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Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Juvenile hemochromatosis is a rare genetic disorder that causes iron overload. Clinical complications, which include liver cirrhosis, heart failure, hypogonadotropic hypogonadism and diabetes, appear earlier and are more severe than in HFE-related hemochromatosis. This disorder, therefore, requires an aggressive therapeutic approach to achieve iron depletion. We report here the case of a young Italian female with juvenile hemochromatosis who was unable to tolerate frequent phlebotomy because of coexistent ss-thalassemia trait. The patient was successfully iron-depleted by combining phlebotomy with recombinant human erythropoietin.
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PMID:Juvenile hemochromatosis associated with B-thalassemia treated by phlebotomy and recombinant human erythropoietin. 1094 34

The efficacy of intermittent, small doses of intravenous iron in hemodialysis patients is well established. But poor peripheral vascular access and frequency of therapy preclude acceptability of this method in peritoneal dialysis (PD) patients. Therefore, despite its marginal efficacy, oral iron remains the common method of iron supplementation in these patients. This prospective, cross-over trial compares infusion of total dose iron (ITDI) and oral iron supplementation in outpatient PD patients. Eleven stable CAPD patients with an hematocrit (Hct) of less than 33%, or a transferrin saturation (TSAT) of less than 30%, or both, were entered into the study. The study design included an oral phase [4 months, ferrous sulfate 325 mg (195 mg elemental iron), three times daily], a "wash-out" phase (1 month, no iron supplementation), and an ITDI phase [4 months, single infusion over 4 hours of 1 g iron dextran mixed in 1/2 normal saline]. Laboratory parameters were monitored monthly, and subcutaneous recombinant human erythropoietin (rHuEPO) doses were adjusted monthly to maintain a hematocrit above 33%. Patients with hyperparathyroidism, aluminum toxicity, and weekly Kt/V below 1.8 were excluded. Nine patients [8 Caucasians, 1 African American; causes of end-stage renal disease (ESRD): hypertension (4 cases), diabetes (3 cases), glomerulonephritis (1 case), and polycystic kidney disease (1 case); mean age: 43.3 +/- 2 years; mean weight: 73.0 +/- 4 kg; duration of ESRD: 28 +/- 13 months] completed the 9-month study. During the oral phase, TSAT rapidly decreased and a higher dose of rHuEPO failed to maintain Hct, a pattern sustained during the "wash-out" phase. During the ITDI phase, TSAT significantly increased and improvement in Hct resulted in a significant lowering of rHuEPO doses. The ITDI therapy was well tolerated. We conclude that ITDI is the preferred method of iron supplementation in outpatient PD patients.
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PMID:Infusion of total dose iron versus oral iron supplementation in ambulatory peritoneal dialysis patients: a prospective, cross-over trial. 1104 66

Some patients on long-term peritoneal dialysis (PD) develop a hyperpermeability state, owing to peritoneal neoangiogenesis. Vascular endothelial growth factor (VEGF), a potent mitogen for endothelial cells, has been implicated in most diseases characterized by microvascular neoformation. Erythropoietin (EPO) is able to induce endothelial proliferation in vitro. Our aim was to elucidate whether VEGF serum levels are influenced by EPO treatment, and whether VEGF serum level maintains a relationship with peritoneal transport data. We analyzed serum levels of VEGF in 35 PD patients (18 males, 17 females). Mean age was 58 years, with a mean time on PD of 98 +/- 75 months. Of the 35 patients, 19 were on automated peritoneal dialysis, and 16 were on continuous ambulatory peritoneal dialysis. Seven patients had diabetes. Peritoneal transport parameters were: urea mass transfer coefficient (MTC), 19.5 +/- 6.6 mL/min; creatinine MTC, 9.9 +/- 4.7 mL/min; net ultrafiltration, 491 +/- 166 mL per 4-hour dwell. Twenty seven patients were under therapy with recombinant human erythropoietin (rHuEPO). Mean serum VEGF levels were 347 +/- 203 pg/mL (range 66-857 pg/mL), with most patients in the normal range (60-700 pg/mL). VEGF levels did not correlate with age, sex, primary renal disease, diabetes, type of PD, time on PD, peritonitis, and cumulative glucose load. We found no correlation with urea MTC, creatinine MTC, ultrafiltration rate, or protein effluent levels. However, a significant negative correlation with residual renal function was seen (r = -0.39, p < 0.05). Patients treated with rHuEPO showed significantly higher serum levels of VEGF than non treated patients (375 +/- 220 pg/mL vs 251 +/- 75 pg/mL, p < 0.05), although they had similar residual renal function. We conclude that increased serum VEGF levels are associated with EPO treatment. Consequently, VEGF might have a role in the EPO effects found in PD patients. Whether both agents are related to peritoneal neoangiogenesis requires further research.
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PMID:Serum level of vascular endothelial growth factor is influenced by erythropoietin treatment in peritoneal dialysis patients. (Grupo de Estudios Peritoneales de Madrid). 1104 67

