Anemia Management in Predialysis Diabetics and in Those on Dialysis
MN Islam, MBBS, from the BIRDEM Hospital, in Dhaka, Bangladesh, presented results from a study that observed the response of erythropoietin use in predialysis anemic diabetic patients (n = 25) and those on maintenance dialysis (n = 25) on improving hemoglobin status. Erythropoietin alfa was given subcutaneously 1-3 times/week and oral IV iron was given as needed to maintain transferring saturation > 20%. Both groups were evaluated at starting, at around 12 weeks (expected time to reach target hemoglobin of 11 g/dL), and at 24 weeks (maintenance period). Baseline hemoglobin in the predialysis group and maintenance hemodialysis group was 9.7 ± 0.7 and 7.9 ± 1.1 g/dL (P < .05), respectively. Results showed that it took 9 ± 3 weeks to reach hemoglobin of 11 ± 0.2 g/dL in the predialysis group and 11 ± 2 weeks in the maintenance hemodialysis group to achieve hemoglobin of 9.4 ± 1.4 g/dL (P < .001). The attained hemoglobin during the maintenance period was 11.8 ± 0.7 and 9.8 ± 1.5 g/dL (P < .001) for the predialysis and maintenance dialysis groups, respectively. Doses of erythropoietin used in the pre-dialysis and maintenance dialysis groups at 3 observation periods were 100 ± 20 vs 104 ± 34; 93 ± 19 vs 95 ± 30; and 62 ± 24 vs 97 ± 27 u/kg/week (P < .001). Iron indices were not different between the 2 groups, but ferritin levels were higher in the maintenance dialysis group (290± 194 vs 1189 ± 1000 mcg/L (P < .001). In conclusion, erythropoietin therapy effectively increases hemoglobin in predialysis diabetics, which can be maintained at a lower dose. In dialysis patients, the response was found to be poor at similar duration and dosing. Therefore, evaluation of different parameters of dialysis adequacy and the initiation of higher erythropoietin dose at the start may be required in hemodialysis patients.
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Cite this: Highlights of the Annual Dialysis Conference: Chronic Kidney Disease Related-Anemia - Medscape - Apr 02, 2007.