losartan-potassium and Nutrition-Disorders

Anemia is a frequent clinical feature with adverse prognostic effects in patients with chronic lymphocytic leukemia (CLL). It may complicate CLL at any time during the course of the disease. Different factors concur to the occurrence of anemia in CLL, as in other lymphoproliferative diseases: leukemic bone marrow infiltration, the myelosuppressive effect of chemotherapy and inhibiting cytokines, autoimmune phenomena, hypersplenism, a poor nutritional status that leads to folic acid, vitamin B12 and iron deficiency. In addition, a defective endogenous erythropoietin (EPO) production has also been described in patients with lymphoproliferative diseases. The severity of anemia, which may be worsened by an impaired cardiopulmonary function, may profoundly compromise the patients' quality of life and, indirectly, the outcome of cancer bearing patients. Several Authors have reported the clinical activity of recombinant human (rHu)EPO in anemic patients with lymphoproliferative diseases, including CLL. Low serum EPO levels at baseline and EPO levels inappropriately low for the degree of anemia help to identify patients who are likely to respond to EPO. A clear dose-dependent response to EPO has been reported by different Authors and it has been suggested that 5,000 IU should be considered as an appropriate initial dose for the majority of patients. rHuEPO represents a potentially effective and safe therapy for the management of anemia associated with lymphoproliferative diseases. The reduction of red blood cell transfusion requirement, the improvement of quality of life through the remission of fatigue-related anemia are two important results that should be considered in the management of patients with CLL. In prospect, the availability of new rHuEPO molecules with a more prolonged half-life may open new therapeutic avenues.

Topics: Anemia; Anemia, Hemolytic, Autoimmune; Antineoplastic Agents; Bone Marrow; Cytokines; Dose-Response Relationship, Drug; Erythropoiesis; Erythropoietin; Granulocyte-Macrophage Colony-Stimulating Factor; Humans; Hypersplenism; Leukemia, Lymphocytic, Chronic, B-Cell; Lymphoproliferative Disorders; Multicenter Studies as Topic; Nutrition Disorders; Radiotherapy; Randomized Controlled Trials as Topic; Recombinant Proteins; Red-Cell Aplasia, Pure; Treatment Outcome

Topics: Aged; Anemia; Chronic Kidney Disease-Mineral and Bone Disorder; Clinical Trials as Topic; Disease Progression; Electrolytes; Epidemiologic Methods; Erythropoietin; Hemodialysis Solutions; Humans; Hypertension; Kidney Failure, Chronic; Male; Models, Biological; Nutrition Disorders; Quality of Life; Renal Dialysis; Toxins, Biological; Uremia

Topics: Anemia; Anemia, Hypochromic; Antihypertensive Agents; Blood Transfusion; Cardiovascular Diseases; Combined Modality Therapy; Erythropoietin; Hemoglobins; Humans; Hypertension; Immunocompromised Host; Immunosuppressive Agents; Iron; Iron Deficiencies; Kidney Failure, Chronic; Nutrition Disorders; Recombinant Proteins; Renal Dialysis

Topics: Anemia; Cardiovascular Diseases; Chronic Kidney Disease-Mineral and Bone Disorder; Erythropoiesis; Erythropoietin; Glutathione; Hemolysis; Humans; Kidney Failure, Chronic; Nutrition Disorders; Oxidation-Reduction

Topics: Anemia; Erythropoiesis; Erythropoietin; Humans; Nutrition Disorders; Oxygen

Topics: Adult; Aged; Anemia; Dietary Proteins; Energy Intake; Erythropoietin; Female; Humans; Iron; Male; Middle Aged; Nutrition Disorders; Parenteral Nutrition; Recombinant Proteins; Renal Dialysis; Serum Albumin

