Journal ArticleDOI
2008 Japanese Society for Dialysis Therapy: guidelines for renal anemia in chronic kidney disease
Yoshiharu Tsubakihara,Shinichi Nishi,Takashi Akiba,Hideki Hirakata,Kunitoshi Iseki,Minoru Kubota,Satoru Kuriyama,Yasuhiro Komatsu,Masashi Suzuki,Shigeru Nakai,Motoshi Hattori,Tetsuya Babazono,Makoto Hiramatsu,Hiroyasu Yamamoto,Masami Bessho,Tadao Akizawa +15 more
TLDR
The Japanese Society for Dialysis Therapy guideline committee, chaired by Dr Y. Tsubakihara, presents the Japanese guidelines, which replace the “2004 JSDT Guidelines for Renal Anemia in Chronic Hemodialysis Patients,” and contain new, additional guidelines for peritoneal dialysis, non‐dialysis (ND), and pediatric chronic kidney disease (CKD) patients.Abstract:
The Japanese Society for Dialysis Therapy (JSDT) guideline committee, chaired by Dr Y. Tsubakihara, presents the Japanese guidelines entitled "Guidelines for Renal Anemia in Chronic Kidney Disease." These guidelines replace the "2004 JSDT Guidelines for Renal Anemia in Chronic Hemodialysis Patients," and contain new, additional guidelines for peritoneal dialysis (PD), non-dialysis (ND), and pediatric chronic kidney disease (CKD) patients. Chapter 1 presents reference values for diagnosing anemia that are based on the most recent epidemiological data from the general Japanese population. In both men and women, hemoglobin (Hb) levels decrease along with an increase in age and the level for diagnosing anemia has been set at <13.5 g/dL in males and <11.5 g/dL in females. However, the guidelines explicitly state that the target Hb level in erythropoiesis stimulating agent (ESA) therapy is different to the anemia reference level. In addition, in defining renal anemia, the guidelines emphasize that the reduced production of erythropoietin (EPO) that is associated with renal disorders is the primary cause of renal anemia, and that renal anemia refers to a condition in which there is no increased production of EPO and serum EPO levels remain within the reference range for healthy individuals without anemia, irrespective of the glomerular filtration rate (GFR). In other words, renal anemia is clearly identified as an "endocrine disease." It is believed that defining renal anemia in this way will be extremely beneficial for ND patients exhibiting renal anemia despite having a high GFR. We have also emphasized that renal anemia may be treated not only with ESA therapy but also with appropriate iron supplementation and the improvement of anemia associated with chronic disease, which is associated with inflammation, and inadequate dialysis, another major cause of renal anemia. In Chapter 2, which discusses the target Hb levels in ESA therapy, the guidelines establish different target levels for hemodialysis (HD) patients than for PD and ND patients, for two reasons: (i) In Japanese HD patients, Hb levels following hemodialysis rise considerably above their previous levels because of ultrafiltration-induced hemoconcentration; and (ii) as noted in the 2004 guidelines, although 10 to 11 g/dL was optimal for long-term prognosis if the Hb level prior to the hemodialysis session in an HD patient had been established at the target level, it has been reported that, based on data accumulated on Japanese PD and ND patients, in patients without serious cardiovascular disease, higher levels have a cardiac or renal function protective effect, without any safety issues. Accordingly, the guidelines establish a target Hb level in PD and ND patients of 11 g/dL or more, and recommend 13 g/dL as the criterion for dose reduction/withdrawal. However, with the results of, for example, the CHOIR (Correction of Hemoglobin and Outcomes in Renal Insufficiency) study in mind, the guidelines establish an upper limit of 12 g/dL for patients with serious cardiovascular disease or patients for whom the attending physician determines high Hb levels would not be appropriate. Chapter 3 discusses the criteria for iron supplementation. The guidelines establish reference levels for iron supplementation in Japan that are lower than those established in the Western guidelines. This is because of concerns about long-term toxicity if the results of short-term studies conducted by Western manufacturers, in which an ESA cost-savings effect has been positioned as a primary endpoint, are too readily accepted. In other words, if the serum ferritin is <100 ng/mL and the transferrin saturation rate (TSAT) is <20%, then the criteria for iron supplementation will be met; if only one of these criteria is met, then iron supplementation should be considered unnecessary. Although there is a dearth of supporting evidence for these criteria, there are patients that have been surviving on hemodialysis in Japan for more than 40 years, and since there are approximately 20 000 patients who have been receiving hemodialysis for more than 20 years, which is a situation that is different from that in many other countries. As there are concerns about adverse reactions due to the overuse of iron preparations as well, we therefore adopted the expert opinion that evidence obtained from studies in which an ESA cost-savings effect had been positioned as the primary endpoint should not be accepted unquestioningly. In Chapter 4, which discusses ESA dosing regimens, and Chapter 5, which discusses poor response to ESAs, we gave priority to the usual doses that are listed in the package inserts of the ESAs that can be used in Japan. However, if the maximum dose of darbepoetin alfa that can currently be used in HD and PD patients were to be used, then the majority of poor responders would be rescued. Blood transfusions are discussed in Chapter 6. Blood transfusions are attributed to the difficulty of managing renal anemia not only in HD patients, but also in end-stage ND patients who respond poorly to ESAs. It is believed that the number of patients requiring transfusions could be reduced further if there were novel long-acting ESAs that could be used for ND patients. Chapter 7 discusses adverse reactions to ESA therapy. Of particular concern is the emergence and exacerbation of hypertension associated with rapid hematopoiesis due to ESA therapy. The treatment of renal anemia in pediatric CKD patients is discussed in Chapter 8; it is fundamentally the same as that in adults.read more
Citations
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Journal ArticleDOI
Guidelines on the diagnosis and treatment of iron deficiency across indications: a systematic review
TL;DR: It appears that for the diagnosis of ID, a cutoff of 100 μg/L for serum ferritin concentration should be considered in most conditions and 20% for TSAT, except in particular situations, including young healthy women with heavy menstrual flow.
