Comparing ESA Dosing Regimens for Anemic Kidney Disease Patients
Pergola et al conducted a randomized, open label, multicenter study to test the hypothesis that extended dosing regimens of epoetin alfa would be as safe and effective as approved dosing regimens, concluding that extended dosing regimens were not inferior to the standard three times per week dosing regimen when used to treat anemia in subjects with stage 3-4 CKD. Unfortunately, the increased dose required for significant extension of the dosing interval would make this approach untenable in the anticipated environment of bundled payments for dialysis services. Until our understanding of the basic physiology improves, we will be continuing to use ESAs in a largely empirical fashion rather than based on the important and distinctive pharmacokinetics and pharmacodynamics of individual agents.
Read Full Summary and Expert Commentary »
Pergola PE, Gartenberg G, Fu M, Wolfson M, Rao S, Bowers P. A Randomized Controlled Study of Weekly and Biweekly Dosing of Epoetin Alfa in CKD Patients With Anemia. Clin J Am Soc Nephrol. 2009 Sep 17.
Anemia can be a consequence of nutritional deficiencies or chronic diseases, but it may also occur from the treatment of the disease itself. Several types of drugs have been reported to cause different forms of anemia, including aplastic anemia, megaloblastic anemia, hemolytic anemia, and anemia caused by blood loss, chronic inflammation or suppression of red blood cell production. This article outlines a range of medications which can lead to these types of anemia so that you may be able to prevent or minimize drug-induced cases of anemia.
Bariatric surgery, also known as weight loss surgery, has become increasingly popular in recent years to help the morbidly obese permanently reduce their weight. In the past decade the number of surgeries has increased more than 10-fold with about 220,000 surgeries taking place in the United States in 2008 alone. Despite its increasing popularity and considerable success, bariatric surgery does not come without important nutritional considerations. Many bariatric patients develop new or worsen preexisting iron and vitamin deficiencies, with some patients becoming anemic in the months and years following the procedure. This article discusses how nutritional deficiencies can develop and provides tips on how to avoid deficiencies and anemia following the procedure.