Iain C Macdougall

..C.E.R.A. has a prolonged and comparable half-life after intravenous or subcutaneous injection, suggesting that extended administration intervals may be feasible in patients with CKD...

..More rigorous studies will be needed to confirm these findings...

..However, therapeutic approaches for this serious immunological reaction to recombinant ESAs remain investigative...

..We review these new therapeutic strategies, and discuss at what stage some of the newer products are in relation to their clinical development programme...

..Other strategies for stimulating erythropoiesis, briefly described in this review, are at an earlier stage of development. This is an exciting and rapidly developing area of scientific and translational research...

..Traditionally, this has been administered as an infusion over 1 or more hours, which requires the use of intravenous fluids and administration tubing, along with extra demands on patient and nursing time...

..This multicentre, open-label prospective, randomized, comparative-group study evaluated the effects of maintaining haemoglobin (Hb) in pre-dialysis chronic kidney disease (CKD) patients...

..CERA may also have different receptor binding characteristics and pharmacology from other erythropoietic agents; these characteristics are the subject of ongoing investigation. CERA is currently in phase III clinical trials...

..This may occur due to inhibition of proinflammatory cytokine production, which could interfere with the effectiveness of rh-Epo...

..Ongoing studies will investigate further the use of pentoxifylline in erythropoietin resistance...

..We investigated whether a novel, synthetic, peptide-based erythropoietin-receptor agonist (Hematide, Affymax) can stimulate erythropoiesis in patients with anemia that is caused by antierythropoietin antibodies...

..We report the first assessment of its efficacy and safety in correcting renal anemia in a population of 139 nondialysis chronic kidney disease patients...

..In the absence of any other cause (such as iron deficiency), the overproduction of cytokines may account for hyporesponsiveness to erythropoietic therapy in patients with renal failure...

..This review addresses these topics and focuses largely on the publications relevant to these areas of clinical anemia management...

..The optimal starting dose and frequency of administration of darbepoetin alfa were investigated for treating renal anaemia in dialysis patients...

..This article aims to explore some of these issues in greater detail so that patients on peritoneal dialysis can derive the greatest benefits from correction of anaemia and maintenance of an adequate haemoglobin...

..This study examined the efficacy of C.E.R.A., a continuous erythropoietin receptor activator, for correcting anemia in patients who had chronic kidney disease (CKD) and were not on dialysis...

..This article provides an overview of the recent history and growing understanding of ESA-associated PRCA together with current approaches to the management of this rare side effect of an otherwise valuable therapy...

..To compare rates of pure red cell aplasia (PRCA) over time in patients with chronic renal failure treated with subcutaneous injections of two brands of epoetin alfa (either Eprex or Epogen) or epoetin beta (NeoRecormon)...

..Obesity increases the comorbidity-adjusted relative risk of developing end-stage renal disease. Body mass index (BMI) > 30 kg/m(2) was a contraindication for transplant in our renal unit until 2008...

..Strategies utilizing anti-cytokine therapy may prove to be a useful adjuvant in optimizing the response to rHuEPO therapy...

..However, 5-10% of such patients do not respond adequately and an important contributory factor to this is chronic inflammation...

..The incidence of this adverse effect peaked in 2002, but new cases still appear sporadically. The aim of this review is to discuss the latest opinions regarding the detection and management of this condition...

..A small number of studies have supported the once-weekly use of rHuEPO. All clinical trials so far conducted on darbepoetin alfa have demonstrated success with once-weekly and once every other week dosing...

..In conclusion, the development of effective therapies for the treatment of anemia has been a highly active field, both scientifically and economically, over the last two decades...

..This study examined the effectiveness of a weight management program (WMP), and sought to determine factors associated with successful weight loss in obese patients with chronic kidney disease (CKD)...

..Recently, an immunoassay has been developed to measure circulating levels of soluble HJV (sHJV). The aim of this study was to measure serum hepcidin and sHJV levels in a chronic kidney disease (CKD) population...

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..v. iron are reassuring, the long-term safety of parenteral iron is not established in well-designed adequately powered randomized controlled trials...

..The management of iron-deficiency anaemia in patients with non-dialysis chronic kidney disease (ND-CKD) remains controversial, particularly regarding the use of oral versus intravenous iron supplementation...

..This has arisen from the paradoxical conclusions obtained from large retrospective or epidemiological studies versus interventional randomized controlled trials...

..This article reviews the latest progress with these novel erythropoietic agents in this new era in anemia management...

..This review focuses on the current knowledge regarding the etiology of antibody-mediated pure red cell aplasia and the current approach to therapy...

..Hematide is a synthetic peptide-based erythropoiesis-stimulating agent that is being developed by Affymax Inc and Takeda Pharmaceutical Co Ltd. Hematide is undergoing phase III clinical trials for anemia...

..Thus, although mass spectrometry is more accurate, it is less practical for routine clinical use at the present time...

..However, the long-term safety of the newer IV iron preparations is not yet established...

..The CREATE trial is anticipated to provide important new data that could have an impact on new strategies for management of patients with moderate anaemia and CKD not yet requiring renal replacement therapy...

..Monthly Hb values were obtained over a 12-month period. The frequency, duration, amplitude and direction of Hb fluctuations (Hb outside the range 11-12 g/dl in the Australian data-set and 11-12.5 g/dl in the UK data-set) were evaluated...

..Clinical trials with darbepoetin alfa began in 1997 and this brief article reports on two patients whose long-term anaemia management has been simplified by its use...

..Our preliminary evidence suggests that LSG is an effective treatment for obesity in patients with CKD. However, there may be additional risk associated with the procedure in patients with CKD, requiring further study...

..The drug was well tolerated, with few adverse events...

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..05). Further work in this area is required to confirm or contest the hypothesis that epoetin resistance is due to enhanced levels of immune activation...

..It is to be hoped that these important clinical trials are conducted, to permit a more subtle characterization of the patient's pathological condition and interventional requirements...

..05). CONCLUSIONS: Patients with acute porphyria may have inappropriately low levels of EPO. In contrast to the diabetic patients, this does not appear to be due to autonomic neuropathy but it may reflect mild renal tubular impairment...

..INTERPRETATION: Immunosuppressive treatment accelerates recovery from erythropoietin-induced pure red cell aplasia...

..The PRE-dialysis survey on anaemia management (PRESAM) was designed to assess the care given to pre-dialysis patients in the 12 months before haemodialysis or peritoneal dialysis, with emphasis on anaemia management...

..In this presentation, we focus on demographic data and patient referral practices of patients who enter kidney centers...

..A large interventional prospective study with valid control groups is now needed to assess the long-term contributions of clinical and biochemical factors of renal function and to elucidate the effects of therapy on outcome...

..Whether correction of anemia in patients with stage 3 or 4 chronic kidney disease improves cardiovascular outcomes is not established...

..The Optimal Renal Anaemia Management Assessment (ORAMA) is the first European study investigating the impact of adherence to the 2004 revised European Best Practice Guidelines (EBPG) and its impact on patient outcomes...

..Anemia management in patients with chronic kidney disease shows considerable regional differences across Europe, and target attainment remains suboptimal in many European nephrology centers after the revised 2004 guidelines...

..A practical algorithm for approaching the investigation and management of patients with ESA hyporesponsiveness is also provided...

..Improvement in the management of anaemia requires a fundamental change of attitude from healthcare professionals...