Hypochromic red cells as predictors of anemia in patients undergoing hemodialysis: an observational retrospective study

The percentage of hypochromic red blood cells (%HRC) estimates the availability of iron by evaluating the degree of hemoglobinization. We investigated whether %HRC was a predictor of anemia in patients undergoing hemodialysis. We recruited 142 patients undergoing routine hemodialysis between 2017 and 2019. Delta hemoglobin level (ΔHb)1mo-baseline was calculated as the difference between the hemoglobin level at 1 month after study enrollment and that at the time of study enrollment. Development of anemia was defined as hemoglobin level ≤ 15% of baseline. The median %HRC was 3.1%. There was a significant negative correlation between (ΔHb)1mo- baseline and %HRC (r = − 0.63, P < 0.001). The incidence of anemia was significantly higher in patients with %HRC > 3.1% than in those with %HRC ≤ 3.1%. In the multivariate logistic regression analysis, %HRC was significantly related to the development of anemia (odds ratio 2.57, 95% confidence interval [CI] 1.72–3.85, P < 0.001). The best cutoff value for %HRC to predict the development of anemia was 4.3%, with a sensitivity and specificity of 67.74 (95% CI, 54.7–79.1) and 97.50 (95% CI, 91.3– 99.7), respectively. %HRC is an independent predictor of anemia in patients undergoing hemodialysis. %HRC ≤ 4.3% is an early marker to consider changing the anemia treatment.

Efficacy of Butanolic Fraction of Cocos Nucifera's Root Aqueous Extract on Induced Anemia Treatment

Cocos nucifera was a coastal plant whose roots were used in pharmacopoeia to treat anemia in Benin. The aqueous extract from its roots stimulated the synthesis of hemoglobin. The aim of this work was to test in vivo the efficacy of the butanolic fraction of the extract in the treatment of anemia. Methods: Wistar rats were anemic with phenylhydrazine for two days. From D2 to D15, some were treated by gavage with the butanolic fraction of the aqueous extract of Cocos nucifera roots at the dose of 40 mg or 60 mg / kg of body weight / day, others were treated with vitafer (an anti-anemic drug) or with distilled water. The rats blood were collected on days D0, D2, D7, D10 and D15 for the complete blood count and the osmotic resistance of the red blood cells. Results: On D2, phenylhydrazine significantly lowered the hemoglobin level and the number of red blood cells, which were respectively corrected on D10 and D15 by the fraction of extract with release of hypochromic macrocytes. However, the effect was slower than that of the crude extract, was not specific to erythropoiesis because it also stimulated thrombopoiesis and was not dose-dependent. Conclusion: The butanolic fraction of the aqueous extract of Cocos nucifera roots corrected anemia by stimulation of hematopoiesis. The observed biological activity would probably be linked to anthocyanins which are mainly isolated by butanol. These results contribute to a better knowledge of bioactive compounds of our antianemic plants.

Cohen’s d and physicians’ opinion on effect size: a questionnaire on anemia treatment

A well-known effect size (ES) indicator is Cohen’s d. Cohen defined d measures of small, medium, and large ES as 0.2, 0.5, and 0.8, respectively. This approach has been criticized because practical and clinical importance depends on the context of research. The aim of the study was to examine physicians’ perception of ES using iron deficiency anemia treatment as an example and observing the effects of pretreatment level and duration of treatment on the magnitude of ES. We prepared a questionnaire describing four different clinical studies: (1) 1 month of treatment of anemia in a group of patients with a mean hemoglobin (Hb) of 10 g/dL; (2) 3 months of treatment at an Hb level of 10 g/dL; (3) 1 month of treatment at an Hb level of 8 g/dL; and (4) 3 months of treatment at an Hb level of 8 g/dL. In each scenario, respondents were required to evaluate six various levels of Hb improvement as being very small, small, medium, large, or very large effect: 0.1 g/dL, 0.3 g/dL, 0.7 g/dL, 1.1 g/dL, 1.7 g/dL, and 2.8 g/dL. The responses of 35 physicians were evaluated. For 10 mg/dL, the Cohen's d for small, medium, and large ES was 0.5, 0.8, and 1.2 respectively, for 1 month of treatment. In terms of 3 months of treatment, the Cohen's d was 0.8, 1.2, and 2, respectively. Two separate pretreatment Hb levels (8 g/dL and 10 g/dL) demonstrated a minor difference. Determination of ES during the planning phase of studies requires thorough evaluation of specific clinical cases. Our results are divergent from the classic Cohen’s d values. Additionally, duration of treatment affects ES perception.