The use of erythropoietin in dialysis patients is associated with improved quality of life and may lead to improved outcomes. Peritoneal dialysis patients are generally taught to give subcutaneous erythropoietin at home. The purpose of this study was to determine compliance with erythropoietin use in peritoneal dialysis patients. Records of patient prescriptions, refills of erythropoietin, the person administering the injection, and average hematocrit were retrospectively examined. Demographic and comorbidity data were collected prospectively on all peritoneal dialysis patients. The use of more than 90% of the prescribed dose was considered compliant. Data were available for 55 patients. The mean follow-up time was 12 months. Thirty patients (55%) were noncompliant with erythropoietin. Compliant patients were older (65.4 years vs 50 years, p = 0.01), had higher comorbidity (p = 0.01), higher average hematocrit (34% vs 31.5%, p < 0.003) and were less likely to self-administer the injection. Sex, diabetes, and compliance with dialysis exchanges were not associated with erythropoietin compliance. Using logistic regression, the only significant variable was the person administering the erythropoietin (r = 0.46, p = 0.005). Noncompliance with subcutaneous erythropoietin is a significant problem. Compliance may improve if someone other than the patient is trained to administer it.
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PMID:Compliance with subcutaneous erythropoietin in peritoneal dialysis patients. 1104 68

The less rigorous attention to the management of the complications of chronic renal insufficiency (CRI) and its comorbid conditions has potentially tragic consequences. In fact, with early recognition and intervention, many of the complications of CRI and its comorbid conditions can be ameliorated or prevented. We review here the most prevalent, troublesome, and potentially preventable complications and comorbidities of CRI with a view toward developing high-quality, cost-effective strategies for delivering early interventional care. Complications of CRI include malnutrition, anemia, disorders of divalent ion metabolism and osteodystrophy, metabolic acidosis, and dyslipidemia. Important comorbid conditions of CRI are hypertension, diabetes mellitus, and cardiovascular disease. Clinical intuition suggests that early intervention will avert morbidity related to the hypoalbuminemia and other nutritional disorders of CRI, the metabolic acidosis, and the dyslipidemias, but prospective data are lacking at present. Correction of anemia, usually with recombinant human erythropoietin, may be key to the prevention of cardiac disease and other comorbidities of CRI. Incipient disorders of bone and mineral metabolism are managed prospectively using such measures as protein restriction to reduce phosphorus intake, phosphate binders, calcium supplementation, and vitamin D analogues. Hypertension, whatever its original etiology, is clearly an important risk factor for the progression of kidney failure and for the development of diffuse vascular disease; appropriate and aggressive treatment is essential. In patients with diabetic nephropathy, the principles of both primary and secondary prevention have been validated in several large trials of glycemic and blood pressure control. The seeds of these insidious, challenging, and costly comorbid conditions are sown very early in CRI, at a time when they are-in theory-most amenable to intervention. We therefore must be as proactive as possible in the timely implementation of relatively simple therapies that have the potential to prevent some of these adverse outcomes of CRI.
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PMID:Complications of chronic renal insufficiency: beyond cardiovascular disease. 1111 56

