losartan-potassium and Hyperparathyroidism

Several factors are involved in conditioning renal anemia, and a critical role is attributed to parathyroid hormone (PTH) oversecretion, which has some direct effects on endogenous erythropoietin (EPO) synthesis, bone marrow erythroid progenitors, and red cell survival. Indirect effects are mainly based on the induction of bone marrow fibrosis. Indirect evidence of the role of PTH is based on the observation that parathyroidectomy, when performed in uremic patients, is often followed by restoration of the hematocrit. The interpretations of such positive results are based on the observation of the restored bone marrow space after operation and also in a rise of immunoreactive EPO serum concentrations observed in the first weeks after gland removal. Another field of clinical interest is the possible beneficial effects of vitamin D therapy in controlling PTH secretion, which in turn determines an improvement of anemia of uremic subjects. Several uncontrolled studies confirmed this possibility, indicating that patients who respond to calcitriol or its analogs also show an increase of their hemoglobin levels. Thus, a combined therapeutic approach to PTH oversecretion and anemia is possible by intravenous calcitriol or parathyroidectomy pointing to the possible reversibility of bone marrow fibrosis, which is a common feature of secondary hyperparathyroidism. The increased sensitivity to EPO therapy can also induce a successful reduction of its dosage, thus allowing an interesting reduction of costs.

Topics: Anemia; Bone Marrow; Erythropoiesis; Erythropoietin; Fibrosis; Humans; Hyperparathyroidism; Parathyroid Hormone; Parathyroidectomy; Uremia; Vitamin D

Insulin resistance is a characteristic feature of uremia. As long as the hyperinsulinemia adequate to overcome the insulin resistance, glucose tolerance remains normal. In patients destined to develop type 2 diabetes, the beta cell compensatory response declines, and relative, or absolute, insulin deficiency develops. At this point glucose intolerance and eventually frank type 2 diabetes occur. Insulin resistance and concomitant hyperinsulinemia are present irrespective of the type of renal disease. Several studies have confirmed that hemodialysis (HD) treatment significantly improves insulin resistance. Both CAPD and CCPD are shown to improve insulin resistance in uremic patients. Comparing the effect of PD and HD treatment, it was found that the CCPD group has significantly higher insulin sensitivity than the HD group with the CAPD group similar to HD. Treatment of calcium and phosphate disturbances, including vitamin D therapy, significantly reduces insulin resistance in uremia. Treatment with recombinant human erythropoietin (EPO) is an efficient way to increase hematocrit, to reverse cardiovascular problems and to improve insulin sensitivity. Angiotensin-converting enzyme inhibitors have been shown to improve insulin resistance, hyperinsulinemia and glucose intolerance in uremic patients. Thiazolidinediones (TZDs), the new insulin-sensitizing drugs, provide the proof that pharmacologic treatment of insulin resistance can be of enormous clinical benefit. The great potential of insulin resistance therapy illuminated by the TZDs will continue to catalyze research in this area directed toward the discovery of new insulin-sensitizing agents that work through other mechanisms.

Topics: Anemia; Angiotensin-Converting Enzyme Inhibitors; Blood Glucose; Diabetes Mellitus, Type 2; Erythropoietin; Humans; Hyperparathyroidism; Hypoglycemic Agents; Insulin Resistance; Phosphoric Diester Hydrolases; Pyrophosphatases; Recombinant Proteins; Renal Dialysis; Thiazoles; Thiazolidinediones; Uremia

The absence of any response to the administration of recombinant human erythropoietin (rHuEpo) is exceptional in uremic patients with anemia. Initial "nonresponders" generally respond to higher doses of the hormone. However, a small number of patients may remain unresponsive. The most common cause of limited response is mild to moderate iron deficiency, either at the start of treatment or secondary to enhanced iron utilization by newly formed erythrocytes. Another common cause of resistance is the presence of an overt or, more often, an unrecognized inflammatory state, including acute or chronic infection. Marked aluminum overload and severe hyperparathyroidism also have been shown to induce resistance in at least some patients. Other factors may contribute to the severity of anemia and hence increase rHuEpo requirements, such as acute or chronic hemolytic conditions or blood loss, folate deficiency, hemoglobinopathies, and still poorly defined uremic toxins. In patients who show a resistance to the effect of the recombinant hormone, these should be sought and eliminated, if possible.

