Erythropoietin and the Role of Inflammation in Anaemia in Patients with Chronic Renal Living in Cote D’ivoire

Introduction: Anemia is one of the most common complications of kidney failure. The kidney is responsible for the production of erythropoietin, a key hormone in erythropoiesis. Insufficient production of erythropoietin due to impaired kidney functions and also inflammation could explain this anemia. This study aimed at contributing to a better understanding of the mechanisms of erythropoietin in anemia observed in kidney failure. Methods: The study population consisted of 138 people: 92 with chronic renal failure (46 not on dialysis, 46 on hemodialysis) and 46 voluntaries as control without kidney failure. Serum concentrations of urea, creatinine, C-reactive protein (CRP), serum iron, ferritin and transferrin were determined using the Cobas C311 Hitachi machine. The erythropoietin assay was performed on the ELISA chain. Results: Lower mean values ​​of EPO, increased CRP and decreased iron were observed in CKF patients (EPO: 5.66 ± 0.97 mIU / L; CRP: 45 ± 7.46 mg / l ; Iron: 12.46 ± 0.85 µmol / l), and patients under dialysis (EPO: 9 ± 0.51 mIU / L; CRP: 9 ± 2.66 mg / l; Iron: 10.07 ± 0.54 µmol / l) compared to controls (EPO: 18 ± 1.29 mIU / L; CRP: 2 ± 0.30 mg / l; Iron: 15.85 ± 0.56 µmol / l). Conclusion: Anemia in chronic renal failure is thought to be due to an erythropoietin deficiency but also to an exacerbation of inflammation with a disruption of the iron status.

Anemia in Chronic Kidney Disease : Role of Hypoxia Inducible Factor Stabilizer

A B S T R A C TAnemia contributes to increased morbidity and mortality in chronic kidney diseasepatients. The pathogenesis of anemia in these patients is multifactorial, but thecontribution of erythropoietin deficiency becomes greater as glomerular filtrationrate declines which related to decreased nephron mass. The current standard ofcare includes supplemental iron, erythropoiesis-stimulating agents (ESA), and redblood cell transfusions, although each has drawbacks. Lately, concern has arisenfollowing randomized clinical trials showing that higher hemoglobin targets and/orhigh ESA doses may cause significant harm including increasing cardiovascular andthrombotic events, and even death. Recent experimental and clinical studies showthe promising efficacy of hypoxia inducible factor (HIF) stabilizer which stimulatesendogenous erythropoietin production and enhance iron availability.

Anemia in Chronic Kidney Disease : Role of Hypoxia Inducible Factor Stabilizer

Anemia contributes to increased morbidity and mortality in chronic kidney disease patients. The pathogenesis of anemia in these patients is multifactorial, but the contribution of erythropoietin deficiency becomes greater as glomerular filtration rate declines which related to decreased nephron mass. The current standard of care includes supplemental iron, erythropoiesis-stimulating agents (ESA), and red blood cell transfusions, although each has drawbacks. Lately, concern has arisen following randomized clinical trials showing that higher hemoglobin targets and/or high ESA doses may cause significant harm including increasing cardiovascular and thrombotic events, and even death. Recent experimental and clinical studies show the promising efficacy of hypoxia inducible factor (HIF) stabilizer which stimulates endogenous erythropoietin production and enhance iron availability.

ETIOLOGICAL PROFILE OF 50 CASES 0F ANAEMIA IN CKD

Background and objectives: Anaemia is a common and significant complication of chronic kidney disease (CKD). When present it may cause symptoms such as fatigue and shortness of breath. It is associated with reduced quality of life and increased cardiovascular disease, hospitalizations, cognitive impairment and mortality. As kidney disease progresses, anaemia increases in prevalence affecting nearly all patients with stage V CKD. In patients with CKD, anaemia is defined as the situation in which the concentration of haemoglobin (Hb) in the blood is below 2 times the SD of the mean Hb of the general population. As the pathogenesis of anaemia in CKD is mutlifactorial, this study is intended to know various etiological factors responsible for anaemia in CKD patients. Methods: 50 patients who met with inclusion criteria and exclusion criteria are subjected to detail clinical examination and investigations. Depending upon data obtained, results are evaluated and the percentage of various types of anaemia in CKD was calculated. Results: At the end of study, anaemia of chronic disease (60%) constitutes the commonest cause of anaemia in CKD, followed by iron deficiency anaemia (30%) and megaloblastic anaemia (10%) due to vitamin B12 deficiency. Conclusion: Among 50 cases of anaemia in CKD, anaemia of chronic disease due to erythropoietin deficiency was the most common cause followed by iron deficiency anaemia. Usually clinical examination and routine simple investigations will clinch the diagnosis in most of the cases.

How I treat renal anemia

Anemia is a frequent complication of kidney disease. When severe, it causes symptoms that can be debilitating. The course of anemia tends to track the decline in kidney function, with prevalence increasing in more advanced disease. Although the most common cause is relative erythropoietin deficiency, other factors such as reduced iron availability contribute to the pathobiology. In this review, we use cases to explore the surprising complexity of decision-making in management of renal anemia.

Clinical and genetic markers of erythropoietin deficiency anemia in chronic kidney disease (predialysis) patients

Aim: To determine the clinical and genetic markers associated with erythropoietin deficiency anemia in predialysis individuals. Materials & methods: Patients were categorized into cases and control group. Demographic characteristics and clinical parameters were obtained from medical record review and serum EPO and ferritin were obtained with ELISA. HIF-1α (rs2057482), IL-1β (rs1143627) and EPO (rs1617640) gene polymorphism were genotyped. Results: Female gender, glomerular filtration rate, treatment with hematinics, anticoagulant and diuretic were strong predictors of EPO-deficient anemia in predialysis chronic kidney disease patients. Genetic polymorphism in the HIF-1α recessive model was associated with non-EPO-deficiency, followed by EPO recessive allele associated with low-serum erythropoietin and IL-1β recessive model with low hemoglobin level. Conclusion: EPO-deficiency anemia can be diagnosed more conveniently in the presence of biomarkers.

Therapeutic efficacy of erythropoietin alfa and erythropoietin beta in hemodialysis; a randomized controlled trial

Introduction: Anemia, as a common complication of end-stage renal disease (ESRD), usually develops due to erythropoietin deficiency. Recombinant human erythropoietins (rHEPOs) are indicated for the correction of renal anemia. Objectives: We aimed to evaluate the efficacy of a new brand of erythropoietin named CinnaPoietin (erythropoietin beta) on hemoglobin levels. Patients and Methods: This is a randomized double-blinded controlled trial. Ninety-six ESRD patients on hemodialysis recruited in the study, whose hemoglobin levels was less than 10 g/dL. They allocated to two groups. PDPoetin (erythropoietin alfa) 50-100 U/kg three times per week intravenously administrated to the control group and CinnaPoietin with exactly same regimen as like PDPoetin group administrated for the rest of the participants. The study duration was 3 months. We measured plasma hemoglobin monthly for 3 months. Results: We found, hemoglobin was increased across the time and it was statistically significant (P<0.001), while there was no statistically significant differences between the groups (P=0.712). Conclusion: According to the result of the present study there is no statistical significant difference between these two brands of exogenous rHEPO in the case of increasing the hemoglobin concentration.