| Inflammation and resistance to treatment with recombinant human erythropoietin. | |
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MedLine Citation:
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PMID: 15648023 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Despite an increase in the use and average dose of recombinant human EPO (rh-EPO) over the last 15 years, a substantial percentage of patients still do not achieve hemoglobin targets recommended by international guidelines. The definition of rh-EPO resistance has been introduced to identify those patients in whom the target hemoglobin level is not attained despite a greater-than-usual dose of erythropoietin-stimulating agent (ESA). In recent years, increasing attention has been paid to the relationship between dialysis, increased inflammatory stimulus, malnutrition, and ESA response. About 35% to 65% of hemodialysis patients show signs of inflammation that could be a cause of anemia through the suppression of bone marrow erythropoiesis by a number of cytokines. A large proportion of chronic kidney disease patients also have protein-energy malnutrition and wasting; low serum albumin levels, together with other more specific nutritional markers, are predictors of rh-EPO response. A diminished nutritional state could then be a feature of patients who are resistant to ESA treatment, with malnutrition probably being a consequence of a chronic inflammatory state. Starting from the hypothesis that anemia, partially attributable to a reduced response to ESA, could be the link among malnutrition, inflammation, and the poor outcome of chronic kidney disease patients, we designed a multicenter observational study, the Malnutrition-Inflammation-Resistance-Treatment Outcome Study (MIRTOS), aimed at evaluating the impact and possible causes of resistance to ESA in a large sample of hemodialysis patients. We hope the results of MIRTOS will represent a step forward toward a better understanding of the factors influencing the response to ESA in hemodialysis patients. |
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Authors:
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Lucia Del Vecchio; Pietro Pozzoni; Simeone Andrulli; Francesco Locatelli |
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Publication Detail:
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Type: Comparative Study; Journal Article |
Journal Detail:
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Title: Journal of renal nutrition : the official journal of the Council on Renal Nutrition of the National Kidney Foundation Volume: 15 ISSN: 1532-8503 ISO Abbreviation: J Ren Nutr Publication Date: 2005 Jan |
Date Detail:
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Created Date: 2005-01-13 Completed Date: 2006-08-18 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 9112938 Medline TA: J Ren Nutr Country: United States |
Other Details:
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Languages: eng Pagination: 137-41 Citation Subset: IM |
Affiliation:
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Department of Nephrology and Dialysis, Ospedale A. Manzoni, Lecco, Italy. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Anemia
/
drug therapy,
etiology Chronic Disease Drug Resistance* Epoetin Alfa / administration & dosage Erythropoietin / administration & dosage, analogs & derivatives Erythropoietin, Recombinant / administration & dosage, therapeutic use* Hemoglobins / analysis Humans Inflammation* / complications Kidney Diseases / complications*, therapy Kidney Failure, Chronic / complications, therapy Malnutrition Protein-Energy Malnutrition / etiology Renal Dialysis |
| Chemical | |
Reg. No./Substance:
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0/Erythropoietin, Recombinant; 0/Hemoglobins; 0/epoetin beta; 11096-26-7/Erythropoietin; 113427-24-0/Epoetin Alfa; 209810-58-2/darbepoetin alfa |
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