Hypochromic Red Cells as Predictors of Anemia in Patients Undergoing Hemodialysis: An Observation Retrospective Study

The percentage of hypochromic red blood cells (%HRC) estimates the availability of iron by evaluating the degree of hemoglobinization. We investigated whether %HRC was a predictor of anemia in patients undergoing hemodialysis. We recruited 142 patients undergoing routine hemodialysis between 2017 and 2019. Delta hemoglobin level (ΔHb)1mo-baseline was calculated as the difference between the hemoglobin level at 1 month after study enrollment and that at study enrollment. Development of anemia was defined as hemoglobin level ≤15% of baseline. The median %HRC was 3.1%. There was a significant negative correlation between (ΔHb)1mo- baseline and %HRC (r = -0.63, P < 0.001). The incidence of anemia was significantly higher in patients with %HRC >3.1% than in those with %HRC ≤3.1%. In the multivariate logistic regression analysis, %HRC was significantly related to the development of anemia (odds ratio 2.57, 95% confidence interval [CI] 1.72–3.85, P < 0.001). The best cutoff value for %HRC to predict the development of anemia was 4.3%, with a sensitivity and specificity of 67.74 (95% CI, 54.7–79.1) and 97.50 (95% CI, 91.3– 99.7), respectively. %HRC is an independent predictor of anemia in patients undergoing hemodialysis. %HRC ≤4.3% is an early marker to consider changing the anemia treatment.

Uptake of evidence by physicians: De-adoption of erythropoiesis-stimulating agents after the TREAT trial

Background Variation in de-adoption of ineffective or unsafe treatments is not well-understood. We examined de-adoption of erythropoiesis-stimulating agents (ESA) in anemia treatment among patients with chronic kidney disease (CKD) following new clinical evidence of harm and ineffectiveness (the TREAT trial) and the FDA’s revision of its safety warning. Method We used a segmented regression approach to estimate changes in use of epoetin alfa (EPO) and darbepoetin alfa (DPO) in the commercial, Medicare Advantage (MA) and Medicare fee-for-service (FFS) populations. We also examined how changes in both trends and levels of use were associated with physicians’ characteristics. Results Use of DPO and EPO declined over the study period. There were no consistent changes in DPO trend across insurance groups, but the level of DPO use decreased right after the FDA revision in all groups. The decline in EPO use trend was faster after the TREAT trial for all groups. Nephrologists were largely more responsive to evidence than primary care physicians. Differences by physician’s gender, and age were not consistent across insurance populations and types of ESA. Conclusions Physician specialty has a dominant role in prescribing decision, and that specializations with higher use of treatment (nephrologists) were more responsive to new evidence of unsafety and ineffectiveness.

The burden and management of anemia in Greek patients with inflammatory bowel disease: a retrospective, multicenter, observational study

Background Anemia is a common extraintestinal manifestation of Inflammatory Bowel Disease (IBD) affecting negatively the patients’ quality of life. The aim of this study was to determine the frequency and real-life management of anemia in IBD patients in Greece. Methods This study was conducted in 17 Greek IBD referral centers. Demographic, clinical, laboratory, IBD and anemia treatment data were collected and analyzed retrospectively. Results A total of 1394 IBD patients [560 ulcerative colitis (UC), 834 Crohn’s disease (CD)] were enrolled. Anemia at any time was reported in 687 (49.3%) patients of whom 413 (29.6%) had episodic and 274 (19.7%) had recurrent/persistent anemia. Anemia was diagnosed before IBD in 45 (6.5%), along with IBD in 269 (39.2%) and after IBD in 373 (54.3%) patients. In the multivariate analysis the presence of extraintestinal manifestations (p = 0.0008), IBD duration (p = 0.026), IBD related surgeries and hospitalizations (p = 0.026 and p = 0.004 accordingly) were risk factors of recurrent/persistent anemia. Serum ferritin was measured in 839 (60.2%) IBD patients. Among anemic patients, 535 (77.9%) received treatment. Iron supplementation was administered in 485 (90.6%) patients, oral in 142 (29.3%) and intravenous in 393 (81%). Conclusions The frequency of anemia in IBD patients, followed at Greek referral centers, is approximately 50%. Development of recurrent/persistent anemia may be observed in 20% of cases and is independently associated with the presence of extraintestinal manifestations, IBD duration, IBD related surgeries and hospitalizations. Anemia treatment is administered in up to $$4/5$$ 4 / 5 of anemia IBD patients with the majority of them receiving iron intravenously.

