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Preventing anemia is important to kidney disease patients' quality of life
November 12, 2008Study indicates that FDA statements may need to be revised
Maintaining sufficient red blood cell levels is important to the physical and mental health of patients with chronic kidney disease (CKD), according to a study appearing in the January 2009 issue of the Clinical Journal of the American Society Nephrology (CJASN). The findings indicate that preventing anemia in kidney disease patients should be an integral part of their care.
Erythropoiesis-stimulating agents-medications that elevate red blood cell levels (hemoglobin)-have been a topic of controversy lately, and their use in patients with chronic kidney disease has come into question. Recent studies have shown an increased risk of death, blood clots, strokes, and heart attacks in patients with chronic kidney failure when erythropoiesis-stimulating agents are given at higher than recommended doses. (Current recommendations indicate that treatment should not elevate hemoglobin levels over 12 gm/dl). Other studies have found a link between the recommended doses of these drugs and an increased risk of death in patients with cancer and an increased risk of blood clots in patients following orthopedic surgery. In addition, the US Food and Drug Administration stated that the benefits of erythropoiesis-stimulating agents have not been well documented, particularly as they relate to quality of life. These suggestions are disturbing to nephrologists, who believe that these drugs have significantly helped their CKD patients.
To help clarify the issue, Fredric Finkelstein, MD, of the Hospital of St. Raphael and Yale University in New Haven, CT, and his colleagues studied the relationship between hemoglobin levels and health-related quality of life (which includes both mental and physical components) in patients with CKD.
A total of 1,186 patients with stage three to stage five CKD participated in this study, and they were grouped into categories based on their hemoglobin levels (<11 gm/dl, 11 to <12 gm/dl, 12 to <13 gm/dl, and ≥13 gm/dl). The investigators noted that as hemoglobin levels increased from <11 gm/dl to ≥13 gm/dl, there were significant improvements in a variety of quality of life domains. These included symptom problems, burden of kidney disease, physical functioning, pain, energy/fatigue, and others.
The study's findings suggest that maintaining hemoglobin levels is important to the health and well-being of patients with CKD. The authors recommend that additional studies should be done to document the changes in quality of life that occur when erythropoiesis-stimulating agents are used to elevate hemoglobin levels in patients with this disease.
More work also is needed to determine when treatment should be initiated and what the hemoglobin target level should be. "The impact of the answers to these questions for the health-related quality of life of chronic kidney disease patients may well be substantial," the authors wrote.
American Society of Nephrology
To help clarify the issue, Fredric Finkelstein, MD, of the Hospital of St. Raphael and Yale University in New Haven, CT, and his colleagues studied the relationship between hemoglobin levels and health-related quality of life (which includes both mental and physical components) in patients with CKD.
A total of 1,186 patients with stage three to stage five CKD participated in this study, and they were grouped into categories based on their hemoglobin levels (<11 gm/dl, 11 to <12 gm/dl, 12 to <13 gm/dl, and ≥13 gm/dl). The investigators noted that as hemoglobin levels increased from <11 gm/dl to ≥13 gm/dl, there were significant improvements in a variety of quality of life domains. These included symptom problems, burden of kidney disease, physical functioning, pain, energy/fatigue, and others.
The study's findings suggest that maintaining hemoglobin levels is important to the health and well-being of patients with CKD. The authors recommend that additional studies should be done to document the changes in quality of life that occur when erythropoiesis-stimulating agents are used to elevate hemoglobin levels in patients with this disease.
More work also is needed to determine when treatment should be initiated and what the hemoglobin target level should be. "The impact of the answers to these questions for the health-related quality of life of chronic kidney disease patients may well be substantial," the authors wrote.
American Society of Nephrology
Kidney Disease Current Events and Kidney Disease News RSSHigh Blood Pressure Easy to Miss in Children with Kidney Disease
Spot blood pressure readings in children with chronic kidney disease often fail to detect hypertension - even during doctor's office visits - increasing a child's risk for serious heart problems, according to research from Johns Hopkins Children's Center and other institutions. A report of the findings appears online in the Journal of American Society of Nephrology.
New research shows versatility of amniotic fluid stem cells
For the first time, scientists have demonstrated that stem cells found in amniotic fluid meet an important test of potential to become specialized cell types, which suggests they may be useful for treating a wider array of diseases and conditions than scientists originally thought.
Young athletes need dual screening tests for heart defects, study suggests
To best detect early signs of life-threatening heart defects in young athletes, screening programs should include both popular diagnostic tests, not just one of them, according to new research from heart experts at Johns Hopkins.
New class of molecules may help prevent fatal complication in patients with kidney disease
Researchers at the University of Maryland School of Medicine have made an important discovery about why potassium builds up to dangerous levels in the bloodstream, a relatively common medical problem that affects about eight percent of hospitalized patients.
Reduction in glycotoxins from heat-processing of foods reduces risk of chronic disease
Researchers from Mount Sinai School of Medicine report that cutting back on the consumption of processed and fried foods, which are high in toxins called Advanced Glycation End products (AGEs), can reduce inflammation and actually help restore the body's natural defenses regardless of age or health status.
Help your kidneys: Pass on salt and diet soda
Individuals who consume a diet high in sodium or artificially sweetened drinks are more likely to experience a decline in kidney function, according to two papers being presented at the American Society of Nephrology's annual meeting in San Diego, California.
Can charcoal fight heart disease in kidney patients?
Charcoal may provide a new approach to managing the high rate of heart disease in patients with advanced kidney disease, according to preliminary research being presented at the American Society of Nephrology's 42nd Annual Meeting and Scientific Exposition in San Diego, CA.
Women with chronic kidney disease more likely than men to go undiagnosed
Woman are at particular risk of their primary care physicians delaying diagnosis of chronic kidney disease (CKD), according to a paper being presented at the American Society of Nephrology's 42nd Annual Meeting and Scientific Exposition in San Diego, California.
For dialysis patients, skinny is dangerous
Dialysis patients with low body fat are at increased risk of death-even compared to patients at the highest level of body fat percentage, according to research being presented at the American Society of Nephrology's 42nd Annual Meeting and Scientific Exposition in San Diego.
Protein critical for insulin secretion may be contributor to diabetes
A cellular protein from a family involved in several human diseases is crucial for the proper production and release of insulin, new research has found, suggesting that the protein might play a role in diabetes.
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