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Inflammation and its impact on anaemia in chronic kidney disease: from haemoglobin variability to hyporesponsiveness

The availability of erythropoiesis-stimulating agents (ESAs) has revolutionized the treatment of anaemia in patients with chronic kidney disease. However, maintaining patients at haemoglobin (Hb) levels that are both safe and provide maximal benefit is a continuing challenge in the field. Based on e...

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Autores principales: de Francisco, Angel L. M., Stenvinkel, Peter, Vaulont, Sophie
Formato: Texto
Lenguaje:English
Publicado: Oxford University Press 2009
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2638546/
https://www.ncbi.nlm.nih.gov/pubmed/19461856
http://dx.doi.org/10.1093/ndtplus/sfn176
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author de Francisco, Angel L. M.
Stenvinkel, Peter
Vaulont, Sophie
author_facet de Francisco, Angel L. M.
Stenvinkel, Peter
Vaulont, Sophie
author_sort de Francisco, Angel L. M.
collection PubMed
description The availability of erythropoiesis-stimulating agents (ESAs) has revolutionized the treatment of anaemia in patients with chronic kidney disease. However, maintaining patients at haemoglobin (Hb) levels that are both safe and provide maximal benefit is a continuing challenge in the field. Based on emerging data on the potential risks of Hb treatment targets >13 g/dL, treatment targets have recently been lowered. In the latest revision (March 2008) of the European product labelling for the ESA class of drugs, the target treatment range was lowered to 10–12 g/dL. Fluctuation of Hb levels or ‘Hb variability’ during treatment with ESAs is a well-documented phenomenon. Hb levels that are either too high or too low may have an adverse effect on patient outcomes; thus, it is important to understand the causes of Hb variability in order to achieve optimal treatment. Several factors are believed to contribute to variation in the Hb level, including patient comorbidities and intercurrent events. Inflammation is also an important factor associated with Hb variability, and the consequences of persistent inflammatory activity are far-reaching in affected patients. This review addresses the complex role of inflammation in chronic kidney disease, as evidenced by the apparent state of deranged inflammatory markers. The mechanisms by which inflammatory cytokines may affect the response to ESAs, the development of anaemia and poor treatment outcomes are also examined. In addition, various options for intervention to enhance the response to ESAs in haemodialysis patients with inflammation are considered.
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spelling pubmed-26385462009-02-25 Inflammation and its impact on anaemia in chronic kidney disease: from haemoglobin variability to hyporesponsiveness de Francisco, Angel L. M. Stenvinkel, Peter Vaulont, Sophie NDT Plus Original Article The availability of erythropoiesis-stimulating agents (ESAs) has revolutionized the treatment of anaemia in patients with chronic kidney disease. However, maintaining patients at haemoglobin (Hb) levels that are both safe and provide maximal benefit is a continuing challenge in the field. Based on emerging data on the potential risks of Hb treatment targets >13 g/dL, treatment targets have recently been lowered. In the latest revision (March 2008) of the European product labelling for the ESA class of drugs, the target treatment range was lowered to 10–12 g/dL. Fluctuation of Hb levels or ‘Hb variability’ during treatment with ESAs is a well-documented phenomenon. Hb levels that are either too high or too low may have an adverse effect on patient outcomes; thus, it is important to understand the causes of Hb variability in order to achieve optimal treatment. Several factors are believed to contribute to variation in the Hb level, including patient comorbidities and intercurrent events. Inflammation is also an important factor associated with Hb variability, and the consequences of persistent inflammatory activity are far-reaching in affected patients. This review addresses the complex role of inflammation in chronic kidney disease, as evidenced by the apparent state of deranged inflammatory markers. The mechanisms by which inflammatory cytokines may affect the response to ESAs, the development of anaemia and poor treatment outcomes are also examined. In addition, various options for intervention to enhance the response to ESAs in haemodialysis patients with inflammation are considered. Oxford University Press 2009-01 /pmc/articles/PMC2638546/ /pubmed/19461856 http://dx.doi.org/10.1093/ndtplus/sfn176 Text en © The Author [2009]. http://creativecommons.org/licenses/by-nc/2.0/uk/ The online version of this article has been published under an open access model http://creativecommons.org/licenses/by-nc/2.0/uk/. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that: the original authorship is properly and fully attributed; the Journal and Oxford University Press are attributed as the original place of publication with the correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals.permissions@oxfordjournals.org
spellingShingle Original Article
de Francisco, Angel L. M.
Stenvinkel, Peter
Vaulont, Sophie
Inflammation and its impact on anaemia in chronic kidney disease: from haemoglobin variability to hyporesponsiveness
title Inflammation and its impact on anaemia in chronic kidney disease: from haemoglobin variability to hyporesponsiveness
title_full Inflammation and its impact on anaemia in chronic kidney disease: from haemoglobin variability to hyporesponsiveness
title_fullStr Inflammation and its impact on anaemia in chronic kidney disease: from haemoglobin variability to hyporesponsiveness
title_full_unstemmed Inflammation and its impact on anaemia in chronic kidney disease: from haemoglobin variability to hyporesponsiveness
title_short Inflammation and its impact on anaemia in chronic kidney disease: from haemoglobin variability to hyporesponsiveness
title_sort inflammation and its impact on anaemia in chronic kidney disease: from haemoglobin variability to hyporesponsiveness
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2638546/
https://www.ncbi.nlm.nih.gov/pubmed/19461856
http://dx.doi.org/10.1093/ndtplus/sfn176
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