We compared the effect of recombinant human erythropoietin (rhEPO) administration by continuous s.c. infusion (CSI) with that of a weekly bolus s.c. injection (SBI) in five malnourished predialysis anemic patients with diabetic nephropathy. rhEPO was either continuously infused at a flow rate of 6000 IU per week (36 IU/h) (CSI group) or injected s.c. at a dose of 6000 IU once a week (SBI group) for 4 weeks, in a cross-over comparative study with a washout period of 4 weeks. Mean+/-S.D. plasma EPO levels increased from a basal value of 18.0+/-4.9 mIU/ml to a steady state value of 70.5+/-38.9 mIU/ml 2 weeks after the start of CSI of rhEPO (P < 0.05). Increases in reticulocyte count above the basal value were greater in the CSI group than the SBI group at 3 weeks after the start of treatment (0.94+/-0.35% vs -0.03+/-0.46%, P < 0.05). Increases in Hb concentration above the basal value were much greater in the CSI group than the SBI group at 4 weeks after the start of treatment (2.56+/-0.77 g/dl vs 0.28+/-0.62 g/dl, P < 0.05). These findings suggest that rhEPO administration by CSI is more effective than by SBI for improving anemia in malnourished predialysis patients with diabetic nephropathy.

Topics: Aged; Aged, 80 and over; Anemia; Body Mass Index; Cross-Over Studies; Diabetic Nephropathies; Erythropoietin; Female; Hemoglobins; Humans; Infusions, Parenteral; Injections, Subcutaneous; Iron; Male; Middle Aged; Nutrition Disorders; Recombinant Proteins; Renal Dialysis; Reticulocyte Count

Anemia is common and under recognized in older adults and associated with increased morbidity and mortality. Estimates of prevalence of anemia in older adults vary considerably based on the setting, gender, age and definition used and likely to increase further based on aging trends. Rather than simply a consequence of aging, anemia is a marker of underlying disease, requiring investigation for an etiology. A cause is discernible in at least two-thirds of cases; management involves addressing the underlying disease process, replacement of deficient nutrients or the use of erythropoietic factors.

Topics: Adaptation, Physiological; Age Factors; Aged; Aged, 80 and over; Aging; Anemia; Antimicrobial Cationic Peptides; Erythropoietin; Female; Hematopoiesis; Hepcidins; Humans; Male; Nutrition Disorders; Sex Factors

Malnutrition with hypoalbuminemia is an independent predictor of mortality in end-stage renal disease patients. Anabolic steroids reduce protein catabolism and therefore may improve nutritional parameters. This study was undertaken to determine the effects of the anabolic steroid nandrolone decanoate on the nutritional status of hemodialysis patients. Secondary endpoints were to examine the effects of androgen therapy on hematocrit and erythropoietin (EPO) dose.. Medical records of chronic hemodialysis patients who received nandrolone decanoate for greater than 30 days were reviewed. Data collected included: demographics, dose, frequency, duration of treatment and cumulative dose of nandrolone. Baseline albumin, transferrin, dry weight, phosphorus, creatinine, hematocrit and erythropoietin dose were obtained for comparison with values after treatment.. Of the 9 patients evaluated (mean +/- SD: age 55+/-28 years, 4/9 male), 2 patients received nandrolone doses of 25 mg intramuscularly (i.m.) every week, while the remaining 7 patients received 100 mg i.m. every 2 weeks. The mean +/- SD duration of treatment was 96+/-43 days, with a mean +/- SD cumulative dose of 656+/-371 mg. The mean +/- SD baseline albumin was 2.9+/-0.6 mg/dl which increased to 3.3+/-0.4 mg/dl after treatment (p = 0.045). Dry weight increased from a mean +/- SD of 64.4+/-11.7 kg to 66.0+/-10.9 kg after nandrolone therapy (p = 0.028). Mean +/- SD hematocrit at baseline was 28.2+/-4.5% and increased to 33.2+/-5.1% (p = 0.033). The dose of EPO was reduced in 4 patients (44%) during nandrolone therapy.. Nandrolone significantly improved markers of nutritional status in our hemodialysis patients. This therapy may also enhance the hematopoietic effects of EPO.