Topics: Anemia; Drug Resistance; Erythropoietin; Hematopoiesis; Humans; Hyperparathyroidism; Inflammation; Kidney Failure, Chronic; Recombinant Proteins

Topics: Adrenal Glands; Aldosterone; Anemia; Biopsy, Needle; Cholinesterases; Erythropoietin; Fibrin; Graft Rejection; Humans; Hyperparathyroidism; Hypertension; Juxtaglomerular Apparatus; Kidney; Kidney Failure, Chronic; Kidney Transplantation; Polycythemia; Proteinuria; Radioisotope Renography; Renin; Transplantation, Homologous; Ultrasonography

Topics: Animals; Calcium; Erythropoietin; Humans; Hyperparathyroidism; Kidney; Kidney Failure, Chronic; Male; Middle Aged; Phosphorus; Rats

The response to recombinant human erythropoietin (rHuEPO), 50 units/kg thrice weekly, was studied prospectively in 17 children and adolescents with end-stage renal disease who were either transfusion dependent or had hematocrits < 25%. For convenience, rHuEPO was given intravenously to 12 hemodialysis (HD) patients and subcutaneously to 5 peritoneal dialysis (PD) patients. Blood pressure, hematocrit, iron indices, and serum potassium, calcium, phosphorus, alkaline phosphatase, urea nitrogen, and intact parathyroid hormone (PTH) were monitored serially. When serum ferritin was < 100 ng/ ml during therapy, 6 patients received iron supplementation. rHuEPO therapy eliminated frequent transfusions in all patients; 11 of 17 patients reached the target hematocrit of 30%-33% by week 16 of rHuEPO, 50 units/kg thrice weekly. The 5 PD patients treated subcutaneously reached target at week 6 +/- 1; 6 HD patients treated intravenously reached target at week 11 +/- 3; 6 additional HD patients never reached target at this dose; 5 of 6 had pre-rHuEPO serum PTH levels >400 pg/ml, significantly higher than those of the other patients (P < 0.005); 3 of 6 later reached a hematocrit of 30%-33% after the rHuEPO dose was increased to 120-130 units/kg thrice weekly. We conclude that most pediatric dialysis patients can be treated successfully with rHuEPO, 50 units/kg thrice weekly, unless the serum PTH concentration is markedly elevated, in which case a higher dose is likely to be needed.

Topics: Adolescent; Adult; Anemia; Child; Child, Preschool; Erythropoietin; Female; Ferritins; Hematocrit; Humans; Hyperparathyroidism; Infant; Kidney Failure, Chronic; Male; Parathyroid Hormone; Peritoneal Dialysis; Prospective Studies; Recombinant Proteins; Renal Dialysis