Comorbid conditions that develop during chronic renal insufficiency (CRI) contribute to the high morbidity and mortality among patients with end-stage renal disease (ESRD). Thus, appropriate management during CRI may lead to improved ESRD outcomes. A retrospective cohort study was performed to describe the management of patients with CRI. A total of 602 patients with CRI (creatinine > or =1.5 mg/dl for women and > or =2.0 mg/dl for men) were seen between October 1994 and September 1998 at five nephrology outpatient clinics in the Boston area. The mean (SD) age of the patients was 63 (15.5) yr, and 53% were male. At the first nephrology visit, mean (SD) serum creatinine was 3.2 (1.6) mg/dl, and mean (SD) predicted GFR was 22.3 (8.9) ml/min per 1.73 m(2). Laboratory tests for iron levels were performed in only 18% of patients, serum parathyroid hormone levels were obtained in only 15%, lipid studies were obtained in fewer than half, and among patients with diabetes, only 28% had a glycosylated hemoglobin level measured. A hematocrit <30% was present in 38%, and abnormal calcium-phosphorus metabolism was noted in 55%. Only 59% of patients who had hematocrit <30% received recombinant human erythropoietin. Among patients who received recombinant human erythropoietin, only 47% received iron. Angiotensin-converting enzyme inhibitor use was recorded for only 65% of patients with diabetes (49% of patients overall). Among patients who were known to have progressed to ESRD, only 41% had permanent access placed before initiation of dialysis. There seems to be room for improvement in the management of patients with CRI, which could result in a slower rate of progression of CRI and reduced severity of comorbid conditions.
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PMID:Management of patients with chronic renal insufficiency in the Northeastern United States. 1142 79

We report the case of a 52-year-old woman with long-term type 1 diabetes mellitus, complicated with proliferative retinopathy, autonomic neuropathy and microalbuminuria and moderate renal failure. A normochromic, normocytic are generative anaemia had been diagnosed for three years. Clinical and biological investigations for the aetiology of anaemia remained normal or negative. Anaemia was associated with a concentration of erythropoietin (EPO) in the normal range, but inappropriately low regarding anaemia. Treatment with recombinant EPO induced a rapid increase in haemoglobin level and improved the patient's quality of life. The role of diabetic neuropathy in the genesis of anaemia, in conjunction with a modest renal impairment is discussed.
Diabetes Metab 2001 Jun
PMID:Erythropoietin-dependent anaemia: a possible complication of diabetic neuropathy. 1143 5

The demonstration of the existence of tissue-specific adult stem cells has had a great impact on our understanding of stem cell biology and its application in clinical medicine. Their existence has revolutionized the implications for the treatment of many degenerative diseases characterized by either the loss or malfunction of discrete cell types. However, successful exploitation of this opportunity requires that we have sufficient know-how of stem cell manipulation. Because stem cells are the founders of virtually all tissues during embryonic development, we believe that understanding the cellular and molecular mechanisms of embryogenesis and organogenesis will ultimately serve as a platform to identify factors and conditions that regulate stem cell behavior. Discovery of stem cell regulatory factors will create potential pharmaceutical opportunities for treatment of degenerative diseases, as well as providing critical knowledge of the processes by which stem cells can be expanded in vitro, differentiated, and matured into desired functional cells for implantation into humans. A well-characterized example of this is the hematopoietic system where the discovery of erythropoietin (EPO) and granulocyte-colony stimulating factor (G-CSF), which regulate hematopoietic progenitor cell behavior, have provided significant clinical success in disease treatment as well as providing important insights into hematopoiesis. In contrast, little is known about the identity of pancreatic stem cells, the focus of this review. Recent reports of the potential existence of pancreatic stem cells and their utility in rescuing the diabetic state now raise the same possibilities of generating insulin-producing beta cells as well as other cell types of the pancreatic islet from a stem cell. In this review, we will focus on the potential of these new developments and how our understanding of pancreas development can help design strategies and approaches by which a cell replacement therapy can be implemented for the treatment of insulin-dependent diabetes which is manifested by the loss of beta cells in the pancreas.
Diabetes Technol Ther 2000
PMID:Manipulation of pancreatic stem cells for cell replacement therapy. 1146 48

