Characteristics of the 238 patients by gender and CKD stage.

<p>Characteristics of the 238 patients by gender and CKD stage.</p

Iron deficiency across chronic kidney disease stages: Is there a reverse gender pattern?

<div><p>In non-dialysis chronic kidney disease patients, looking for iron deficiency is highly variable in practice and there is a great variability regarding the cutoffs used to treat iron deficiency. The aim of this study is to investigate the degree of iron deficiency in non-dialysis chronic kidney disease patients on erythropoiesis-stimulating agents. We included all non-dialysis chronic kidney disease patients that applied to the Lebanese Ministry of Public Health for erythropoiesis-stimulating agents’ coverage during a 5-month period. Iron requirement was assessed based on two guidelines’ target-to-treat cutoffs: 1-ferritin <100 ng/ml and/or TSAT < 20% (KDOQI 2006), 2- ferritin ≤500 ng/ml and TSAT ≤30% (KDIGO 2012). A total of 238 CKD patients were included over 5 months. All patients had a ferritin level in their record and 64% had an available TSAT. Median age was 71.0 (59.8–79.3) years and 61.8% were female. All had an eGFR<60 ml/min. The proportion of patients found to require iron therapy ranged between 48 and 78% with a trend towards higher values when using KDIGO-based criteria. Using ANCOVA test, inverse normal transformations of ferritin and TSAT showed a reverse pattern between men and women with women being more iron deficient in the early stage. Iron deficiency is highly prevalent in non-dialysis chronic kidney disease patients on erythropoiesis-stimulating agents’ therapy. These findings reflect a lack in effective iron supplementation when managing anemia in pre-dialysis patients, especially in men at advanced stages. Renal societies should spread awareness about iron deficiency screening in those patients.</p></div

Characteristics of the 238 patients by gender and CKD stage.

<p>Characteristics of the 238 patients by gender and CKD stage.</p

Comparison between men and women across different stages of chronic kidney disease.

<p>Abbreviations: Hb, hemoglobin; MH OR, Mantel-Haenszel Common Odds Ratio Estimate; KDOQI 2006 criteria, ferritin <100 ng/ml and/or TSAT<20%; KDIGO 2012 criteria, ferritin ≤500 ng/ml and TSAT ≤30%.</p

Analysis of covariance of inverse normal transform (INT) of ferritin rank (A) and TSAT rank (B).

<p>Analysis of covariance of inverse normal transform (INT) of ferritin rank (A) and TSAT rank (B).</p

Hemoglobin and iron parameters of the 238 patients after adjusting for CKD stage.

<p>Hemoglobin and iron parameters of the 238 patients after adjusting for CKD stage.</p

Characteristics of the 238 patients.

<p>Characteristics of the 238 patients.</p

Reduction of intracerebral hemorrhage in hemodialysis patients after reducing aspirin use: A quality-assurance observational study

<div><p>There is so far no international consensus concerning the prescription of antithrombotic agents in hemodialysis patients. It is not clear yet why they cause more bleeding in some patients and are beneficial in others. We therefore tried to find out what triggers bleeding in this population. This is an observational before-and-after study that included all patients undergoing hemodialysis in our center between 2005 and 2015. We divided the study into two phases: phase one (125 patients) where aspirin was used without restrictions and phase two (110 patients) where aspirin was avoided in severe hypertension and primary prevention. We aimed to assess the differential occurrence of intracerebral hemorrhage between the two phases and the cardiovascular mortality of patients whether on aspirin or not. Bleeding events occurred in 12.8% of patients in phase one and 13.6% in phase two (<i>p</i> = 0.85). Seven out of 125 patients (6%) in phase one experienced intracerebral hemorrhage and none in phase two. Intracerebral hemorrhage was significantly increased in those with the combination of aspirin and severe hypertension (<i>p</i> = 0.003). Aspirin and acenocoumadin were significantly associated with total bleeding (OR = 3.81 and 4.85 with <i>p</i> = 0.005 and 0.001 respectively). Cardiovascular mortality did not differ between phase one and two whether patients were on aspirin or not (<i>p</i> = 0.45 and 0.31 respectively). Minimizing aspirin use in hemodialysis patients with severe hypertension reduced intracerebral bleeding without a significant difference in cardiovascular mortality.</p></div

Demographic and baseline clinical characteristics of patients in the two phases.

<p>Demographic and baseline clinical characteristics of patients in the two phases.</p

Outcomes: Bleeding and death in the two phases.

<p>Outcomes: Bleeding and death in the two phases.</p