Primary as well as secondary hyperparathyroidism may be associated with anemia, and parathyroidectomy (PTx) may improve or even heal it. The precise link between the two conditions is still matter of discussion. The purpose of the present study was to investigate possible effects of PTx on serum immunoreactive erythropoietin (iEPO) in secondary (group I, n = 23), and primary (group II, n = 16) hyperparathyroidism patients, and in 3 patients undergoing cervicotomy for thyroid mass removal (group III). In group I patients, circulating iEPO levels rose from 23.1 +/- 4.8 mU/ml before PTx to 28.2 +/- 5.0 and 245 +/- 125 mU/ml (mean +/- SEM) at day 7 (p = NS) and 14 after PTx (p less than 0.003), respectively. Reticulocyte count increased 2 weeks after PTx: from 61,000 +/- 13,317 to 86,533 +/- 13,462/mm3 (p less than 0.05, n = 23). In 4 of these patients serum iEPO levels could be measured again 12-24 months after PTx. They were slightly higher than those determined before PTx: 37.0 +/- 8.4 versus 31.8 +/- 13.5 mU/ml. Their hematocrits were also higher than before PTx: 12.8 +/- 0.9 versus 11.0 +/- 0.9 g/dl. In group II patients, serum iEPO levels remained unchanged after PTx: 17.5 +/- 2.0 mU/ml before PTx and 20.0 +/- 3.0 mU/ml 14 days PTx. The reticulocyte count, however, increased significantly 2 weeks after PTx: from 25,103 +/- 3,000 to 40,827 +/- 4,080/mm3 (p less than 0.01). In group III patients, serum iEPO, reticulocyte count, and hemoglobin remained stable after surgery. Since all group I patients had received vitamin D supplementation after PTx, we studied an additional group of 14 chronic dialysis patients (group IV) who received either calcitriol (1 micrograms/day, n = 7) or placebo (n = 7) during 14 days. The patients on calcitriol treatment, but not those on placebo, had a significant decrease of serum iEPO: 18.6 +/- 4.9 versus 16.0 +/- 4.2 mU/ml (p less than 0.03). In conclusion, PTx led to a striking increase of serum iEPO and blood reticulocytes in uremic patients with secondary hyperparathyroidism, and an increase of reticulocyte count, but not of iEPO, in patients with primary hyperparathyroidism. Marked changes of circulating PTH, extra-or intracellular calcium and phosphorus concentrations as well as of tissue sensitivity to EPO after PTx could all be responsible. In contrast, the surgical procedure and the therapeutic increase in plasma calcitriol do not appear to be involved.

Topics: Calcitriol; Erythropoiesis; Erythropoietin; Female; Humans; Hyperparathyroidism; Hyperparathyroidism, Secondary; Male; Middle Aged; Parathyroid Hormone; Parathyroidectomy

In a European multicenter trial the weekly rates of increase in hematocrit and reticulocyte values were investigated in hemodialyzed patients with transfusion-dependent anemia treated with recombinant human erythropoietin (rHuEPO). Within a few months of therapy, the number of transfusion-dependent patients decreased to less than 5% of the group. Patients with aluminum overload indicated by elevated basal serum levels or elevated levels after a desferrioxamine challenge showed a significantly reduced response to rHuEPO. whereas in patients with elevated levels of parathyroid hormone a normal response to rHuEPO was found.

Topics: Aluminum; Anemia; Bone Marrow; Erythropoietin; Europe; Hematologic Tests; Humans; Hyperparathyroidism; Recombinant Proteins; Renal Dialysis

Uncontrolled hy-per-parathyroidism causes bone marrow fibrosis, leading to erythropoietin (EPO) resistance. Medical treatment with cinacalcet is effective in reducing plasma parathyroid hormone (PTH) levels, but its effect on darbepoetin dosing is unknown.. We conducted a retrospective cohort study of 40 end-stage renal disease (ESRD) patients (age: 55 ± 14; mean ± SD; 21:male) who had at least 12 months of cinacalcet therapy. The distribution of renal replacement therapies were: 14 peritoneal dialysis, 18 conventional hemodialysis and 8 nocturnal hemodialysis. Standard dialysis related biochemical indices and medications used were recorded. The primary objective of the study was to ascertain the difference in darbepoetin responsiveness before and after 12 months of cinacalcet therapy. Our secondary objective was to determine if there was a relationship between the changes in PTH and darbepoetin requirement.. Overall, PTH levels decreased from 197.5 (151.8; 249.2) to 66.1 (41.2; 136.5) (median (25th;75th percentile)) pmol/l; p < 0.001. Cinacalcet dose increased from 30.0 ± 6 to 63 ± 25 mg/day, p < 0.05. Hemoglobin remained unchanged (116 ± 13 to 116 ± 13 g/l), while darbepoetin requirement decreased from 40 (20; 60) to 24 (19; 59) μg/week, p = 0.02. The remainder of the dialysis-related biochemistry (electrolytes, calcium, phosphate, iron status) and vitamin D use remained unchanged. A reduction in PTH level of greater than 30% was experienced by 82.5% (33/40) of our cohort. Among the responders, the fall in PTH and reduction darbepoetin requirement were related (R = -0.48, p = 0.004).. Reduction of PTH by cinacalcet is associated with a decrease in darbepoetin requirement. The interface between bone and bone marrow in uremia represents a critical step in red blood cell production which merits further investigation.

