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

The addition of recombinant human erythropoietin (rHuEPO) to the therapeutic regimen for children with chronic renal failure (CRF) is one of the most important improvements in care in the last 20 years. Anemia had played an important role in the morbidity of chronic dialysis treatment. Before the availability of rHuEPO, repeated erythrocyte transfusions provided incomplete treatment and had significant long-term sequelae. Recombinant erythropoietin treatment resulted in the amelioration of anemia and marked reduction in transfusions. Additional benefits of the correction of anemia with rHuEPO include improvements in exercise tolerance and regression of ventricular hypertrophy. Many rHuEPO-treated patients have had subjective increases in appetite, but there has been no consistent improvement in dietary intake or anthropometric measures. Correction of anemia with rHuEPO has not been shown to improve the growth of children with CRF receiving dialysis. The most significant adverse effects of rHuEPO are the development of iron deficiency and the exacerbation or development de novo of hypertension. RHuEPO treatment has been shown to treat the anemia of CRF in children safely and effectively. In most cases, putative inhibitors of erythropoiesis and blood loss can be overcome. Many of the symptoms previously ascribed to "uremia" have improved with correction of anemia. The full implications of treatment of anemia with rHuEPO will be clearer when the health outcomes for children who never become severely anemic or require transfusions are more completely studied.
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PMID:Recombinant human erythropoietin therapy in children on dialysis. 862 Mar 65

Anaemia is a common problem in patients with renal failure, whether or not they are on dialysis. There is a continuum of declining renal function. In addition, the creatinine clearance at which dialysis is initiated varies widely between institutions and between studies. The term 'progressive renal insufficiency' is therefore preferable to 'pre-dialysis'. The adverse effects of renal anaemia on left ventricular mass become apparent early in the course of progressive renal insufficiency; 75% of patients starting dialysis already have left ventricular hypertrophy (LVH). Correction of anaemia in patients with progressive renal insufficiency has been shown to improve physical function and anaemia-related symptoms, but no controlled studies have yet been conducted to determine its effects on LVH. Although one animal study generated some concern that epoetin may exacerbate a decline in renal function, there is no evidence from human studies for any such effect. Treatment of anaemia with epoetin in anaemic patients with progressive renal insufficiency is therefore recommended, provided blood pressure is controlled. To date, however, there are insufficient data to determine whether normalization of haemoglobin is advisable in this patient group. Detection and correction of iron deficiency is important to achieve the full benefits of epoetin, though recommendations cannot yet be made regarding the optimum route and timing of iron supplementation in patients with progressive renal insufficiency. In these patients the role of other adjuvant therapies, such as L-carnitine, vitamin B6, vitamin B12 and folic acid, also requires further investigation.
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PMID:How should anaemia be managed in pre-dialysis patients? 1033 70

Renal anaemia starts earlier in the progression of chronic kidney disease (CKD) than was previously thought and is often inadequately monitored and treated. Current treatment guidelines recommend giving recombinant erythropoietin (rHuEPO) as soon as haemoglobin (Hb) concentration falls below 11 g/dl and alternative causes of anaemia have been ruled out. Recent studies show that, in practice, few patients receive rHuEPO in the pre-dialysis period and Hb concentrations are often <9 g/dl at the start of haemodialysis. This is at odds with best practice since renal anaemia is a major risk factor for left ventricular hypertrophy. Many factors other than provision of rHuEPO therapy can affect the occurrence and severity of renal anaemia. Iron deficiency is the most common cause of resistance to rHuEPO and appropriate use of iron supplementation in patients with CKD is still being debated. The acute-phase immune response has a more significant role in renal anaemia and rHuEPO resistance than previously believed, as demonstrated by the need for higher rHuEPO doses in patients with raised levels of C-reactive protein. Women often need higher doses of rHuEPO than men, which may be related to differences in androgen levels between the sexes. Low erythropoietin concentrations are a major factor in diabetic nephropathy. Correction of anaemia with rHuEPO may slow progression of CKD by reducing oxidative stress. These and other factors need to be considered for the optimal treatment of patients with anaemia of CKD.
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PMID:Non-erythropoietin-based anaemia management in chronic kidney disease. 1238 56

In renal failure, severe anemia and associated fatigue, cognitive and sexual dysfunction have a significant impact on the patient's quality of life. Anemia has also been identified as an important etiologic factor in the development of left ventricular hypertrophy. The major cause of anemia in presence of a reduction of glomerular filtration rate is an inadequate production of a glycoprotein hormone, the erythropoietin (EPO). EPO is the primary regulator of the growth and survival of erythroid progenitor. The introduction of recombinant human erythropoietin (rHuEPO) has revolutionized the treatment of anemia in chronic renal failure. The vast majority of patients respond very well to treatment, but 5-10% of patients show some resistance to EPO, the most common cause of which is iron deficiency. Several studies are recently commenced to investigate the effects of preventing renal anemia ever developing. The target of hemoglobin concentration in pre-dialysis and dialysis patients are object of continuous re-examinations.
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PMID:Anemia in renal insufficiency. 1273 11

