Abstract:
:Recombinant human erythropoietin (rHuEPO, epoetin) revolutionized the treatment of anemia in patients with chronic kidney disease (CKD) when it was approved for use in the United States in 1989. Among dialysis patients, the mean hemoglobin (Hb) in patients undergoing dialysis rose from 7-8 g/dl prior to 1989 to 11-12 g/dl today. Among patients with CKD not on dialysis, epoetin use has not been as broadly applied as among dialysis patients, and although the mean Hb level in this patient population has increased, the impact has been less than in patients on dialysis. The optimal treatment target for epoetin remains controversial. Consistent with clinical practice guidelines, current practice in dialysis patients in the United States aims to maintain a target Hb of 11-12 g/dl, a level that is still well below the normal range. Debate centers on whether the current Hb target is too low and whether the target range is too narrow. Quality of life clearly improves in many individuals as Hb rises into the normal range from lower levels. In retrospective studies, higher Hb levels have been associated with lower risks of hospitalization and mortality. However, one large, prospective clinical trial has raised concern about normalizing Hb in hemodialysis patients with cardiac disease, and other prospective studies have not yet provided convincing evidence of significant benefits from normalizing Hb in dialysis-dependent and non-dialysis-dependent patients with CKD. A relative lack of information on non-dialysis-dependent patients with CKD and changes in fiscal policies regulating reimbursement for epoetin have contributed to uncertainty as to the best practices for anemia management in patients with CKD. There is increasing interest in the potential benefits of broadening the current target Hb range or eliminating an upper limit altogether and instead establishing a minimum Hb goal. While some extension of the upper limit of the currently recommended target Hb range might appear to be reasonable, the extent to which this should be extended, the benefits, risks, and costs of maintaining higher Hb levels in patients with CKD, and whether target Hb levels should be different in different CKD patient groups remains to be determined. Future efforts are likely to focus on selecting patient populations most likely to benefit from normalizing Hb, while adjusting the range of a subnormal Hb target for others.
journal_name
Semin Dialjournal_title
Seminars in dialysisauthors
Berns JSdoi
10.1111/j.1525-139X.2005.18105.xsubject
Has Abstractpub_date
2005-01-01 00:00:00pages
22-9issue
1eissn
0894-0959issn
1525-139Xpii
SDI18105journal_volume
18pub_type
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journal_title:Seminars in dialysis
pub_type: 杂志文章,评审
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journal_title:Seminars in dialysis
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journal_title:Seminars in dialysis
pub_type: 杂志文章,评审
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journal_title:Seminars in dialysis
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更新日期:2012-11-01 00:00:00
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journal_title:Seminars in dialysis
pub_type: 杂志文章
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journal_title:Seminars in dialysis
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更新日期:2004-05-01 00:00:00
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journal_title:Seminars in dialysis
pub_type: 社论
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更新日期:2011-01-01 00:00:00
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journal_title:Seminars in dialysis
pub_type: 杂志文章
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更新日期:2020-01-01 00:00:00
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journal_title:Seminars in dialysis
pub_type: 杂志文章
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更新日期:2020-01-01 00:00:00
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journal_title:Seminars in dialysis
pub_type: 社论,评审
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更新日期:2003-09-01 00:00:00
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journal_title:Seminars in dialysis
pub_type: 杂志文章
doi:10.1111/j.0894-0959.2004.17356.x
更新日期:2004-09-01 00:00:00
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journal_title:Seminars in dialysis
pub_type: 社论
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更新日期:2012-05-01 00:00:00
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journal_title:Seminars in dialysis
pub_type: 杂志文章,评审
doi:10.1111/sdi.12496
更新日期:2016-07-01 00:00:00
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journal_title:Seminars in dialysis
pub_type: 杂志文章
doi:10.1111/sdi.12917
更新日期:2020-10-14 00:00:00
abstract::Hypermagnesemia is an uncommon electrolyte abnormality, due to the fact that magnesium toxicity is only seen in the setting of a massive exposure to exogenous magnesium, often in the setting of renal insufficiency. Here, we report a case of severe hypermagnesemia that resulted in complete paralysis that was secondary ...