The aim of the present study was to examine the association between 4-hour dialysate-to-plasma ratio of creatinine (D/PCr), erythropoietin (EPO) responsiveness [EPO (U/week)/hemoglobin (g/L)], and C-reactive protein (CRP). Subjects were 54 prevalent peritoneal dialysis (PD) patients [mean age: 58 years; 30 women, 24 men; 28 with diabetes; 15 on continuous ambulatory peritoneal dialysis (CAPD); 39 on continuous cycling peritoneal dialysis (CCPD); mean Kt/V: 2.44]. In 17 patients, CRP was elevated (> 15 mg/L), and in 39 patients, 4-hour D/PCr was high or high-average (> or = 0.65). Mean hemoglobin (Hb) was 115.5 +/- 12.9 g/L; median EPO dose was 2800 U/week, and median EPO/Hb was 24.5. A nonsignificant negative correlation was noted between CRP and hemoglobin (r = -0.25, p = 0.07), but no correlations were seen between CRP and 4-hour D/PCr, or hemoglobin and 4-hour D/PCr. No correlation was seen between EPO/Hb and 4-hour D/PCr or CRP. Multiple linear regression (stepwise, alpha = 0.05) was performed with outcome hemoglobin and independent variables EPO [U/week (forced in)], percent transferrin saturation [TSAT (forced in)], age, sex, diabetes mellitus, serum albumin, CRP, time on PD, 4-hour D/PCr, normalized protein catabolic rate (nPCR), ferritin, intact parathyroid hormone (iPTH), aluminum, and angiotensin converting enzyme inhibitor (ACEI) use. Serum albumin (1.27, p < 0.01) and diabetes mellitus (-6.69, p = 0.04) were the only significant predictors of hemoglobin. With serum albumin removed from the model, age (but not CRP) became significant. These results do not support an association between peritoneal transport and EPO responsiveness, mediated by inflammation. The association between serum albumin and hemoglobin appears to be confounded by age more than by inflammation.
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PMID:Inflammation, peritoneal transport, and response to erythropoietin in peritoneal dialysis patients. 1151 Feb 66

The present study looked for variations in blood morphology between diabetic patients (group I, n = 7) and non diabetic patients (group II, n = 16) treated with continuous ambulatory peritoneal dialysis (CAPD). A subsequent trial sought to find a reason for discrepancies in the results between the two groups. The patients in both groups and similar ages, CAPD durations, and erythropoietin dosages. Nutrition, CAPD adequacy, serum iron and ferritin levels, total iron binding capacity (TIBC), transferrin saturation (TSAT), red blood cells (RBCs), mean corpuscular hemoglobin (MCH), mean corpuscular volume (MCV), mean corpuscular hemoglobin concentration (MCHC), hemoglobin (Hb), hematocrit (Hct), white blood cells (WBCs), total lymphocyte count (TLC), platelets (PLTs), and serum intact parathyroid hormone (PTH) were evaluated every three months. The mean result of each parameter was obtained in every patient as representative for the entire CAPD course. Means and standard deviations for all respective parameters were then calculated for the two groups and compared. In patients with diabetes as compared with patients without diabetes, significantly higher numbers of RBCs, WBCs, and PLTs were seen, as were higher values for Hb and Hct and a lower serum PTH concentration. Values for WBCs, PLTs, and MCH obtained in all patients (n = 23) were correlated with serum intact PTH (r = -0.520, p = 0.011; r = -0.422, p = 0.045; and r = -0.436, p = 0.037 respectively). When data obtained in the patients receiving erythropoietin were excluded and the correlation analysis was repeated for the 10 remaining patients, a correlation between serum PTH and RBCs was found (r = -0.685, p = 0.029). With comparable age, renal function, nutrition, erythropoietin dosage, iron indices, and CAPD adequacy, duration, and outcome, higher parameters of blood morphology in diabetic patients may be related to lower levels of serum intact PTH, indicating no or only mild secondary hyperparathyroidism. Patients with diabetes usually show smaller disturbances in PTH level than do non diabetic uremic patients on CAPD. Better peripheral morphology indices in the group with diabetes can be expected when other factors affecting hematologic status are similar.
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PMID:Parathyroid hormone contributes to variations in blood morphology in diabetic and non diabetic patients treated with continuous ambulatory peritoneal dialysis. 1151 Feb 96


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