Erythropoietin-Stimulating Agent Hyporesponsiveness in Patients Living with Chronic Kidney Disease

<b><i>Background:</i></b> Erythropoietin-stimulating agent (ESA) hyporesponsiveness is commonly observed in patients with anemia secondary to chronic kidney disease (CKD). Because of its complexity, a global consensus on how we should define ESA hyporesponsiveness remains unavailable. The reported prevalence and demographic information on ESA hyporesponsiveness within the CKD population are variable with no consensus definition. <b><i>Summary:</i></b> ESA hyporesponsiveness is defined as having no increase in hemoglobin concentration from baseline after the first month of treatment on appropriate weight-based dosing. The important factors associated with ESA hyporesponsiveness include absolute or functional iron deficiency, inflammation, and uremia. Hepcidin has been demonstrated to play an important role in this process. Mineral bone disease secondary to CKD and non-iron malnutrition among other factors are also associated with ESA hyporesponsiveness. There is continued debate toward determining a gold-standard treatment pathway to manage ESA hyporesponsiveness. The development of hypoxia-inducing factor-stabilizers brings new insights and opportunities in the management of ESA hyporesponsiveness. <b><i>Key Message:</i></b> Management of ESA hyporesponsiveness involves a comprehensive multidisciplinary team approach to address its risk factors. The progression of basic and clinical research on identifying risk factors and management of ESA hyporesponsiveness brings greater hope on finding solutions to eventually tackling one of the most difficult problems in the topic of anemia in CKD.

Studies on bioavailability of iron from fe-fortified commercial edible mushroom Hypsizygusulmarius and standardization of its delivery system for human nutrition

Iron is one of the most important micronutrients for human health. Iron deficient diet and defective iron absorption are among the major reasons for iron malnutrition. Mushrooms are edible fungi, which are a very good source of iron and can be easily grown on agricultural residues at-home scale, dehydrated, and stored in powder form, which can supplement the daily diet. Although mushrooms in general and oyster mushrooms, in particular, are a rich source of iron, yet, have not become a recommended diet by nutritionists due to lack of data pertaining to its bioavailability from mushrooms. Data has been generated in the present study on the in vitro bioavailability of iron from non-fortified and iron-fortified Hypsizygus ulmarius, which is a commercially grown species. This is the first report pertaining to the bioavailability of iron from iron-fortified mushrooms. A delivery system for human nutrition was also standardized in the form of Arka Mushroom Fortified Rasam Powder using iron-fortified and non-fortified mushrooms, which can be used to mitigate iron malnutrition. The data generated in this study will help in providing application techniques to use mushrooms as a dietary source of iron in everyday diet to mitigate iron deficiency.