Topics: Anemia; Cinacalcet; Cohort Studies; Darbepoetin alfa; Drug Interactions; Erythropoietin; Female; Hematinics; Humans; Hyperparathyroidism; Kidney Failure, Chronic; Male; Middle Aged; Naphthalenes; Parathyroid Hormone; Renal Dialysis; Retrospective Studies; Treatment Outcome

The erythropoietic response in hemodialysis patients depends on several physiologic factors. Most epidemiologic studies include the effect of these factors by representing them as confounders. This study tested the hypothesis that iron stores, inflammation, dialysis adequacy, nutritional status, and hyperparathyroidism act as nonlinear effect modifiers of the erythropoietic response and quantified the magnitude of those effects over clinically relevant ranges.. The following retrospective data from 209 hemodialysis patients receiving Epoetin alfa (Epo) were collected: monthly: predialysis hemoglobin (Hgb), transferrin saturation, serum albumin, dialysis adequacy (Kt/V); quarterly: predialysis serum ferritin and intact parathyroid hormone over a period of 13 to 69 months. The study analyzed the dynamic relationship between hemoglobin and Epo, considering nonlinear effect modification by ferritin, transferrin saturation, Kt/V, albumin, and parathyroid hormone individually.. Maximum Hgb response to Epo was achieved for serum ferritin between 350 and 500 ng/ml, transferrin saturation greater than 30%, Kt/V greater than 1.4, and albumin greater than 3.8 g/dl. Hgb sensitivity to Epo decreases by about 30% as parathyroid hormone increases from 0 through 1000 pg/ml.. Serum ferritin, transferrin saturation, Kt/V, serum albumin, and intact parathyroid hormone are markers of nonlinear effect modification of the erythropoietic response in hemodialysis patients.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anemia; Biomarkers; Confounding Factors, Epidemiologic; Dose-Response Relationship, Drug; Epoetin Alfa; Erythropoiesis; Erythropoietin; Female; Ferritins; Hematinics; Hemoglobins; Humans; Hyperparathyroidism; Inflammation; Iron; Kidney Diseases; Likelihood Functions; Logistic Models; Male; Middle Aged; Nonlinear Dynamics; Nutritional Status; Parathyroid Hormone; Recombinant Proteins; Renal Dialysis; Retrospective Studies; Serum Albumin; Time Factors; Transferrin; Treatment Outcome; Young Adult

The objective of this study was to assess the response to recombinant human erythropoietin (rHuEPO) during treatment of anemia in dialysis patients with hyperparathyroidism.. A total of 118 patients with stage 5 renal failure on dialysis therapy were selected for this study. Anemia was treated with rHuEPO. Laboratory data for each patient included intact parathyroid hormone (iPTH), hemoglobin (Hb), hematocrit (Hct), blood urea nitrogen, serum creatinine, calcium, phosphate, and alkaline phosphatase. Patients with iPTH >32 pmol/l were considered hyperparathyroid. Erythropoietin resistance index (ERI) was expressed as the ratio of weekly rHuEPO dose/Hct level.. Of the 118 patients, 83 (70.3%) were on hemodialysis (HD) and 35 (29.7%) were on continuous ambulatory peritoneal dialysis (CAPD). Sixty-three patients (64.3%) with iPTH >32 pmol/l had Hb <11 g/dl, while 34 (54.8%) with iPTH <32 had Hb >11 g/dl (p = 04). Thirty-three (56%) patients with iPTH >32 pmol/l had hemocrit <33%, while 38 (61.3%) with iPTH <32 had hemocrit <33% (p = 0.4). The median value of weekly rHuEPO dose in HD patients (12,000 units) was significantly higher in comparison with CAPD patients (6,000 units; p < 0.0001). ERI was significantly higher in HD than CAPD patients with iPTH <16 pmol/l (p = 0002) as well as with patients with 16-32 pmol/l (p = 0.012).. CAPD patients showed a reduced requirement for rHuEPO and better control of anemia compared with HD patients. ERI was also lower in CAPD than in HD patients. Hyperparathyroidism is a parameter predictive of rHuEPO hyporesponsiveness in dialysis patients.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anemia; Erythropoietin; Female; Humans; Hyperparathyroidism; Male; Middle Aged; Parathyroid Hormone; Peritoneal Dialysis, Continuous Ambulatory; Renal Dialysis

