Anemia: Fast Facts (Peer reviewed publications)
New England Journal of Medicine publishes important review article on anemia of chronic disease
An article on anemia of chronic disease, which was co-authored by the Vice President of the National Anemia Action Council, Inc. and the President of the Society for the Advancement of Blood Management, was recently published in the New England Journal of Medicine. Weiss and Goodnough reviewed anemia of chronic disease, also known as "anemia of inflammation." The article discussed in detail various aspects of the pathophysiology of the anemia of chronic disease, laboratory evaluation, and therapeutic modalities. The authors identified knowledge gaps and provided recommendations for future research stating, "Needed are prospective, controlled studies to evaluate the effect of the management of anemia on underlying diseases, with defined end points and analysis of the possible clinical significance of erythropoietin-receptor expression on certain tumor cells…End points that correlate with improvements in morbidity and mortality in well-designed, prospective studies must be identified in order to determine the optimal therapeutic regimen for patients with anemia of chronic disease."
Weiss G, Goodnough LT. Anemia of chronic disease. N Engl J Med. 2005 Mar 10;352(10):1011-23
Study evaluates the effect of rHuEPO on the correction of anemia and kidney function after renal transplantation
Belgium researchers recently studied the treatment effects of erythropoietin (EPO) on patients receiving renal transplantation. Patients with a hemoglobin (Hb) concentration <12.5 g/dL were randomized to either receive or not receive EPO 100 U/kg three times per week. The treatment group who did not receive EPO reached a Hb level >12.5 g/dL in 66.5 days (+/- 14.5 days) versus 52.6 days (+/- 23.7 days) in the treatment group who did receive EPO. Statistical analysis determined Hb levels were not different after 3 months between the non-EPO and EPO groups except for higher increases in the EPO group from baseline. The study found 14 of 22 patients in the treatment group receiving EPO reached the target Hb level of more than 12.5 g/dL versus 12 of 18 patients in the non-EPO group (P=not significant). The researchers determined, "rHuEPO in the immediate post transplantation period seems to have no relevant clinical impact on the correction of anemia. In view of the cost, the use of rHuEpo in the post transplantation period should be limited to high-risk patients."
Van Biesen W, Vanholder R, Veys N, Verbeke F, Lameire N. Efficacy of erythropoietin administration in the treatment of anemia immediately after renal transplantation. Transplantation. 2005;79:367-368
Study evaluates erythropoietic response and anemia in hepatitis C
Researchers assessed the time course and extent of hemoglobin (Hb) changes and the erythropoietic response to PEG-IFN/RBV-induced anemia in a multicenter, observational study. Of 97 patients, mean Hb decreased from baseline to week 8 was 14.4 +/- 1.4 g/dL to 11.9 +/- 1.3 g/dL, respectively. The mean ribavirin dose decreased from a baseline of 986 +/- 190 mg/day to 913 +/- 228 mg/day by week eight. Seventy-four percent of patients who completed the study maintained their initial prescribed RBV dose, and patients with a higher baseline Hb and viral load who were maintained on the initial dose of ribavirin showed a trend toward larger Hb declines. The researchers concluded, "HCV-infected patients receiving PEG-IFN/RBV therapy have reductions in Hb, platelets, and WBCs, possibly due to bone marrow suppression. They also have diminished endogenous sEPO production for their degree of anemia."
Balan V, Schwartz D, Wu GY, et al. Erythropoietic response to anemia in chronic hepatitis C patients receiving combination pegylated interferon/ribavirin. Am J Gastroenterol. 2005;100:299-307
Researchers review the impact of anemia on outcomes in cancer patients
Researchers conducted a review of the impact of anemia on outcomes in cancer patients. The article provides a review of current practice guidelines for anemia management in cancer patients and discusses prevalence and predictive factors for anemia in relation to tumor type, hemoglobin concentration at time of treatment, and duration of treatment. The authors discuss the prognostic significance of anemia in cancer patients, specifically in association with patients receiving radiotherapy. In addition, the pathophysiology of tumor hypoxia and mechanism of action for chemotherapy and radiotherapy are discussed. The authors state there is circumstantial data which is suggestive of the ability to correct the negative effect of anemia on outcome by the use of repeated blood transfusions or recombinant human erythropoietin, but recognize the relationship is complex and attempts to evaluate this relationship have been negatively impacted by difficulty comparing study results due to diverse patient populations and multiple variables. The authors recognize, "Early attempts to measure the impact on survival in cancer patients of treating anemia have served to underline the complexity of the relationship and have produced unexpected results."
Clarke H, Pallister CJ. The impact of anaemia on outcome in cancer. Clin Lab Haematol. 2005;27:1-13
Higher prevalence of anemia with diabetes mellitus in moderate kidney insufficiency
The results of a retrospective study assessing the prevalence of anemia in the The Kidney Early Evaluation Program (KEEP 2.0) cross-sectional, community-based study were published recently in Kidney International. Statistical analysis revealed diabetes was present in 26.9% of participants, and anemia in 7.7% of this population. The study found patients with diabetes had significantly increased odds of anemia in the presence of an estimated glomerular filtration rate <30 or 30-59 mL/min/1.73m(2). The authors concluded, "Diabetes was independently correlated with anemia, more so in men than women, and may be linked to premature expression of anemia in persons with moderate reductions in kidney function."
El-Achkar TM, Ohmit SE, McCullough PA, et al. Higher prevalence of anemia with diabetes mellitus in moderate kidney insufficiency: The Kidney Early Evaluation Program. Kidney Int. 2005;67(4):1483-8
Researchers report a low hematocrit predicts contrast-induced nephropathy after percutaneous coronary interventions
A study published in Kidney International determined a decreased hematocrit is an important risk factor for contrast-induced nephropathy. Researchers evaluated 6,773 consecutive patients with percutaneous coronary interventions and contrast-induced nephropathy to evaluate the relationship between this condition and a decreased hematocrit. The data showed patients in the lowest quintile of baseline hematocrit (with hematocrit drops greater than 5.9%) had almost twice the odds of developing contrast-induced nephropathy regardless of their kidney function. The research team concluded, "Lower hematocrit is an important risk factor for contrast-induced nephropathy. Whether correcting the hematocrit prepercutaneous coronary intervention might decrease the rates of contrast-induced nephropathy should be addressed in a prospectively designed trial."
Nikolsky E, Mehran R, Lasic Z, et al. Low hematocrit predicts contrast-induced nephropathy after percutaneous coronary interventions. Kidney Int. 2005;67(2):706-13
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