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[PMID]:29357391
[Au] Autor:Aoun M; Karam R; Sleilaty G; Antoun L; Ammar W
[Ad] Endereço:Department of Nephrology, Saint-Joseph University, Beirut, Lebanon.
[Ti] Título:Iron deficiency across chronic kidney disease stages: Is there a reverse gender pattern?
[So] Source:PLoS One;13(1):e0191541, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:In non-dialysis chronic kidney disease patients, looking for iron deficiency is highly variable in practice and there is a great variability regarding the cutoffs used to treat iron deficiency. The aim of this study is to investigate the degree of iron deficiency in non-dialysis chronic kidney disease patients on erythropoiesis-stimulating agents. We included all non-dialysis chronic kidney disease patients that applied to the Lebanese Ministry of Public Health for erythropoiesis-stimulating agents' coverage during a 5-month period. Iron requirement was assessed based on two guidelines' target-to-treat cutoffs: 1-ferritin <100 ng/ml and/or TSAT < 20% (KDOQI 2006), 2- ferritin ≤500 ng/ml and TSAT ≤30% (KDIGO 2012). A total of 238 CKD patients were included over 5 months. All patients had a ferritin level in their record and 64% had an available TSAT. Median age was 71.0 (59.8-79.3) years and 61.8% were female. All had an eGFR<60 ml/min. The proportion of patients found to require iron therapy ranged between 48 and 78% with a trend towards higher values when using KDIGO-based criteria. Using ANCOVA test, inverse normal transformations of ferritin and TSAT showed a reverse pattern between men and women with women being more iron deficient in the early stage. Iron deficiency is highly prevalent in non-dialysis chronic kidney disease patients on erythropoiesis-stimulating agents' therapy. These findings reflect a lack in effective iron supplementation when managing anemia in pre-dialysis patients, especially in men at advanced stages. Renal societies should spread awareness about iron deficiency screening in those patients.
[Mh] Termos MeSH primário: Ferro/deficiência
Insuficiência Renal Crônica/metabolismo
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Anemia Ferropriva/complicações
Anemia Ferropriva/tratamento farmacológico
Anemia Ferropriva/metabolismo
Feminino
Ferritinas/sangue
Hematínicos/uso terapêutico
Seres Humanos
Ferro/sangue
Ferro/uso terapêutico
Falência Renal Crônica/complicações
Falência Renal Crônica/tratamento farmacológico
Falência Renal Crônica/metabolismo
Líbano
Masculino
Meia-Idade
Insuficiência Renal Crônica/complicações
Insuficiência Renal Crônica/tratamento farmacológico
Fatores Sexuais
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Nm] Nome de substância:
0 (Hematinics); 9007-73-2 (Ferritins); E1UOL152H7 (Iron)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180302
[Lr] Data última revisão:
180302
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180123
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0191541


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[PMID]:29254377
[Au] Autor:Del Vecchio L; Locatelli F
[Ad] Endereço:a Department of Nephrology and Dialysis , A. Manzoni Hospital , Lecco , Italy.
[Ti] Título:Roxadustat in the treatment of anaemia in chronic kidney disease.
[So] Source:Expert Opin Investig Drugs;27(1):125-133, 2018 Jan.
[Is] ISSN:1744-7658
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Anaemia is one of the hallmarks of advanced chronic kidney disease (CKD); it correlates with a lower quality of life and increased cardiovascular risk. Currently its management is based on iron and erythropoiesis-stimulating agents (ESAs) therapy. Given safety issues on ESA therapy and excessive iron use, anaemia management is still suboptimal. Areas covered: The inhibitors of the prolyl-hydroxylases domain (PHD) are oral drugs which activate the hypoxia-inducible factors (HIF) and stimulate the production of endogenous erythropoietin. Roxadustat (FG-4592) is a second-generation PHD inhibitor; it is undergoing now phase-III clinical development. Expert opinion: Phase-II clinical trials have shown that roxadustat is effective and save in the short term in either non-dialysis or dialysis CKD patients. Roxadustat is a chemical drug and thus has the potential of being cheaper than traditional ESAs. Given that the peaks of endogenous EPO are much lower than those observed with traditional ESA, it is possible to speculate the roxadustat (and more in general PHD inhibitors) will be safer than ESA on cardiovascular safety end-points. Considering that HIFs are involved in different pathways, with possible promotion of relevant side effects, their safety must be proven in long-term studies.
[Mh] Termos MeSH primário: Anemia/tratamento farmacológico
Glicina/análogos & derivados
Isoquinolinas/uso terapêutico
Insuficiência Renal Crônica/complicações
[Mh] Termos MeSH secundário: Anemia/etiologia
Animais
Doenças Cardiovasculares/etiologia
Doenças Cardiovasculares/prevenção & controle
Eritropoetina/metabolismo
Glicina/efeitos adversos
Glicina/farmacologia
Glicina/uso terapêutico
Hematínicos/efeitos adversos
Hematínicos/uso terapêutico
Seres Humanos
Isoquinolinas/efeitos adversos
Isoquinolinas/farmacologia
Inibidores de Prolil-Hidrolase/efeitos adversos
Inibidores de Prolil-Hidrolase/farmacologia
Inibidores de Prolil-Hidrolase/uso terapêutico
Qualidade de Vida
Diálise Renal
Insuficiência Renal Crônica/terapia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (FG-4592); 0 (Hematinics); 0 (Isoquinolines); 0 (Prolyl-Hydroxylase Inhibitors); 11096-26-7 (Erythropoietin); TE7660XO1C (Glycine)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180222
[Lr] Data última revisão:
180222
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171220
[St] Status:MEDLINE
[do] DOI:10.1080/13543784.2018.1417386