Journal ArticleDOI
Four-Week Studies of Oral Hypoxia-Inducible Factor–Prolyl Hydroxylase Inhibitor GSK1278863 for Treatment of Anemia
Louis Holdstock,Amy M Meadowcroft,Rayma Maier,Brendan M. Johnson,Delyth Jones,Anjay Rastogi,Steven Zeig,John J. Lepore,Alexander R. Cobitz +8 more
TL;DR: GSK1278863 may prove an effective alternative for managing anemia of CKD and was generally safe and well tolerated at the doses and duration studied, with clinically significant elevations in plasma vascular endothelial growth factor concentrations.
Journal ArticleDOI
Association between hemoglobin variability, serum ferritin levels, and adverse events/mortality in maintenance hemodialysis patients.
Takahiro Kuragano,Osamu Matsumura,Akihiko Matsuda,Taiga Hara,Hideyasu Kiyomoto,Toshiaki Murata,Kenichiro Kitamura,Shouichi Fujimoto,Hiroki Hase,Nobuhiko Joki,Atushi Fukatsu,Toru Inoue,Ikuhiro Itakura,Takeshi Nakanishi +13 more
TL;DR: There is a high risk of death and/or adverse events in patients with hemoglobin levels outside the target range, in those with high-amplitude hemoglobin fluctuations, in Those with consistently high serum ferritin levels, and in thoseWith high-AMplitude ferritIn fluctuations.
Journal ArticleDOI
2015 Japanese Society for Dialysis Therapy: Guidelines for Renal Anemia in Chronic Kidney Disease
Hiroyasu Yamamoto,Shinichi Nishi,Tadashi Tomo,Ikuto Masakane,Kazuhide Saito,Masaomi Nangaku,Motoshi Hattori,Takahiro Suzuki,Takahiro Suzuki,Satoshi Morita,Akira Ashida,Yasuhiko Ito,Takahiro Kuragano,Yasuhiro Komatsu,Ken Sakai,Yoshiharu Tsubakihara,Kazuhiko Tsuruya,Terumasa Hayashi,Hideki Hirakata,Hirokazu Honda +19 more
TL;DR: This is the third edition of the guidelines for renal anemia published by the JSDT, and the purpose is to improve the prognosis of chronic kidney disease patients, including after renal transplantation, through the treatment of renalAnemia.
Journal ArticleDOI
An overview of regular dialysis treatment in Japan (as of 31 December 2012).
Shigeru Nakai,Norio Hanafusa,Ikuto Masakane,Masatomo Taniguchi,Takayuki Hamano,Tetsuo Shoji,Takeshi Hasegawa,Noritomo Itami,Kunihiro Yamagata,Toshio Shinoda,Junichiro James Kazama,Yuzo Watanabe,Takashi Shigematsu,Seiji Marubayashi,Osamu Morita,Atsushi Wada,Seiji Hashimoto,Kazuyuki Suzuki,Hidetomo Nakamoto,Naoki Kimata,Kenji Wakai,Naohiko Fujii,Satoshi Ogata,Kenji Tsuchida,Hiroshi Nishi,Kunitoshi Iseki,Yoshiharu Tsubakihara +26 more
TL;DR: The dialysis patient population has been growing every year in Japan; it was 310 007 at the end of 2012, which exceeded 310’000 for the first time, and the percentage of dialysis patients with diabetic nephropathy has been continuously increasing, whereas not only the percentage but also the actual number of dial renal failure patients with chronic glomerulonephritis has decreased.
References
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Journal ArticleDOI
Correction of Anemia with Epoetin Alfa in Chronic Kidney Disease
Ajay K. Singh,Lynda A. Szczech,Kezhen L. Tang,Huiman X. Barnhart,Shelly Sapp,Marsha Wolfson,Donal N. Reddan,Abstr Act +7 more
TL;DR: The use of a target hemoglobin level of 13.5 g per deciliter (as compared with 11.3 g perDeciliter) was associated with increased risk and no incremental improvement in the quality of life and the use of epoetin alfa targeted to achieve a level of 11.4 g perdeciliter was not associated with an increased risk.
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Correction of the anemia of end-stage renal disease with recombinant human erythropoietin. Results of a combined phase I and II clinical trial.
TL;DR: It is demonstrated that recombinant human erythropoietin is effective, can eliminate the need for transfusions with their risks of immunologic sensitization, infection, and iron overload, and can restore the hematocrit to normal in many patients with the anemia of end-stage renal disease.
Journal ArticleDOI
Normalization of Hemoglobin Level in Patients with Chronic Kidney Disease and Anemia
Tilman B. Drüeke,Francesco Locatelli,Naomi Clyne,Kai-Uwe Eckardt,Iain C. Macdougall,Dimitrios Tsakiris,Hans-Ulrich Burger,Armin Scherhag +7 more
TL;DR: In patients with chronic kidney disease, early complete correction of anemia does not reduce the risk of cardiovascular events and there was no significant difference in the combined incidence of adverse events between the two groups.
Journal ArticleDOI
The effects of normal as compared with low hematocrit values in patients with cardiac disease who are receiving hemodialysis and epoetin.
Anatole Besarab,W K Bolton,J K Browne,Joan C. Egrie,Allen R. Nissenson,D M Okamoto,Steve J. Schwab,David A. Goodkin +7 more
TL;DR: In patients with clinically evident congestive heart failure or ischemic heart disease who are receiving hemodialysis, administration of epoetin to raise their hematocrit to 42 percent is not recommended.
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