The aim of this study was to analyze the effects of elevated parathyroid hormone (iPTH) and C-reactive protein (CRP) on rHuEPO requirements and associated clinical and biochemical parameters of hemodialysis patients.. A total of 127 hemodialysis patients were included. Laboratory values from the previous 3 months (monthly measured CRP, iPTH, albumin, prealbumin, calcium, phosphorus, and hemoglobin) and clinical findings (rHuEPO requirements, iron supplements, Kt/V) were recorded retrospectively. Patients were subgrouped according to presence of hyperparathyroidism (mean iPTH > 350 pg/mL) and chronic inflammation (mean CRP > 8.5 mg/L) as group I (low iPTH, low CRP, n = 32), group II (high iPTH, low CRP, n = 32), group III (low iPTH, high CRP, n = 32), and group IV (high iPTH, high CRP, n = 31).. We found that group IV had lowest hemoglobin (P < .0001, .0001, .01, respectively), albumin (P < .0001), prealbumin (P < .0001, .0001, .02, respectively), and highest rHuEPO requirements (P < .0001, .0001, .01, respectively) compared to other groups despite of similar iron indices. Group III also had lower albumin (P < .002, .0001, respectively), prealbumin (P < .001, .01, respectively), hemoglobin (P < .001, .005, respectively), but higher rHuEPO requirements (P < .01) compared to group I and group II.. We propose that hyperparathyroidism increases rHuEPO requirements and aggravates the negative effects of chronic inflammation in hemodialysis patients.

Topics: Adult; Aged; Albuminuria; C-Reactive Protein; Dose-Response Relationship, Drug; Erythropoietin; Female; Humans; Hyperparathyroidism; Inflammation; Male; Middle Aged; Recombinant Proteins; Renal Dialysis

Vascular access failure is the main cause of morbidity in hemodialysis. Venous stenosis and subsequent thrombosis, as the result of intimal hyperplasia, is the major cause of vascular access failure. Intimal hyperplasia of the arteriovenous fistula (AVF) closely resembles the main histopathologic feature of atherosclerosis. In addition to the classic atherogenic risk factors, recently, cytomegalovirus (CMV) infection and parathyroid hormone (PTH) have been suggested as a potential cause of vascular disease.. In the present study, we evaluated the relationship between AVF dysfunction and mean plasma PTH, cholesterolemia, high titer anti-CMV immunoglobulin G (IgG) (>250 U/mL), hematocrit, and mean erythropoietin (EPO) dose in 36 cases and 51 controls matched for age, time on dialysis, and type of AVF.. A higher percentage of patients with AVF failure had a smoking habit and presented high anti-CMV IgG titer. Patients with AVF failure had significantly higher mean plasma PTH, whereas the groups did not differ for mean cholesterolemia and hematocrit. Mean EPO dose was slightly, but significantly, higher in the AVF failure group. Multiple logistic regression revealed that smoking, EPO dose, elevated mean plasma PTH and high titer anti-CMV antibodies, significantly increased the risk of AVF dysfunction.. Our data suggest that hyperparathyroidism, smoking habits, CMV infection and EPO, independently of the hematocrit achieved, represent independent risk factors for hemodialysis access thrombosis.