Topics: Adult; Aged; Anabolic Agents; Anemia; Erythropoiesis; Erythropoietin; Female; Hematocrit; Humans; Kidney Failure, Chronic; Male; Middle Aged; Nandrolone; Nandrolone Decanoate; Nutrition Disorders; Nutritional Status; Renal Dialysis

Topics: Aluminum; Anemia; Anemia, Hypochromic; Drug Resistance; Erythropoiesis; Erythropoietin; Humans; Inflammation Mediators; Iron Deficiencies; Isoantibodies; Nutrition Disorders; Primary Myelofibrosis; Recombinant Proteins; Renal Dialysis; Treatment Failure

Secondary hyperparathyroidism is a frequent condition of dialysis patients. Endocrine derangements, with disturbance of calcium metabolism are complex, involving bone, heart (left ventricular hypertrophy-dilatation), bone marrow (anemia and erythropoietin resistance), muscle (increase of body fat mass) and insulin resistance. Aim of the study was to assess how these conditions are inter-correlated in the same patients. 45 patients (m 20, f 25; years 61.8 +/- 11.6) in maintenance bicarbonate three-weekly hemodialysis since > 3 years were studied. Cardiac function was assessed by echocardiography (EF%: left ventricular ejection fraction), which showed an inverse correlation both with parathormone (iPTH vs EF%: r = -0.64; p < 0.001) and with erythropoietin (rHu-EPO vs EF%: r = -0.62; p < 0.001). This suggests the possibility of a multi-endocrine resistance in dialysis patients with chronic renal failure, secondary to the degree of malnutrition. Lower lean mass is correlated with hyperparathyroidism (iPTH vs fat mass%: r = 0.37; p < 0.01), with lower left ventricular systolic function (EF% vs fat mass%: r = -0.41; p < 0.005) and with rHu-EPO resistance. Moreover, patients with higher iPTH show a hypercatabolic disposition, assessed as protein catabolic rate (PCR/kg vs iPTH r = 0.54; p < 0.001). This pattern can be a consequence of chronic renal failure, but bio-compatibility of materials can be involved as well.

Topics: Body Mass Index; Drug Resistance; Erythropoietin; Female; Hemoglobin A; Humans; Hyperparathyroidism, Secondary; Hypertrophy, Left Ventricular; Kidney Failure, Chronic; Male; Middle Aged; Myocardial Contraction; Nutrition Disorders; Parathyroid Hormone; Recombinant Proteins; Renal Dialysis; Stroke Volume; Systole

We examined the value of transferrin concentrations in estimating nutritional status as determined by the subjective global assessment (SGA) score. Fifty-nine hemodialysis patients (37 men and 22 women, aged 59+/-16 years, dialyzed for 3.6+/-3.9 years) were selected by predetermined criteria. All received erythropoietin (EPO) and oral iron therapy. SGA evaluation was conducted twice by both a dietitian and a physician. Serum iron, total iron-binding capacity (TIBC; which is linearly correlated with transferrin), transferrin saturation ratio, ferritin, albumin, total protein, and cholesterol were measured. Twenty-seven (46%) patients were well nourished (group A), 20 (34%) were moderately nourished (group B), and 12 (20%) were poorly nourished (group C) according to the SGA. TIBC values were 276+/-47 mg/dL, 217+/-54 mg/dL, and 176+/-41 mg/dL, respectively (P < 0.00001), and thus directly correlated with the state of nutrition. The relationship between TIBC and nutritional status was independent of age and number of years on hemodialysis. Serum ferritin values were 104+/-93 ng/mL, 161+/-154 ng/mL, and 363+/-305 ng/mL, respectively (P < 0.0003), and thus inversely correlated with the state of nutrition. Transferrin saturation ratios were slightly higher in the severely malnourished patients. The number of years on dialysis were a determinant of nutritional status. These values were 2.4+/-2.4 years for group A, 3.9+/-4.0 years for group B, and 5.7+/-3.9 years for group C (P < 0.05). The average age of the poorly nourished patients was 10 years older than the well-nourished patients. Serum iron values were lower but transferrin saturation ratios were higher in the severely malnourished patients. The required EPO doses were higher in the poorly nourished patients. We suggest that transferrin values are superior to other laboratory tests in assessing nutrition and will supplement SGA criteria. Serum ferritin may be useful as a predictor of illness. Older patients who have been on dialysis longer warrant special concern. Malnutrition may be an indicator of EPO resistance in dialysis patients. Finally, since a decreased TIBC level in poorly nourished patients may erroneously increase the transferrin saturation ratio, our findings may have implications in making the diagnosis and treatment of anemia and iron deficiency in malnourished dialysis patients.

