3 research outputs found
PowerPoint Slides for: Targeting Hypoxia-Inducible Factors for the Treatment of Anemia in Chronic Kidney Disease Patients
<p><b><i>Background:</i></b> Anemia, a common complication of chronic
kidney disease (CKD), has previously been attributed primarily to
decreased production of erythropoietin. More recently, it has become
apparent that the etiology of anemia involves several other factors,
most notably dysfunctional iron metabolism, mediated via increased
hepcidin activity and reduced clearance. Current management of anemia in
patients with advanced CKD is based on erythropoiesis-stimulating
agents and iron supplementation, along with red blood cell transfusions
when necessary; however, safety considerations associated with these
therapies highlight the need to pursue alternative treatment options
targeting other mechanisms such as hypoxia-inducible factors (HIFs) that
act as central regulators of erythropoiesis by coordinating a series of
graded hypoxic responses. <b><i>Summary:</i></b> This review discusses
the discovery of the HIF pathway and its regulation via HIF prolyl
hydroxylase enzymes in the context of erythropoiesis and iron
metabolism. The rationale for targeting this pathway and the clinical
development of HIF prolyl hydroxylase inhibitors are reviewed, with a
commentary on the potential implications of this class of agents in CKD
anemia management. <b><i>Key Messages:</i></b> Pharmacologic activation
of the HIF pathway results in a transient pseudo-hypoxic state that
stimulates erythropoiesis in CKD patients with anemia. Results from
clinical studies of a number of HIF prolyl hydroxylase inhibitors are
increasingly available and provide support for the continued evaluation
of the risk-benefit ratio of this novel therapeutic approach to the
treatment of anemia in CKD.</p
PowerPoint Slides for: Does Intragastric Balloon Treatment for Obesity in Chronic Kidney Disease Heighten Acute Kidney Injury Risk
<p><b><i>Background:</i></b> The outcomes of intragastric balloon (IGB) placement to achieve weight loss in obese patients with chronic kidney disease (CKD) have not been reported to date. This study aimed to assess the safety and efficacy of the IGB as a weight-loss treatment among this patient population. <b><i>Methods:</i></b> A prospective, single-arm, ‘first in CKD' interventional study was conducted in patients with a body mass index >35 kg/m<sup>2</sup> and CKD stages 3-4, referred for weight loss. After clinical assessment, the IGB was endoscopically inserted into the stomach and kept in place for 6 months. Complications, adverse events, acceptability, weight loss and metabolic responses were monitored over 6 months. <b><i>Results:</i></b> Eleven participants were recruited over 18 months. Two patients withdrew (1 prior to IGB insertion and 1 early removal after 3 days due to persistent vomiting) from the study; 9 patients completed the study. There were 5 episodes of acute kidney injury (AKI), occurring in 3 patients. After 6 months, the mean body mass decreased by 9.6% (SD ±6.8). Median waist circumference and total cholesterol decreased significantly (-7.7 cm; interquartile range (IQR) -15.3 to -3.9; and -0.2 mmol/l; IQR -0.6 to -0.05, respectively), with no changes in estimated glomerular filtration rate, blood pressure, triglycerides, adipokines, inflammation, or arterial stiffness measured by carotid-femoral pulse wave velocity. At IGB removal, there was 1 new case each of gastritis and esophagitis. <b><i>Conclusions:</i></b> Treatment with IGB has only moderate efficacy on weight loss; yet it results in a high rate of complications in obese patients with established CKD. The risk of AKI may be raised due to increased risk of dehydration secondary to gastrointestinal symptoms associated with IGB placement and reduced baseline kidney function.</p
Supplementary Material for: An Epidemiological Study of Hemodialysis Patients Based on the European Fresenius Medical Care Hemodialysis Network: Results of the ARO Study
<p><i>Background/Aims:</i> ARO, an observational study of hemodialysis
(HD) patients in Europe, aims to enhance our understanding of patient
characteristics and practice patterns to improve patient outcome. <i>Methods:</i>
HD patients (n = 8,963) from 134 Fresenius Medical Care facilities
treated between 2005 and 2006 were randomly selected from 9 European
countries (Czech Republic, France, Hungary, Italy, Poland, Portugal,
Spain, Slovak Republic and Slovenia) and Turkey. Information was
captured on demographics, comorbidities, medications, laboratory and
dialysis parameters, and outcome. <i>Results:</i> Patients were followed
for 1.4 ± 0.7 years. Wide variation by country was observed for age,
sex and diabetes as a cause of chronic kidney disease. Cardiovascular
disease was present in 73% of patients. Dialysis parameters were
homogeneous across countries. Arteriovenous fistulas were frequently
used (73%). More incident patients had hemoglobin <11 g/dl than
prevalent patients (50 vs. 33%, respectively). Phosphatemia and intact
parathyroid hormone were similar between incident and prevalent patients
(4.7 ± 1.2 mg/dl and 190 vs. 213 ng/l, respectively). Medication use
varied widely by country. In total, 5% of patients underwent renal
transplantation. Overall death rate was 124/1,000 patient-years. <i>Conclusion:</i>
ARO revealed differences in HD practice patterns and patient
characteristics in the 10 participating countries. Future ARO studies
will fill gaps in the knowledge about the care of European HD patients.</p