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 51,768 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Predialysis patients often suffer from debilitating anemia, which is evident through reduced exercise tolerance, weakness, and fatigue as well as lowered hematocrit (HCT). As has been shown in dialysis populations, the anemia of predialysis patients can be treated successfully using Epoetin alfa therapy. Therapy with Epoetin alfa allows patients to resume many of their normal activities and treats the anemia without the need for blood transfusion. The nephrology nurse plays a multifactorial role in the physiologic monitoring and counseling of these patients.
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PMID:Nursing care of predialysis patients receiving epoetin alfa. 206 56

Anemia is an inevitable and potentially serious complication of chronic renal failure and one of the most important limiting factors in patient rehabilitation. Although adequate dialysis can control many of the symptoms of uremia, dialysis does not reverse anemia-associated fatigue, and thus, many patients are not rehabilitated. Human recombinant erythropoietin (epoetin) therapy has proven to be effective in reversing anemia and increasing hematocrit levels in the majority of patients with chronic renal failure. Among this patient population, increases in hematocrit level have resulted in improvements in the symptomatology of organ hypoxia, neurobehavioral indices, anorexia, insomnia, depression, and sexual disinterest and dysfunction, as well as a reduction in cardiomegaly. However, despite the availability of epoetin and the dramatic improvements in the complications associated with the anemic state observed following therapy, it appears that patient rehabilitation remains a challenge. One aspect of the continuing problem of rehabilitation appears to be the reluctance of the medical community to increase hematocrit levels above 30%, despite the fact that higher hematocrit levels are associated with greater improvements and that potential adverse events related to hemodynamic adaptation are manageable. Indeed, a comparison of the results from two Epoetin alfa clinical trials, one in which hematocrit levels were maintained at 35% and a large phase IV study in which the target hematocrit level appears to have been approximately 30%, clearly demonstrate the benefits of optimizing hematocrit levels and thus improving the potential for rehabilitation.
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PMID:In search of an optimal hematocrit level in dialysis patients: rehabilitation and quality-of-life implications. 802 33

Patients with anemia caused by end-stage renal disease experience significant fatigue and decreased tolerance for activity. Epoetin alfa corrects anemia in virtually all of these patients, thereby providing several cardiovascular benefits, but some patients may develop increased blood pressure. Nephrology nurses should maximize the benefits of correcting anemia, while ensuring that blood pressure is optimally controlled, thus preserving cardiovascular function.
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PMID:Case study of the anemic patient: epoetin alfa--focus on blood pressure. 808 Mar 16

Anemia is common in patients infected with the human immunodeficiency virus (HIV). The etiology is often multifactorial and may include the HIV infection itself, opportunistic infections, cancer, medications (particularly zidovudine and sulfa-containing drugs), or anemia of chronic disease. Epoetin alfa therapy may play a supportive role in some HIV-infected patients by increasing hemoglobin, decreasing fatigue, and reducing the need for exposure to red blood cell transfusions. A large, placebo-controlled trial in the United States for anemic patients with the acquired immunodeficiency syndrome taking zidovudine demonstrated a statistically significant improvement in hematocrit in patients treated with epoetin alfa compared with placebo. Transfusion requirements decreased in epoetin alfa-treated patients over a 3-month period compared with placebo with a trend toward improvement in quality of life. Epoetin alfa was effective, however, only in patients whose pretreatment erythropoietin levels were less than 500 mU/mL. These advantages of epoetin alfa treatment may become especially important as HIV becomes more of a chronic disease, with the concern that red blood cell transfusion may accelerate progression of HIV.
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PMID:Experience with epoetin alfa and acquired immunodeficiency syndrome anemia. 967 34

Cancer-related anaemia has a number of causes, not least the underlying malignancy itself which plays a role in suppressing erythropoiesis. Anaemia is often exacerbated by cancer treatments, in particular routinely used cytotoxic chemotherapy. Chronic anaemia of cancer is often characterized by inappropriately low levels of endogenous erythropoietin for the degree of anaemia, and manifests clinically with generalized hypoxia and resultant severe fatigue. Epoetin alfa is one recombinant form of erythropoietin, the primary human growth factor responsible for promoting proliferation and survival of erythroid progenitor cells. Epoetin alfa has been widely studied for the treatment of anaemia associated with renal failure and is now recognized as having significant potential in the management of cancer-related anaemia. Studies suggest that epoetin alfa is an effective treatment in a proportion of cancer patients with symptomatic anaemia. It also appears useful for the prevention of chemotherapy-induced anaemia. Studies in a number of different cancer settings have shown that epoetin alfa significantly increases haemoglobin and haematocrit, reduces transfusion requirements and improves quality of life for the patient.
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PMID:Epoetin in cancer-related anaemia. 1033 73

Anemia is equally devastating in children as in adults. Decreased energy levels from anemia can lead to deterioration in the ability to (a) exercise, (b) participate in the normal activities of childhood, and (c) learn. Moreover, these effects may make it difficult for children to engage in social interactions with their peers, thereby altering their development. Epoetin alfa therapy effectively ameliorates the anemia of end-stage renal disease in pediatric dialysis patients and thus minimizes many of these negative effects. This article examines the use of Epoetin alfa in the pediatric population, including the role of nurses in educating patients and ensuring prescribed outcomes.
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PMID:Anemia management in pediatric dialysis patients. Case study of the anemic patient. 1063 9