Topics: Adult; Aged; Aged, 80 and over; Erythropoietin; Female; Ferritins; Humans; Iron; Male; Middle Aged; Nutrition Assessment; Nutrition Disorders; Renal Dialysis; Serum Albumin; Time Factors; Transferrin

The nutritional status of 75 maintenance hemodialysis (MHD) patients was evaluated according to the dietary intake analysis, anthropometric measurements, biochemical and immunological parameters in this study. Furthermore, some possible factors which would affect nutritional status of hemodialysis patients were discussed. The results showed that hemodialysis patients demonstrated a high incidence of malnutrition. The low intake of protein and calorie, metabolic acidosis and inadequate dialysis would worsen the malnutrition while erythropoietin treatment improve the nutritional status of hemodialysis patients. Based on these results, suggestions were proposed for the improvement of nutritional status of MHD.

Topics: Body Constitution; Case-Control Studies; Diet; Dietary Proteins; Energy Intake; Erythropoietin; Female; Humans; Incidence; Kidney Failure, Chronic; Male; Middle Aged; Nutrition Disorders; Nutritional Status; Recombinant Proteins; Renal Dialysis

Lisa Capaldini, a physician who treats patients with HIV-related fatigue, discusses symptoms, diagnosis techniques, and treatments of depression, anemia, and various other roots of fatigue in HIV-positive patients. Biochemical depression, caused by abnormal levels of serotonin and norepinephrine in the brain, is easily misdiagnosed or overlooked. Physical and emotional symptoms of depression mirror common effects of HIV such as exhaustion, anger, and irritability. Knowing the history of depression prior to HIV infection, including previous drug abuse and family history of depression, will help to diagnose fatigue. Dr. Capaldini recommends antidepressants provided the condition is properly diagnosed and the side effects are not harmful to the patient. Selective serotonin reuptake inhibitors (SSRI), the most frequently prescribed antidepressants, can cause short term sexual dysfunction. Bupropion and Wellbutrin can be prescribed to avoid this side effect. Psychotherapy can be effective if therapists are familiar with HIV disease and can distinguish between symptoms brought on by behavior, addictive habits, or pre-existing depression. Consideration also must be given to drug interactions, particularly with the antiretrovirals ritonavir and delavirdine, which can cause seizures or disturb cardiac rhythm. Anemia is most noticeable after physical exertion, and symptoms are more evident based on the increased rate that red blood cells move out of the normal range. To determine the course of treatment, physicians need to clarify the cause of anemia. Anemia can be caused by drugs, vitamin deficiencies, or other nutritional problems. Adrenal insufficiency, methemoglobinemia, and malnutrition are also causes of fatigue. Diagnosing fatigue due to hepatitis B or C, rather than HIV, can be achieved by measuring hepatitis levels and observing T cell counts and viral load. Dr. Capaldini suggests that proper diet and exercise prevent fatigue from getting worse.

Topics: Adrenal Insufficiency; Anemia; Anti-HIV Agents; Antidepressive Agents; Depression; Drug Interactions; Erythropoietin; Fatigue; Female; Hepatitis, Viral, Human; HIV Infections; Humans; Male; Methemoglobinemia; Nutrition Disorders

Despite the prevalent use of recombinant human erythropoietin (rhEPO), anemia is a frequent finding in hemodialysis patients. The goal of this study was to evaluate the impact of anemia on patient survival and characterize the determinants of hematopoiesis that may be amenable to therapeutic manipulation to enhance rhEPO responsiveness and reduce death risk. Patient characteristics and laboratory data were collected for 21,899 patients receiving hemodialysis three times per week in dialysis centers throughout the United States in 1993. Hemoglobin concentrations (Hb) < or =80 g/L were associated with a twofold increase in the odds of death (odds ratio = 2.01; P = 0.001) when compared with Hb 100 to 110 g/L. No improvement in the odds of death was afforded for Hb >110 g/L. Using multiple linear regression, variables of rhEPO administration (rhEPO dose and percentage of treatments that rhEPO was administered), variables of iron status (serum iron, transferrin saturation, and ferritin), variables of nutritional status (serum albumin and creatinine concentration), and the dose of dialysis (urea reduction ratio) were found to be significantly associated with hemoglobin concentration (P < 0.001). Age, race, and gender were also found to be significantly associated with hemoglobin concentrations (P < 0.001). From this report, the following conclusions may be made. (1) Anemia may be predictive of an increased risk of mortality in some hemodialysis patients. (2) Hemoglobin concentrations > 110 g/L are not associated with further improvements in the odds of death. (3) Laboratory surrogates of iron stores, nutritional status, and the delivered dose of dialysis are predictive of hemoglobin concentration. Whether manipulation of the factors that improve anemia will also enhance the survival of patients on hemodialysis is unknown and should be evaluated by prospective, interventional studies.