Impact of chronic kidney disease on hemoglobin among patients with peripheral artery disease treated with P2Y12 inhibitors: Insights from the EUCLID trial

Patients with chronic kidney disease may develop new or more severe anemia when treated with antiplatelet agents due to blood loss in conjunction with impaired erythropoiesis. Because anemia independently predicts limb amputation and mortality among patients with peripheral artery disease (PAD), we evaluated the relationship between estimated glomerular filtration rate (eGFR) and hemoglobin (Hb) levels in the EUCLID trial in which patients with symptomatic PAD were randomized to ticagrelor or clopidogrel. At baseline, 9025, 1870, and 1000 patients had eGFR ⩾ 60, 45–59, and < 45 mL/min/1.73 m2, respectively. The mean fall in Hb during the trial was 0.46 ± 1.68 g/dL and did not differ by baseline eGFR category, although Hb fall ⩾ 10% was more frequent among patients with lower eGFR ( p for trend < 0.0001). On-study treatment with iron, erythropoiesis-stimulating agents, and/or red blood cell transfusion was reported for 479 (5.3%), 165 (8.8%), and 129 (12.9%) patients in the three eGFR categories, respectively ( p for trend < 0.0001). After adjustment for baseline and post-randomization effects, those not receiving anemia treatment had a smaller reduction in Hb from baseline than those receiving anemia treatment ( p < 0.0001). Other determinants of Hb reduction included absence of on-study myocardial infarction, coronary or peripheral revascularization, residence outside North America, male sex, and baseline eGFR. We conclude that among patients with PAD treated with P2Y12 inhibitors, lower baseline eGFR was associated with a greater reduction in Hb. ClinicalTrials.gov Identifier: NCT01732822

P537 Anemia in Crohn’s Disease: Response to treatment and risk of recurrence

Background Anemia is common in Crohn’s Disease (CD). Iron deficiency and inflammation are the most common etiologies. The aim of our study is to assess the response of patients with CD to anemia treatment , as well as the predisposing factors for recurrence after treatment. Methods This is a retrospective study including patients with CD complicated by anemia, treated in the gastroenterology department between January 2015 and December 2019. Iron deficiency anemia is defined by a ferritin level &lt;50 ng /ml, it is inflammatory if the CRP level is high with a ferritin level which exceeds 100 ng/ml and mixed if this later ranges between 50 and 100 ng/ml. Results Fifty-four patients were included with a M / F sex ratio of 1.3. The mean age was 40.5 years old with a mean age at diagnosis of CD of 29 years old. Patients had ileal or ileocolic involvement in 82.2% of cases and pure colonic involvement in 16.7%. The main symptoms of anemia were asthenia (64.8%) and mucocutaneous pallor (42.6%). Severe anemia was noted in 64.8% of patients. The factors statistically associated with severe anemia were: the number of relapses before the diagnosis of anemia (p= 0.012), an active disease (p = 00.024) assessed by the CDAI score, the presence of a deficiency syndrome, in particular hypocholesterolemia (p= 0.007) and hypocalcemia (p= 0.006). The anemia was inflammatory in 44.4% of patients, iron deficiency in 31.7%, mixed in 20.4% and vitamin B12 deficiency in 16.7% of them. Treatment of anemia depending on the etiology was effective in 72% of patients. The response was partial in 24% of cases. Only 4% of patients did not respond to treatment. The predictive factors of a poor response to anemia treatment were: the disease duration (p= 0.05), an active disease at the time of diagnosis of anemia (p= 0.025) and an extended ileal resection (p= 0.005). Patients with inflammatory anemia responded better to treatment (p= 0.006). A longer duration of iron suplementation (p = 0.02), as well as the route of administration (IV) (p= 0.014) were correlated with a better response to therapy in case of iron deficiency anemia. Recurrence of anemia was observed in 84.3% of patients with a mean time after anemia correction of 11.5 months. Serum ferritin levels &lt;20 ng/ml during follow-up was the main risk factor for recurrence of anemia (p= 0.01). Conclusion Even after treatment, recurrence of anemia is common especially in patients followed for CD with ileal involvement. A clinical-biological remission, a sufficient duration of iron treatment and the control of the response to treatment by the dosage of the ferritin level even after the correction of the anemia is necessary in order to avoid this recurrence and thus ensure a better quality of life .

Quality of life of CKD patients with routine hemodialysis in Haji Adam Malik Hospital Medan

Objective: To elicit quality of life of chronic kidney disease (CKD) patients with routine hemodialysis receiving erythropoietin from clinical and humanistic outcome, to analysis characteristic factors to Hb, fatique and the quality of life (QOL) of CKD patients with routine hemodialysis, and to explore the change in QOL over one month for patients managed in the hospitals. Methods: A prospective study was conducted among adult CKD patients in Haji Adam Malik Hospital Medan. QOL was measured using kidney disease quality of life – short form (KDQOL–SFTM) questionnaire and FACIT fatigue scale questionnaire. CKD patients. Patients were asked to complete the KDQOL–SFTM questionnaire and FACIT fatigue scale questionnaire two times in one month range. Results: Average rate of haemoglobin was increased after one month anemia treatment using erythropoietin 8.68: 8.82. Average rate of FACIT was increased after one month anemia treatment using erythropoietin 43.98: 44.81. Average rate of KDQOL was increased after one month anemia treatment using erythropoietin 76.83: 77.94. Conclusion: Erythropoietin can improve QOL of CKD patients with routine hemodialysis.