Combination drug therapy and enhanced patient management techniques result in increased survival for many AIDS patients. This phenomenon has brought the issue of fatigue, a common and difficult side effect of HIV/AIDS treatment, to the forefront. Three-quarters of the AIDS patients surveyed in a recent study indicated that fatigue negatively affects their quality of life and influences their willingness to continue aggressive treatment. New advances for combating fatigue include the use of nutritional therapy, anti-depressants, anti-infectives, medications that boost the production of red blood cells, hormone replacement, exercise, massage, and acupuncture. The most common source of fatigue in HIV-positive patients is anemia, which also causes shortness of breath and dizziness. Anti-HIV medications may inhibit red blood cell production. An alternative treatment, Epoetin alfa, works by increasing low levels of naturally producing erythropoietin, a protein manufactured in the kidneys. Fatigue resulting from low testosterone levels can be treated with anabolic steroids. Poorly functioning adrenal glands can be the cause of fatigue in patients with advanced disease. Taking hydrocortisone pills is often effective. Depression is the fourth most common cause of fatigue. Antidepressants work well without traditional side effects.
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PMID:More awareness needed in treatment of fatigue. 1136 53

Researchers and physicians are becoming more aware of the importance of quality-of-life for HIV/AIDS patients who are surviving longer than was previously possible. Fatigue ranks as one of the most devastating side effects of HIV treatment. A survey of HIV/AIDS patients indicates that fatigue prevents them from working or continuing aggressive treatment. Only 37 percent of physicians, however, were aware of their patients' struggle with fatigue. Recent advances in HIV treatment have included the area of fatigue management. The most common sources of fatigue are anemia, hormone deficiencies, depression, and lack of exercise. New advances for combating fatigue include the use of nutritional therapy, anti-depressants, anti-infectives, medications that boost the production of red blood cells, hormone replacement, exercise, massage, and acupuncture. Anti-HIV medications may inhibit red blood cell production. An alternative treatment among HIV-positive patients is the drug Epoetin alfa which works by increasing low levels of naturally producing erythropoietin, a protein manufactured in the kidneys. Fatigue can also result from low testosterone levels, which can be treated with anabolic steroids. Poorly functioning adrenal glands can be the cause of fatigue in patients with advanced disease. Taking hydrocortisone pills is often effective. Depression is the fourth most common cause of fatigue. Antidepressants work well without traditional side effects. Finally, exercise is very important in the treatment of fatigue. HIV-positive people who attend exercise classes find benefits that are both physiological and psychological.
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PMID:Fighting fatigue requires battle on many fronts. 1136 58

Recombinant human erythropoietin (r-HuEPO, epoetin alfa) is used for treatment of anemia associated with chemotherapy for non-myeloid malignancies, chronic renal failure and zidovudine treatment in patients infected with the human immunodeficiency virus and for anemic patients undergoing elective, noncardiac, nonvascular surgery. Epoetin alfa has been shown to safely increase preoperative hemoglobin (Hb) levels in anemic patients undergoing elective noncardiac, nonvascular surgery and is more effective than preoperative autologous blood donation in reducing the need for perioperative blood transfusions in orthopedic surgery patients. Epoetin alfa was shown to significantly increase Hb levels and decrease transfusion requirements in gynecologic cancer patients undergoing chemotherapy. A once-weekly regimen of 40,000 IU per dose was effective in these patients. In addition to decreasing transfusion requirements and increasing Hb, epoetin alfa for relieving anemia-related fatigue and improving quality of life was demonstrated in clinical trials in anemic cancer patients receiving chemotherapy. With regard to quality of life in orthopedic surgery patients, a novel instrument to measure the effect of Hb management on postoperative recuperative power (i.e., vigor, functional ability) has been validated and may prove to be useful in optimizing rehabilitation and discharge planning. Extensive clinical experience with epoetin alfa in anemic patients undergoing major elective orthopedic surgery or those with gynecologic cancer provides a strong basis for its use in gynecologic surgery.
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PMID:Clinical experience with epoetin alfa in the management of hemoglobin levels in orthopedic surgery and cancer. Implications for use in gynecologic surgery. 1139 87

Anaemia occurs in a significant number of patients with cancer, and is associated with symptoms of fatigue, dizziness, headache and decreased health-related quality of life. Clinical trials have demonstrated the ability of epoetin alfa to increase haemoglobin concentrations and reduce transfusion requirements in patients with cancer. Data from three large, open-label, community-based trials of >7000 patients, as well as a series of smaller, randomized, placebo-controlled studies, have confirmed the efficacy of treatment with epoetin alfa in patients undergoing chemotherapy. In two of the community-based studies (>2000 patients in each), patients undergoing chemotherapy received epoetin alfa, 150-300 IU/kg or 10,000-20,000 IU, three times weekly. Significant (P<0.01) increases in haemoglobin concentrations and reductions in transfusion rates were seen in both studies. Significant improvements in quality of life were also reported, as measured by the Linear Analogue Scale Assessment and the Functional Assessment of Cancer Therapy-Anaemia. Importantly, the increases in quality of life were independent of tumour response. These findings were also observed in randomized, placebo-controlled studies. The third study, in approximately 3000 patients, evaluated the efficacy of once-weekly dosing, which significantly (P<0.01) increased haemoglobin concentrations, reduced transfusion requirements and improved quality of life. Greater increases in haemoglobin concentration were associated with greater improvements in quality-of-life scores. The safety and efficacy profile of the once-weekly regimen was comparable with that of the three times weekly regimen. Maintaining optimal quality of life, while achieving tumour stabilization or regression, is essential to the successful management of patients with cancer. Epoetin alfa has been shown to increase haemoglobin concentration, decrease transfusion requirements and increase quality of life. Given the frequency of adverse sequelae associated with anaemia, its aggressive management should become an integral and routine part of cancer treatment.
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PMID:Managing cancer-related anaemia with epoetin alfa. 1181 17


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