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[PMID]:29228059
[Au] Autor:Rohner E; Grabik M; Tonia T; Jüni P; Pétavy F; Pignatti F; Bohlius J
[Ad] Endereço:Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
[Ti] Título:Does access to clinical study reports from the European Medicines Agency reduce reporting biases? A systematic review and meta-analysis of randomized controlled trials on the effect of erythropoiesis-stimulating agents in cancer patients.
[So] Source:PLoS One;12(12):e0189309, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Since 2010, the European Medicines Agency (EMA) has provided access to clinical study reports (CSRs). We requested CSRs for randomized controlled trials (RCTs) of erythropoiesis-stimulating agents (ESAs) in cancer patients from EMA and identified RCT publications with literature searches. We assessed CSR availability and completeness, the impact of unreported and unpublished data obtained from CSRs on the effects of ESAs on quality of life (QoL) of cancer patients, and discrepancies between data reported in the public domain and in CSRs. We used random-effects meta-analyses to evaluate the effect of ESAs on QoL measured with Functional Assessment of Cancer Therapy-Anemia (FACT-An), FACT-Fatigue (FACT-F) and FACT-Anemia Total (FACT-An Total) stratified by data source and the impact of discrepancies on QoL, mortality, adverse events, and clinical effectiveness outcomes. We identified 94 eligible RCTs; CSRs or other study documentation were available for 17 (18%) RCTs at EMA. Median report length was 1,825 pages (range 72-14,569). Of 180 outcomes of interest reported in the EMA documentation, 127 (71%) were publicly available. For 80 of those (63%) we noted discrepancies, but these had little impact on the pooled effect estimates. Of 27 QoL outcomes reported in the CSRs, 17 (63%) were unpublished. Including six unpublished comparisons (pooled mean difference [MD] 0.20; 95% confidence interval [CI] -1.93, 2.33) reduced the pooled effect of ESAs for FACT-An from MD 5.51 (95% CI 4.20, 6.82) in published data to MD 3.21 (95% CI 1.38, 5.03), which is below a clinically important difference (defined as MD ≥4). Effects were similar for FACT-F and FACT-An Total. Access to CSRs from EMA reduced reporting biases for QoL outcomes. However, EMA received documentation for a fraction of all RCTs on effects of ESAs in cancer patients. Additional efforts by other agencies and institutions are needed to make CSRs universally available for all RCTs.
[Mh] Termos MeSH primário: Hematínicos/uso terapêutico
Viés de Publicação
Ensaios Clínicos Controlados Aleatórios como Assunto
[Mh] Termos MeSH secundário: Anemia/tratamento farmacológico
Anemia/etiologia
Seres Humanos
Neoplasias/complicações
Qualidade de Vida
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Nm] Nome de substância:
0 (Hematinics)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180104
[Lr] Data última revisão:
180104
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171212
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0189309


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[PMID]:29182650
[Au] Autor:Alabdan N; AlRuthia Y; Yates MED; Sales I; Finch CK; Hudson JQ
[Ad] Endereço:Department of Pharmacy Practice, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
[Ti] Título:Predictors of adherence to a new erythropoiesis-stimulating agent inpatient ordering policy: A cross-sectional study.
[So] Source:PLoS One;12(11):e0188390, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Erythropoiesis-stimulating agents (ESAs) are recommended for treating anemia in patients with chronic kidney disease and end-stage renal disease. However, misappropriate and over-use of these agents can be costly and unnecessary in some settings. OBJECTIVE: The primary aim was to identify predictors of adherence to a newly approved ESA inpatient ordering policy. The secondary aims were to evaluate the impact of a 5-day delay in the initiation of ESA therapy on ESA usage, hemoglobin (Hb) levels, and costs. METHODS: This retrospective observational record review included a sample of adult patients admitted to four tertiary care hospitals from November 1, 2013 to August 31, 2014. Multivariable logistic and linear regression analyses were used to calculate the odds of adherence to the new ESA inpatient ordering policy and the impact of this policy on discharge Hb level, respectively. RESULTS: A total of 242 patients were included. The majority of the prescribers (77%) adhered to the new ESA ordering policy. Hemoglobin (OR = 1.306; 95% CI: 1.03-1.65) and ferritin (OR = 3.91; 95% CI: 1.23-12.51) levels at admission and length of hospital stay were positively correlated with the odds of patients receiving ESAs after day 5 (OR = 1.12; 95% CI:1.05-1.20). Furthermore, adherence to the new policy did not have a significant impact on discharge Hb level (ß = 0.02349; P = 0.895). CONCLUSIONS: Prescribers were adherent to a 5-day delay in the initiation of ESA therapy policy which resulted in a reduction in ESA usage, did not impact the discharge Hb levels, and was proven to be cost effective.
[Mh] Termos MeSH primário: Anemia/tratamento farmacológico
Fidelidade a Diretrizes
Hematínicos/uso terapêutico
Pacientes Internados
[Mh] Termos MeSH secundário: Idoso
Estudos Transversais
Feminino
Seres Humanos
Masculino
Meia-Idade
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Hematinics)
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171226
[Lr] Data última revisão:
171226
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171129
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0188390


