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Query: UMLS:C0240066 (iron deficiency)
 7,156 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Pediatric patients with end-stage renal disease undergoing hemodialysis (HD) frequently develop anemia. Administration of recombinant human erythropoietin (rHuEPO) is effective in managing this anemia, although the additional demand for iron often results in iron deficiency. In adult patients undergoing HD, intravenous (IV) iron administration is known to replenish iron stores more effectively than oral iron administration. Nevertheless, IV iron supplementation is underutilized in pediatric patients, possibly because of unproved safety in this population. This international, multicenter study investigated the safety and efficacy of two dosing regimens (1.5 mg kg(-1) and 3.0 mg kg(-1)) of sodium ferric gluconate complex (SFGC) therapy, during eight consecutive HD sessions, in iron-deficient pediatric HD patients receiving concomitant rHuEPO therapy. Safety was evaluated in 66 patients and efficacy was evaluated in 56 patients. Significant increases from baseline were observed in both treatment groups 2 and 4 weeks after cessation of SFGC dosing for mean hemoglobin, hematocrit, transferrin saturation, serum ferritin, and reticulocyte hemoglobin content. Efficacy and safety profiles were comparable for 1.5 mg kg(-1) and 3.0 mg kg(-1) SFGC with no unexpected adverse events with either dose. Administration of SFGC was safe and efficacious in the pediatric HD population. Given the equivalent efficacy of the two doses, an initial dosing regimen of 1.5 mg kg(-1) is recommended for pediatric HD patients.
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PMID:Sodium ferric gluconate complex therapy in anemic children on hemodialysis. 1597 Oct 73

Anemia is as a frequent complication in patients with chronic kidney disease, which gains in importance in the treatment of patients with renal disease. The main cause of renal anemia is the inadequately low production of endogenous erythropoietin. Often the patients develop an additional absolute or functional iron deficiency, which complicates the diagnostic and therapeutic procedures. Substitution of recombinant human erythropoietin (r-HuEPO) is the most effective therapy. The goal is a stable haemoglobin level >11 g/dl. An often additional existing iron deficiency should be balanced adequately according to the guidelines. With consequent and early treatment morbidity, mortality, and quality of life can be effectively improved.
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PMID:[Renal anemia - an important secondary disease in renal insufficiency]. 1647 Mar 56

Sleep complaints are very common in patients with end-stage renal disease (ESRD) and contribute to their impaired quality of life. Both obstructive and central sleep apnea syndromes are reported more often in patients on dialysis than in the general population. Impaired daytime functioning, sleepiness, and fatigue, as well as cognitive problems, are well known in patients with sleep apnea. Increasing evidence supports the pathophysiological role of sleep apnea in cardiovascular disorders, which are the leading cause of death in ESRD patients. Uremic factors may be involved in the pathogenesis of sleep apnea in this patient population and optimal dialysis may reduce disease severity. Furthermore, treatment with continuous positive airway pressure may improve quality of life and may help to manage hypertension in these patients. Secondary restless legs syndrome is highly prevalent in patients on maintenance dialysis. The pathophysiology of the disorder may also involve uremia-related factors, iron deficiency, and anemia, but genetic and lifestyle factors might also play a role. The treatment of restless legs syndrome involves various pharmacologic approaches and might be challenging in severe cases. In this article we review the diagnosis and treatment of sleep apnea and restless legs syndrome, with a focus on dialysis patients. We also briefly review current data regarding sleep problems after transplantation, since these studies may indirectly shed light on the possible pathophysiological role of uremia or dialysis in the etiology of sleep disorders. Considering the importance of sleep disorders, more awareness among professionals involved in the care of patients on dialysis is necessary. Appropriate management of sleep disorders could improve the quality of life and possibly even impact upon survival of renal patients.
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PMID:Diagnosis and management of sleep apnea syndrome and restless legs syndrome in dialysis patients. 1668 72

Epidemiological studies in restless legs syndrome (RLS) have often been limited by misdiagnosis and by the fact that affected individuals, even when their symptoms are severe, might not seek medical care. Some of these limitations have been overcome in the last years as population studies based on face to face interviews have been carried out with new standardized diagnostic criteria. According to these studies, and in contrast to earlier views, RLS has been shown to be a common disorder with prevalences ranging between 2.5 and 10% of the population. Although few studies performed outside Europe/North America have shown a low prevalence, a number of methodological issues have been raised that might question these results. Furthermore, once established, RLS usually follows a chronic course, and preliminary evidence shows that it might worsen over time in some patients. Endstage renal disease, increasing age, female gender, pregnancy, frequent blood donations, iron deficiency and neuropathy are considered to be risk factors for this disorder. The association to RLS is less definitely established for other conditions, such as PD or diabetes. In summary, epidemiological evidence suggests that RLS is a common neurological disorder-with high impact on many aspects of the life of those affected.
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PMID:Epidemiology of restless legs syndrome: the current status. 1676 6

The pathophysiology of restless legs syndrome (RLS) is complex and remains to be fully elucidated. The condition is predominantly a disorder of the central rather than the peripheral, nervous system, and dopaminergic dysfunction in subcortical systems appears to play a central role. Conditions associated with secondary RLS, such as pregnancy or end-stage renal disease, are characterized by iron deficiency, which suggests that disturbed iron homeostasis may also play a role in the development of the condition. Although most patients with RLS have normal serum ferritin levels, concentrations of ferritin and transferrin in the cerebrospinal fluid are reduced, suggesting iron deficiency within the central nervous system. Although iron is necessary for the activity of tyrosine hydroxylase, the rate-limiting step in dopamine synthesis, it is unclear whether this relationship plays a role in the aetiology of RLS. There also appears to be a genetic component, particularly when the condition develops before the age of 45 years. Candidate genetic loci have been located on chromosomes 9p, 12q and 14q, but the genes involved have yet to be identified. How these three identified aetiological factors, namely dopaminergic dysfunction, impaired iron homeostasis and genetic disposition, are inter-related in the genesis of RLS remains unclear.
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PMID:Considering the causes of RLS. 1693 Mar 77