journal_title:Seminars in dialysis
pub_type: 杂志文章
doi:10.1111/sdi.12479
更新日期:2016-05-01 00:00:00
abstract::Dialysis vascular access associated coronary-subclavian steal or hypoperfusion syndrome is an uncommon but potentially life threatening condition. Awareness of this syndrome is important in the management of vascular access in hemodialysis patients. We report a case of dialysis vascular access associated coronary-subc...
journal_title:Seminars in dialysis
pub_type: 杂志文章,评审
doi:10.1111/sdi.12077
更新日期:2013-09-01 00:00:00
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journal_title:Seminars in dialysis
pub_type: 杂志文章,评审
doi:10.1111/sdi.12741
更新日期:2018-11-01 00:00:00
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journal_title:Seminars in dialysis
pub_type: 杂志文章
doi:10.1111/sdi.12268
更新日期:2014-11-01 00:00:00
abstract::This article reviews the pharmacokinetic characteristics of calcitriol, paricalcitol, and doxercalciferol, and provides an overview of the metabolism of vitamin D. Calcitriol and paricalcitol have similar pharmacokinetic profiles, with terminal half-lives ranging from 5 to 10 hours in healthy subjects to 15-30 hours i...
journal_title:Seminars in dialysis
pub_type: 杂志文章,评审
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更新日期:2002-09-01 00:00:00
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journal_title:Seminars in dialysis
pub_type: 杂志文章,评审
doi:10.1046/j.1525-139x.2001.00071.x
更新日期:2001-07-01 00:00:00
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journal_title:Seminars in dialysis
pub_type: 杂志文章,评审
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更新日期:2014-01-01 00:00:00
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journal_title:Seminars in dialysis
pub_type: 杂志文章,评审
doi:10.1111/j.1525-139X.2010.00708.x
更新日期:2010-03-01 00:00:00
abstract::In the United States, presently there are more than 50,000 patients with end-stage renal disease (ESRD) awaiting a cadaveric kidney and each year less than a quarter receive kidney transplantation. Although the real incidence in unknown, a significant number of these patients die due to lack of dialysis access. While ...
journal_title:Seminars in dialysis
pub_type: 社论
doi:10.1046/j.1525-139x.2002.00001.x
更新日期:2002-01-01 00:00:00
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journal_title:Seminars in dialysis
pub_type: 杂志文章
doi:10.1111/sdi.12492
更新日期:2016-07-01 00:00:00
abstract::Computed tomographic (CT) peritoneography has been widely used as reference standard to evaluate continuous ambulatory peritoneal dialysis-related complications. However, given the varying CT peritoneography approaches used across different institutions, there is no standard value for non-ionic iodinated contrast medi...
journal_title:Seminars in dialysis
pub_type: 杂志文章
doi:10.1111/sdi.12867
更新日期:2020-03-01 00:00:00
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journal_title:Seminars in dialysis
pub_type: 杂志文章,评审
doi:10.1111/sdi.12584
更新日期:2017-05-01 00:00:00
abstract::Coping with the transition from end-stage kidney disease to dialysis can be challenging for patients and their care partners. Introducing incident dialysis patients to incremental forms of dialysis is associated with better quality of life and reduced cost. Incremental hemodialysis (HD) has generated significant inter...
journal_title:Seminars in dialysis
pub_type: 社论
doi:10.1111/sdi.12712
更新日期:2018-09-01 00:00:00
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journal_title:Seminars in dialysis
pub_type: 杂志文章,评审
doi:10.1111/j.1525-139X.2006.00138.x
更新日期:2006-03-01 00:00:00
abstract::Few prospective studies have looked at the incidence of hyperkalemia in outpatient hemodialysis access procedures. Our study prospectively evaluated 167 procedures using a preadmit venous blood gas (VBG) and found that 14.3% had moderate or severe hyperkalemia. When the individual procedures were analyzed it was found...
journal_title:Seminars in dialysis
pub_type: 杂志文章
doi:10.1111/sdi.12243
更新日期:2015-01-01 00:00:00
abstract::The etiology and management of intradialytic hypotension has become an increasingly complex issue. Volume depletion due to ultrafiltration remains the predominant underlying etiologic factor. However, patients vary markedly in their hemodynamic tolerance to fluid removal. While many risk factors have been identified, ...
journal_title:Seminars in dialysis
pub_type: 社论,评审
doi:10.1046/j.1525-139x.2002.00002.x
更新日期:2002-05-01 00:00:00