Topics: Adult; Aged; Anemia; Anemia, Hypochromic; Comorbidity; Creatinine; Diabetes Mellitus; Erythropoietin; Female; Ferritins; Hemoglobins; Humans; Iron; Kidney Failure, Chronic; Male; Middle Aged; Nutrition Disorders; Odds Ratio; Predictive Value of Tests; Prevalence; Recombinant Proteins; Regression Analysis; Renal Dialysis; Risk Factors; Serum Albumin; Survival Analysis; Transferrin; Treatment Outcome; United States

Topics: Anemia; Blood Donors; Blood Transfusion, Autologous; Blood Volume; Bone Marrow; Contraindications; Erythropoiesis; Erythropoietin; Female; Hemorrhage; Humans; Iron; Male; Nutrition Disorders; Recombinant Proteins; Safety

A previous report suggests that treatment with recombinant human erythropoietin (rH-EPO) significantly improves many abnormalities in circulating amino acids (AA) in hemodialysis patients. We evaluated the effects of a 12-month treatment with rH-EPO (150-250 U/kg/week) on blood AA levels in 10 patients with chronic renal failure under regular dialytic treatment. During treatment, hemoglobin levels increased from 7.0 +/- 0.3 to 10.1 +/- 0.3 g/dl at 3 months remaining steady thereafter. Before the treatment, patients showed reduced levels of essential AA (EAA), mainly valine, leucine and threonine (p < 0.05-0.01); among non-EAA (NEAA), aspartate and serine were reduced, whereas glycine, alanine, proline, citrulline and cyst(e)ine were increased (p < 0.05-0.001). Val/Gly, Ser/Gly and Tyr/Phe ratios were low (p < 0.05-0.01). Total EAA and total NEAA (619 +/- 21 and 1,382 +/- 75 mumol/l, respectively, before the study) were unchanged (639 +/- 22 and 1,410 +/- 89 mumol/l, respectively) at 12 months. Abnormalities in AA levels observed before the treatment persisted throughout the study. Only serine increased at the end of the study (p < 0.05). In conclusion, contrary to what has been reported, treatment with rH-EPO is not associated with an amelioration of AA metabolism in hemodialysis patients.

Topics: Adult; Amino Acids, Essential; Analysis of Variance; Erythropoietin; Female; Hemoglobins; Humans; Kidney Failure, Chronic; Male; Middle Aged; Nutrition Disorders; Recombinant Proteins; Renal Dialysis; Time Factors

The erythropoietin (EPO) response to anemia was assessed for 244 subjects aged 1-64 years (mean 45.2 years) and 121 subjects aged 65-94 years (mean 68.3 years). Subjects included non-anemic individuals as well as those with anemia of various etiologies, excluding renal disease and pregnancy. Significant inverse correlations between serum immunoreactive EPO and hematocrit were noted for both groups. Regression lines failed to show a significantly lower slope or y-intercept for older compared to younger subjects. EPO levels were not significantly lower for older compared to younger subjects when controlled for hematocrit level. These results suggest that the EPO response to anemia in older subjects is similar to that of younger subjects.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Aging; Anemia; Child; Child, Preschool; Chronic Disease; Erythropoietin; Hematocrit; Humans; Infant; Infant, Newborn; Middle Aged; Nutrition Disorders

Topics: Anemia, Hemolytic; Cell Membrane; Erythropoiesis; Erythropoietin; Ethanol; Folic Acid; Hematopoiesis; Hematopoietic Stem Cells; Hepatitis; Humans; Intestinal Absorption; Iron; Megakaryocytes; Mitochondria; Mononuclear Phagocyte System; Nutrition Disorders; Pancreatitis; Pyridoxal Phosphate