I C MacDougall

..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...

..Some causes of hyporesponsiveness to erythropoietin, such as iron deficiency and underdialysis, are easily corrected; but others, such as primary bone marrow disorders and hemoglobinopathies, are not possible to overcome...

..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...

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

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

..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...

..The potential role of each of these inhibitory substances is discussed in this article...

..As long as the cost of epoietin therapy remains fairly high, the challenge will continue as to the best way of optimizing its effect, and we can look forward to new developments in this expanding area of research...

..This survey was performed to determine how anaemia in pre-dialysis patients is currently managed...

..NESP therefore represents a triumph for drug synthesis by recombinant DNA technology, and we can look to the future of this new therapeutic agent with much hope and expectation...

..The longer half-life of NESP is likely to confer a clinical advantage over Epoetin by allowing less frequent dosing in patients treated for anemia...

..This simple, practical IV iron dosing policy resulted in dramatic savings in epoetin dosage and cost with no significant adverse effects...

..CONCLUSIONS: Anemia associated with EPO deficiency can occur early in DN before the onset of advanced renal failure, but does not normally occur in nondiabetic renal disease of similar severity. The pathogenesis requires elucidation...

..Other potential erythropoietic substances are still at the laboratory stage of development, but may be available for therapeutic use in the next decade or so...

..Chronic renal failure is also associated with increased hepcidin production which may also exacerbate the anaemia by inducing a functional iron deficiency in such patients...

..e. either once weekly or once every other week). NESP is well tolerated, adverse effects are similar to those seen with rHuEPO, and no antibodies have been detected in >1500 patients exposed to NESP thus far...

..The incidence of adverse events with the 400- and 500-mg doses administered as a 2-hour infusion seems too high to recommend their routine use, although it may be possible to administer these doses over a longer period...

..It is important that renal anaemia patients are considered as individuals, and their treatment tailored accordingly. It is time to establish evidence-based criteria for individualizing renal anaemia treatment...

..Hypertension and nonsteroidal antiinflammatory drug use were present in about a half of the patients. It is postulated that the nephrotoxic effects of porphyrin precursors may contribute to the etiology of this clinical syndrome...

..The aim of this study was to determine whether the EPO response to hypoxia was deficient in order to clarify the mechanisms involved in this process...

..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...

..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...

..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...

..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...

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

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

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

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

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

..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...

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

..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...

..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...

..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...

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

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

..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...

..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...

..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...

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

..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 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...

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

..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...

..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...

..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...

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

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

..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...