Topics: Aged; Arteriovenous Shunt, Surgical; Cytomegalovirus Infections; Erythropoietin; Female; Graft Occlusion, Vascular; Hematocrit; Humans; Hyperparathyroidism; Incidence; Kidney Failure, Chronic; Male; Middle Aged; Parathyroid Hormone; Renal Dialysis; Risk Factors; Smoking; Thrombosis

Secondary hyperparathyroidism (HPT) worsens anemia and may cause hyporesponsiveness to recombinant human erythropoietin therapy (r-HuEPO). To investigate the effect of parathyroidectomy (PTX) on iron homeostasis and erythropoiesis, we conducted a prospective study in chronic hemodialysis patients who underwent PTX.. Thirty-two patients were enrolled in this study. Based on the increases in hemoglobin level after PTX, patients were divided into responders and nonresponders. Iron homeostasis and erythropoiesis were assessed before and 1 and 3 months after PTX, hemoglobin and parathyroid hormone levels were monitored until 6 months after PTX.. In the responders, increased hemoglobin levels were observed in 15 patients at 1 and 3 months after PTX (8.0 +/- 0.8 g/dl vs. 9.2 +/- 1.3 and 10.1 +/- 0.9 g/dl, p < 0.05). The nonresponders had higher pre-PTX hemoglobin levels than the responders (10.3 +/- 1.6 g/dl vs. 8.0 +/- 0.8 g/dl, p < 0.05). There was no further increase in hemoglobin at 6 months compared to 3 months after PTX in both groups. In neither group did PTX affect serum ferritin, transferrin saturation and serum erythropoietin level. Serum soluble transferrin receptor (sTfR) concentration was found to be higher in responders than in nonresponders (3.32 +/- 1.28 mg/l vs. 1.70 +/- 0.31 mg/l, p < 0.05).. We conclude that PTX can improve anemia in hemodialysis patients with severe hyperparathyroidism and greater resistance to r-HuEPO therapy. The reversing of anemia does not involve altering iron mobilization. Pre-PTX hemoglobin and serum sTfR levels can predict the effect of PTX on correcting anemia.

Topics: Adult; Anemia; Erythropoiesis; Erythropoietin; Female; Homeostasis; Humans; Hyperparathyroidism; Iron; Male; Middle Aged; Parathyroidectomy; Prospective Studies; Receptors, Transferrin; Renal Dialysis

It is suggested that parathyroid hormone (PTH), when in excessive amounts, interferes with normal erythropoiesis by downregulating the erythropoietin receptors on erythroid progenitor cells in the bone marrow. Therefore, physiologic concentrations of EPO can no longer sustain normal red cell counts, so normocytic and normochromic anaemia ensues. In primary hyperparathyroidism (HPT), this effect is observed with very high concentrations of PTH. In secondary HPT during chronic renal failure, this effect is more pronounced because erythropoietin synthesis is impaired.

Topics: Anemia; Erythropoiesis; Erythropoietin; Humans; Hyperparathyroidism; Models, Biological; Parathyroid Hormone

Topics: Anemia; Blood Transfusion; Calcitriol; Erythropoietin; Hemoglobins; Humans; Hyperparathyroidism; Kidney Failure, Chronic; Male; Middle Aged; Parathyroidectomy; Recombinant Proteins; Renal Dialysis

The authors reached the suppression of serum intact parathormone (iPTH) by calcitriol therapy in chronic hemodialyzed patients with secondary hyperparathyroidism. Parallel with the depression of iPTH levels it was enough a lower doses of recombinant human erythropoietin (Rh-EPO) to maintain the target hematocrit, while on two patients non-treated with Rh-EPO they founded an improvement in moderate anemia. Their data confirm that the calcitriol is an effective drug in the treatment of secondary hyperparathyroidism. The results speak in favour that in the improvement of renal anemia on regular hemodialysis patients play an important role the suppression of serum iPTH levels too.