In patients with renal failure, severe anemia and associated fatigue, cognitive and sexual dysfunctions have a significant impact on the quality of life. Anemia also represents an important etiological factor in the development of left ventricular hypertrophy. An inadequate production of a glycoprotein hormone, erythropoietin (EPO), is the major cause of anemia in presence of a reduction in the glomerular filtration rate. EPO is the primary regulator of the growth and survival of the erythroid progenitor. The treatment of anemia in chronic renal failure has been revolutionized by the introduction of recombinant human EPO. The vast majority of patients responds very well to treatment, although 5-10% of patients shows some resistance to EPO, the most common cause of which is iron deficiency. Several studies have recently been started in order to investigate the effects of preventing renal anemia from ever developing in uremic patients. The hemoglobin concentration target in pre-dialysis and dialysis patients is the subject of continuous re-assessment.
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PMID:Anemia and erythropoietin treatment in chronic kidney diseases. 1594 19

Anemia in children with chronic kidney disease (CKD) is common secondary to inadequate erythropoietin production, iron deficiency, blood loss, inflammation, secondary hyperparathyroidism, uremic toxins, and nutritional deficiencies. Anemia has a variety of deleterious consequences, including associations with increased mortality and left ventricular hypertrophy. Recombinant human erythropoietin is effective in treating anemia in children with CKD, and recent studies show that darbepoetin alpha is an attractive alternative because it requires less frequent injections. Iron deficiency is a major cause of anemia that is resistant to erythropoietin or darbepoetin alpha. Although oral iron is effective in some patients, many children, especially those receiving hemodialysis, require intravenous iron to replenish their iron stores. Both acute dosing and chronic dosing of intravenous iron are effective in pediatric patients.
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PMID:Anemia in children with chronic kidney disease. 1619 78

Anemia is common in renal failure in both predialysis and in patients maintained on dialysis. Consequences of anemia include decreased cognitive function, decreased exercise tolerance and a feeling of inadequate well being as well as increased left ventricular hypertrophy and dilatation that result in increased cardiovascular morbidity and mortality. Iron deficiency is the most common factor for erythropoietin resistance even in predialysis patients. This article reviews the factors involved in anemia in predialysis patients, management issues and current recommendations.
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PMID:Anemia management in patients with chronic renal disease: current recommendations. 1820 28

Anemia is the most frequent haematological problem of chronic kidney disease (CKD). It begins in early stage of CKD and worsens with disease progression, affecting nearly all of predialysis patients. It is usually asymptomatic, therefore is underdiagnosed and undertreated. Anemia of CKD is predominantly a result of abnormal erythropoietin (EPO) production and iron deficiency. Renal anemia is associated with an increased risk of ischemic heart disease, left ventricular hypertrophy, chronic heart failure and higher cardiovascular morbidity and mortality. Patients et risk for CKD should be more often monitored for early detection of anemia so they could start with treatment on time. Recent studies show that erythropoeisis-stimulating agents (ESAs) are effective in predialysis especially if used with antihypertensive agents and statin. Correcting anemia in early stage kidney disease may delay progression to end-stage kidney disease (ESRD) and prolong time to start dialysis. Improved cardiac function in those patients reduce morbidity and mortality risk and improve quality of life (QoL) in patients with CKD.
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PMID:[Treatment anaemia of chronic kidney disease in predialysis patients (stage 1-4)]. 2023 47

Chronic untreated anemia or iron deficiency (ID) can result in an increased cardiac output, chronic sympathetic activation, left ventricular hypertrophy, and left ventricular dilation, leading to symptomatic chronic heart failure (CHF). Only in the past decade has there been an increase in interest in anemia and ID occurring in the course of CHF. The pharmacologic support in erythropoietin signaling or the correction in iron metabolism may activate molecular pathways that can protect the heart and prevent myocardial remodeling, and hence become a novel therapeutic approach in patients with CHF. Most of the data come from experimental models. Further studies, in particular performed in clinical settings, are warranted.
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PMID:Molecular changes in myocardium in the course of anemia or iron deficiency. 2063 Apr 4

Pulmonary hypertension (PH), a serious disorder with a high morbidity and mortality rate, is known to occur in a number of unrelated systemic diseases. Several hematological disorders such as sickle cell disease, thalassemia and myeloproliferative diseases develop PH which worsens the prognosis. Associated oxidant injury and vascular inflammation cause endothelial damage and dysfunction. Pulmonary vascular endothelial damage/dysfunction is an early event in PH resulting in the loss of vascular reactivity, activation of proliferative and antiapoptotic pathways leading to vascular remodeling, elevated pulmonary artery pressure, right ventricular hypertrophy and premature death. Hemolysis observed in hematological disorders leads to free hemoglobin which rapidly scavenges nitric oxide (NO), limiting its bioavailability, and leading to endothelial dysfunction. In addition, hemolysis releases arginase into the circulation which converts L-arginine to ornithine, thus bypassing NO production. Furthermore, treatments for hematological disorders such as immunosuppressive therapy, splenectomy, bone marrow transplantation, and radiation have been shown to contribute to the development of PH. Recent studies have shown deregulated iron homeostasis in patients with cardiopulmonary diseases including pulmonary arterial hypertension (PAH). Several studies have reported low iron levels in patients with idiopathic PAH, and iron deficiency is an important risk factor. This article reviews PH associated with hematological disorders and its mechanism; and iron homeostasis and its relevance to PH.
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PMID:Hematological disorders and pulmonary hypertension. 2807 Feb 38


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