 18 mo. Although not realized short term, Medicare savings from potential rHuEPO-related reductions in hospital care may be long term through future adjustments in diagnosis-related group-based hospital payment.
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PMID:Effect of recombinant erythropoietin on hospital admissions, readmissions, length of stay, and costs of dialysis patients. 816 27

Hemodialysis is frequently complicated by hypotension and associated symptoms. It has been suggested that these symptoms may be related to the biochemical changes caused by cellulosic dialysis membranes. In this study, a prospective randomized crossover trial was conducted comparing the incidence of hypotension and acute symptoms during dialysis with large-surface-area (1.6 m2) cellulosic (cuprophane [CUP]) and noncellulosic (polyacrylonitrile [PAN], AN69) membranes. Dialyzers were used for a single use only. There was no difference in predialysis BUN, predialysis blood pressure, intradialytic weight gain, blood flow, dialysis efficiency (urea reduction), dialysis duration, hematocrit, or erythropoietin dose between the two study phases. When these clinical characteristics were matched, there was no difference in the number of episodes of hypotension (CUP, 19 +/- 3; PAN, 22 +/- 3; P = not significant [NS]). The incidence of symptomatic hypotension, as reflected by the number of episodes of hypotension requiring more than 100 mL of saline for correction, was also not different between study phases (CUP, 10 +/- 1; AN69, 11 +/- 2; P = NS). The incidence of intradialytic symptoms, including emesis, cramping, headache, angina, pruritus, and bronchospasm, was similar during the two study phases (CUP, 11 +/- 2; AN69, 10 +/- 1; P = NS). It was concluded that noncellulosic membranes do not offer any significant advantage over cellulosic membranes in reducing the acute complications of hemodialysis.
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PMID:Tolerance of hemodialysis: a randomized prospective trial of high-flux versus conventional high-efficiency hemodialysis. 840 77

Aiming to know the factors that influenced the use of erythropoietin (EPO) in chronic hemodialysis patients, we retrospectively studied 82 patients (41 male), of whom 15 received EPO. No differences, between patients receiving or not receiving EPO, were found in age (46.9 +/- 25 and 57 +/- 13 years respectively), male/female ratio (9/6 and 32/35 respectively), time on dialysis (36.4 +/- 25.6 and 36.8 +/- 31.8 months respectively), dialysis hours (3.19 +/- 0.6 and 3.33 +/- 0.39 h respectively) and proportion of diabetics (6.6 and 20.8% respectively). Prior to EPO use and compared to untreated patients, treated patients were transfused with a higher frequency (60 vs 22%) and with more units/patients/years (0.12 vs 0.08). Hemoglobin levels at the start of the treatment was similar in treated and untreated patients (8.4 +/- 1.46 vs 8.78 +/- 1.97 g/dl). EPO was indicated in 11 patients due to general symptomatology associated to anemia and in 4 due to cardiac failure or angina. We conclude that EPO treatment is indicated in approximately 18% of patients in dialysis. An adequate dialytic treatment may achieve optimal hemoglobin levels with minimal transfusion requirements and without need of EPO, thus reducing costs.
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PMID:[Erythropoietin and transfusions in patients with anemia of chronic renal failure origin : an update view]. 852 89

Many patients are donating their own blood before surgery to avoid blood-borne infections, often on the advice of their physicians. But autologous blood transfusion, while safer than allogeneic transfusion, is not completely risk-free. It is also expensive, its benefits are difficult to assess, and its increasing popularity raises many difficult ethical issues, such as whether the benefit of allogeneic transfusion supports its additional expense. Record-keeping, collection, and transfusion errors are occasional risks of autologous transfusions. In addition, risks associated with blood donation, from mild dizziness to precipitation of angina, should be considered when high-risk patients are referred for autologous collection. Only approximately half of autologous units collected are actually used, and the cost per quality-adjusted year of life saved may be as high as $1 million, depending on the type of surgical procedure. Although recombinant human erythropoietin can stimulate red blood cell production before autologous donation and decrease the need for transfusion, it is not clear whether this strategy, which can cost thousands of dollars per patient, will be cost-effective. Perioperative hemodilution may become an important component in efforts to reduce patient exposure to allogeneic blood, but its use remains controversial.
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PMID:Preoperative autologous blood donation: clinical, economic, and ethical issues. 887 Mar 40

Anemia is a common complication of chronic renal failure (CRF). With the availability of recombinant human erythropoietin (rhEPO) over the last decade, much progress has been made in the management of anemia in patients with end-stage renal disease (ESRD) [Eschbach 1995, Gimenez and Scheel 1994, Muirhead et al. 1995, Winearls 1995]. The clearest benefit of rhEPO in ESRD is a substantial reduction in transfusion dependency, which reduces the need for hospital admission and the risk of viral transmission. Improvements in hemostasis and a decrease in human leucocyte antigen (HLA) antibodies have also been reported. Beneficial effects of rhEPO on the cardiovascular system in ESRD include regression of left ventricular hypertrophy (LVH), improvement of angina, and a modest increase in aerobic work capacity. Treatment of anemia with rhEPO has also been shown to improve cognitive function, socialization and quality of life in dialysis patients, although this has not led to better vocational rehabilitation or employment status. It has also been reported that a lower hemoglobin (Hb) content is an independent risk factor for increased mortality in hemodialysis patients [Harnett et al. 1995]. Clearly, therefore, treatment of anemia associated with ESRD is required and beneficial. The optimum treatment of anemia prior to dialysis, however, is still a matter for debate.
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PMID:Does early anemia correction prevent complications of chronic renal failure? 998 40


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