Topics: Anemia; Calcitriol; Dose-Response Relationship, Drug; Erythropoietin; Hematocrit; Humans; Hyperparathyroidism; Kidney Failure, Chronic; Parathyroid Hormone; Recombinant Proteins; Renal Dialysis

The present study aimed assess the relationship between erythropoietin (EPO) and parathormone (PTH) secretion in patients with primary hyperparathyroidism (PHP). Seventeen patients with PHP and 24 patients with uncomplicated cholelithiasis were examined before and during 14 days after surgical treatment. In PHP patients plasma EPO levels were significantly higher than in patients with cholelithiasis (31.5 + 4.3 vs 14.1 + 0.9 mU/ml, p < 0.01). After cholecystectomy transient increase of plasma EPO level was noticed postoperatively during the first 6 days. Such an increase of plasma EPO was absent in PHP patients after removal of the cause of primary hyperparathyroidism. Only in PHP patients a significant negative correlation was found preoperatively between plasma EPO level and Hct value or creatinine clearance respectively.. 1. Patients with PHP are characterized by significantly elevated plasma EPO levels which are related to the degree of anaemia and decrease of GFR. 2. In patients with PHP presence of significant relationship between EPO and PTH secretion could not be proven.

Topics: Adult; Cholecystectomy; Cholelithiasis; Creatinine; Erythropoietin; Female; Hematocrit; Humans; Hyperparathyroidism; Male; Parathyroid Hormone

Topics: Acquired Immunodeficiency Syndrome; Aluminum; Anemia; Drug Resistance; Erythropoietin; Humans; Hyperparathyroidism; Iron; Kidney Transplantation; Uremia

Topics: Adult; Aged; Anemia; Erythropoietin; Female; Hemoglobins; Humans; Hydroxycholecalciferols; Hyperparathyroidism; Kidney Failure, Chronic; Male; Middle Aged

The burden of cardiac disease in dialysis patients is high. Congestive heart failure, ischemic heart disease, left ventricular hypertrophy, and systolic dysfunction occur frequently and are associated with an adverse prognosis. In addition, during dialysis therapy anemia, hypoalbuminemia, low blood pressure, and lower serum creatinine levels are adverse predictors of mortality. Risk factors for systolic dysfunction include older age, ischemic heart disease, hyperparathyroidism, and smoking. Risk factors for left ventricular hypertrophy include older age, hypertension, anemia, and diabetes mellitus. Interventions with potential for improving cardiomyopathy include normalization of hematocrit with erythropoietin, improved uremia therapy, and angiotensin-converting enzyme inhibitors. Trials to determine the most appropriate interventions to reduce the impact of cardiac disease in chronic uremia are urgently required.

Topics: Age Factors; Aged; Anemia; Angiotensin-Converting Enzyme Inhibitors; Canada; Cardiomyopathies; Cohort Studies; Comorbidity; Diabetes Mellitus; Echocardiography; Erythropoietin; Female; Hematocrit; Humans; Hyperlipidemias; Hyperparathyroidism; Hypertension; Kidney Failure, Chronic; Male; Middle Aged; Prevalence; Prognosis; Proportional Hazards Models; Prospective Studies; Renal Dialysis; Risk Factors; Smoking; Survival Analysis; Systole

Topics: Adult; Aluminum; Anemia; Anemia, Hypochromic; Erythropoiesis; Erythropoietin; Humans; Hyperparathyroidism; Infections; Iron Deficiencies; Kidney Failure, Chronic; Middle Aged; Occult Blood; Recombinant Proteins; Renal Dialysis

Topics: 2,3-Diphosphoglycerate; Animals; Calcium; Diphosphoglyceric Acids; Erythrocytes; Erythropoiesis; Erythropoietin; Hyperparathyroidism; Iron; Male; Parathyroid Hormone; Phosphates; Rats; Rats, Inbred Strains

Topics: Adolescent; Erythropoiesis; Erythropoietin; Hemoglobins; Hepatitis B; Humans; Hyperparathyroidism; Kidney Failure, Chronic; Male; Nephrectomy; Renal Dialysis

Topics: Androgens; Anemia; Bone and Bones; Bone Marrow Diseases; Erythropoietin; Estrogens; Female; Folic Acid; Gonadal Steroid Hormones; Hematopoiesis; Humans; Hyperparathyroidism; Kidney; Male; Osteoporosis; Polycythemia; Primary Myelofibrosis; Uremia