[Therapy of anemia and iron deficiency in dialysis patients: an update]. 2014

Guy Rostoker, and Aurélie Hummel, and François Chantrel, and Jean-Philippe Ryckelynck
Service de néphrologie et de dialyse, hôpital privé Claude-Galien, générale de santé, 20, route de Boussy-Saint-Antoine, 91480 Quincy-sous-Sénart, France. Electronic address: rostotom@orange.fr.

The Kidney Disease Improving Global Outcomes (KDIGO)-2012 on the treatment of anemia emit suggestions (which differ from recommendations) based on a scientific evidence of low level. The first rule is no harm; physicians must take into account the profile of the patient and its associated morbidities and remember on the potential risks to begin a treatment by erythropoiesis stimulating agents (ESA) (thrombosis of arteriovenous fistula, hypertension, stroke). All correctable causes of anemia other than erythropoietin deficiency should be actively sought. It is necessary to individualize the treatment by ESA and assess the clinical improvement expected. The ESA will be used in the following way: initiate at 10 g/dL of hemoglobin level with the aim of 11.5 g/dL, without exceeding 13 g/dL. In case of ESA resistance, it seems suitable to assess the risks and benefits of ESA versus blood transfusion. The ERBP-2013 have endorsed the KDIGO-2012 except the proposals dealing with the treatment by IV iron. The use of intravenous iron must be more cautious in the future taking into account the results of a recent French study published in the American Journal of Medicine showing the high frequency of iron overload at quantitative hepatic MRI among haemodialysis patients receiving iron IV following the current guidelines. It is appropriate to use oral iron in first intention as recommended by the ANSM (French Drug Agency) in a recent information note and respect the dosage regimen of the label. The realization of a quantitative hepatic MRI to evaluate iron overload and monitor the treatment by iron IV must also be considered on a case by case basis.

UI MeSH Term Description Entries
D006397 Hematinics Agents which improve the quality of the blood, increasing the hemoglobin level and the number of erythrocytes. They are used in the treatment of anemias. Erythropoiesis Stimulating Agent,Hematinic,Hematopoietic Agents,Erythropoiesis Stimulating Agents,Agent, Erythropoiesis Stimulating,Stimulating Agent, Erythropoiesis
D006435 Renal Dialysis Therapy for the insufficient cleansing of the BLOOD by the kidneys based on dialysis and including hemodialysis, PERITONEAL DIALYSIS, and HEMODIAFILTRATION. Dialysis, Extracorporeal,Dialysis, Renal,Extracorporeal Dialysis,Hemodialysis,Dialyses, Extracorporeal,Dialyses, Renal,Extracorporeal Dialyses,Hemodialyses,Renal Dialyses
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000740 Anemia A reduction in the number of circulating ERYTHROCYTES or in the quantity of HEMOGLOBIN. Anemias
D017410 Practice Guidelines as Topic Works about directions or principles presenting current or future rules of policy for assisting health care practitioners in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. Clinical Guidelines as Topic,Best Practices,Best Practice
D051436 Renal Insufficiency, Chronic Conditions in which the KIDNEYS perform below the normal level for more than three months. Chronic kidney insufficiency is classified by five stages according to the decline in GLOMERULAR FILTRATION RATE and the degree of kidney damage (as measured by the level of PROTEINURIA). The most severe form is the end-stage renal disease (CHRONIC KIDNEY FAILURE). (Kidney Foundation: Kidney Disease Outcome Quality Initiative, 2002) Kidney Insufficiency, Chronic,Chronic Kidney Diseases,Chronic Kidney Insufficiency,Chronic Renal Diseases,Chronic Renal Insufficiency,Chronic Kidney Disease,Chronic Kidney Insufficiencies,Chronic Renal Disease,Chronic Renal Insufficiencies,Disease, Chronic Kidney,Disease, Chronic Renal,Diseases, Chronic Kidney,Diseases, Chronic Renal,Kidney Disease, Chronic,Kidney Diseases, Chronic,Kidney Insufficiencies, Chronic,Renal Disease, Chronic,Renal Diseases, Chronic,Renal Insufficiencies, Chronic
D058085 Iron Compounds Organic and inorganic compounds that contain iron as an integral part of the molecule. Compounds, Iron
D019190 Iron Overload An excessive accumulation of iron in the body due to a greater than normal absorption of iron from the gastrointestinal tract or from parenteral injection. This may arise from idiopathic hemochromatosis, excessive iron intake, chronic alcoholism, certain types of refractory anemia, or transfusional hemosiderosis. (From Churchill's Illustrated Medical Dictionary, 1989) Overload, Iron

Related Publications

Guy Rostoker, and Aurélie Hummel, and François Chantrel, and Jean-Philippe Ryckelynck
January 1979, Nephron,
Guy Rostoker, and Aurélie Hummel, and François Chantrel, and Jean-Philippe Ryckelynck
January 2016, Journal of midwifery & women's health,
Guy Rostoker, and Aurélie Hummel, and François Chantrel, and Jean-Philippe Ryckelynck
March 2006, Praxis,
Guy Rostoker, and Aurélie Hummel, and François Chantrel, and Jean-Philippe Ryckelynck
May 2010, Therapeutische Umschau. Revue therapeutique,
Guy Rostoker, and Aurélie Hummel, and François Chantrel, and Jean-Philippe Ryckelynck
September 2018, Pharmaceuticals (Basel, Switzerland),
Guy Rostoker, and Aurélie Hummel, and François Chantrel, and Jean-Philippe Ryckelynck
June 1994, Vnitrni lekarstvi,
Guy Rostoker, and Aurélie Hummel, and François Chantrel, and Jean-Philippe Ryckelynck
January 1958, Praxis,
Guy Rostoker, and Aurélie Hummel, and François Chantrel, and Jean-Philippe Ryckelynck
January 2015, Anemia,
Guy Rostoker, and Aurélie Hummel, and François Chantrel, and Jean-Philippe Ryckelynck
March 1989, Seminars in nephrology,
Guy Rostoker, and Aurélie Hummel, and François Chantrel, and Jean-Philippe Ryckelynck
March 1992, Schweizerische medizinische Wochenschrift,
Copied contents to your clipboard!