Anemia has recently been recognized as a frequent complication of diabetic nephropathy, appearing earlier than in nondiabetic renal disease and amplifying the risks of cardiovascular and microvascular complications. A major cause is an inappropriate erythropoietin response to anemia, often accompanied by iron deficiency and therapy with angiotensin-converting enzyme inhibitors and angiotensin receptor blockers.
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PMID:Anemia and diabetic nephropathy. 1711 31

Restless legs syndrome (RLS) can occur as a primary disorder, with no apparent cause other than a possible genetic predisposition, or as a secondary condition, most commonly related to iron deficiency, pregnancy, or end-stage renal disease. Recent studies have identified 2 different phenotypes of RLS based on age at onset of symptoms. Persons whose RLS symptoms start at an earlier age (<45 years) are more likely to have a family history of RLS and tend to have a more slowly progressive development of the disorder compared with individuals who have later onset of symptoms. In the past, our ability to determine either prevalence or population factors associated with increased occurrence of RLS has been limited. However, 4 different diagnostic criteria have been established. Familiarity with diagnostic criteria and clinical characteristics are essential for diagnosis and appropriate treatment, if required.
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PMID:Controversies and challenges in defining the etiology and pathophysiology of restless legs syndrome. 1719 66

Iron deficiency is the most common cause of hyporesponsiveness to erythropoiesis-stimulating agents (ESAs) in end-stage renal disease (ESRD) patients. Iron deficiency can easily be corrected by intravenous iron administration, which is more effective than oral iron supplementation, at least in adult patients with chronic kidney disease (CKD). Iron status can be monitored by different parameters such as ferritin, transferrin saturation, percentage of hypochromic red blood cells, and/or the reticulocyte hemoglobin content, but an increased erythropoietic response to iron supplementation is the most widely accepted reference standard of iron-deficient erythropoiesis. Parenteral iron therapy is not without acute and chronic adverse events. While provocative animal and in vitro studies suggest induction of inflammation, oxidative stress, and kidney damage by available parenteral iron preparations, several recent clinical studies showed the opposite effects as long as intravenous iron was adequately dosed. Thus, within the recommended international guidelines, parenteral iron administration is safe. Intravenous iron therapy should be withheld during acute infection but not during inflammation. The integration of ESA and intravenous iron therapy into anemia management allowed attainment of target hemoglobin values in the majority of pediatric and adult CKD and ESRD patients.
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PMID:Iron therapy for renal anemia: how much needed, how much harmful? 1720 11

Anemia associated with chronic renal disease remains a major concern for nephrologists as it significantly increases the morbidity and mortality in this patient group. The introduction of erythropoietin has dramatically changed the treatment of anemia in uremic patients. However, some patients showed hyporesponsiveness to erythropoietin because of inadequate iron supply to the erythroid bone marrow. Patients undergoing chronic intermittent hemodialysis are especially vulnerable to iron deficiency due to blood loss during the hemodiaylsis sessions, gastrointestinal bleeding and compromised gastrointestinal absorption. Demand for iron is also increased by the treatment for anemia with erythropoietin. Intravenous administration is more effective than oral iron supplemantation in renal failure patients. Some studies have raised concerns of the potential serious side effects associated with intravenous iron administration. Besides anaphylactic reactions that were reported to occur in less than 1% of patients treated with iron dextran and have not been associated with other iron formulations, concerns about the long-term use of iron include the increased risk of infections and oxidative stress with consequent cardiovascular disease. Therapy with dextran-free iron formulations is an essential part of anemia treatment protocols, and was not found to be associated with either short- or long-term serious side effects.
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PMID:[Principles of iron therapy in hemodialysis patients]. 1721 2

The anemia which commonly accompanies end-stage kidney disease usually remits within 10 - 16 weeks following successful kidney transplantation. However, a significant number of patients remain anemic or become anemic after transplantation. Unlike the great amount of data available on anemia in end-stage renal disease population, much less is known about post-transplant anemia (PTA). Existing literature data indicate that PTA prevalence is high; the findings of a few longitudinal studies showed a very high prevalence of PTA in the early post-transplantation period; during the first 5-year post-transplant period, 30-40% of transplant patients are anemic, and PTA increases subsequently after transplantation. Available information suggests that PTA prevalence is higher in pediatric compared to adult patients. A decrease in renal allograft function has been identified in several studies as the most important risk factor for PTA development. Other common causes of PTA include iron deficiency, systemic illnesses, acute and chronic infections, and drug toxicities. Several reports indicate that PTA is associated with an increased cardiovascular disease risk. Although PTA is a frequent problem in transplanted patients, iron and erythropoietin therapy are even underused in this population. Erythropoietinis effective and safe in correcting anemia during both early and late post-transplantation period. Prospective interventional studies in anemic kidney transplant recipients are needed to determine the most appropriate hemoglobin target in these patients and the potential beneficial role of erythropoietin therapy for cardiovascular and renal protection.
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PMID:[Anemia after renal transplantation]. 1734 89


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