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[PMID]:28953654
[Au] Autor:Nomoto H; Miyoshi H; Nakamura A; Nagai S; Kitao N; Shimizu C; Atsumi T
[Ad] Endereço:aDepartment of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University bDivision of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan.
[Ti] Título:A case of osteomalacia due to deranged mineral balance caused by saccharated ferric oxide and short-bowel syndrome: A case report.
[So] Source:Medicine (Baltimore);96(39):e8147, 2017 Sep.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: Saccharated ferric oxide has been shown to lead to elevation of fibroblast growth factor 23, hypophosphatemia, and, consequently, osteomalacia. Moreover, mineral imbalance is often observed in patients with short-bowel syndrome to some degree. PATIENT CONCERNS: A 62-year-old woman with short-bowel syndrome related with multiple resections of small intestines due to Crohn disease received regular intravenous administration of saccharated ferric oxide. Over the course of treatment, she was diagnosed with tetany, which was attributed to hypocalcemia. Additional assessments of the patient revealed not only hypocalcemia, but also hypophosphatemia, hypomagnesemia, osteomalacia, and a high concentration of fibroblast growth factor 23 (314 pg/mL). DIAGNOSES: We diagnosed her with mineral imbalance-induced osteomalacia due to saccharated ferric oxide and short-bowel syndrome. INTERVENTIONS: Magnesium replacement therapy and discontinuation of saccharated ferric oxide alone. OUTCOMES: These treatments were able to normalize her serum mineral levels and increase her bone mineral density. LESSONS: This case suggests that adequate evaluation of serum minerals, including phosphate and magnesium, during saccharated ferric oxide administration may be necessary, especially in patients with short-bowel syndrome.
[Mh] Termos MeSH primário: Densidade Óssea/efeitos dos fármacos
Compostos Férricos/efeitos adversos
Ácido Glucárico/efeitos adversos
Magnésio/administração & dosagem
Osteomalacia
Síndrome do Intestino Curto
[Mh] Termos MeSH secundário: Feminino
Compostos Férricos/administração & dosagem
Fatores de Crescimento de Fibroblastos/sangue
Ácido Glucárico/administração & dosagem
Hematínicos/administração & dosagem
Hematínicos/efeitos adversos
Seres Humanos
Hipocalcemia/diagnóstico
Hipocalcemia/etiologia
Hipofosfatemia/diagnóstico
Hipofosfatemia/etiologia
Deficiência de Magnésio/diagnóstico
Deficiência de Magnésio/etiologia
Meia-Idade
Osteomalacia/diagnóstico
Osteomalacia/etiologia
Síndrome do Intestino Curto/complicações
Síndrome do Intestino Curto/tratamento farmacológico
Síndrome do Intestino Curto/metabolismo
Resultado do Tratamento
Suspensão de Tratamento
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Ferric Compounds); 0 (Hematinics); 0 (fibroblast growth factor 23); 62031-54-3 (Fibroblast Growth Factors); FZ7NYF5N8L (ferric oxide, saccharated); I38ZP9992A (Magnesium); QLZ991V4A2 (Glucaric Acid)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171016
[Lr] Data última revisão:
171016
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170928
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000008147


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[PMID]:28845959
[Au] Autor:Burman D
[Ad] Endereço:Latterman Family Health Center, 2347 Fifth Ave, McKeesport, PA 15132.
[Ti] Título:Sleep Disorders: Restless Legs Syndrome.
[So] Source:FP Essent;460:29-32, 2017 Sep.
[Is] ISSN:2159-3000
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Restless legs syndrome (RLS) is a common disorder that often is underdiagnosed and undertreated. Patients with RLS describe an urge to move their legs, especially in the evenings and during periods of inactivity. The prevalence of clinically significant RLS is approximately 2% to 3% in adults in Europe and North America. RLS can be an independent disorder or may occur in conjunction with other conditions (eg, iron deficiency, pregnancy, chronic renal failure). Diagnosis is based on clinical history. Routine polysomnography typically is not recommended unless there is suspicion of other sleep disorders (eg, obstructive sleep apnea). Management includes a combination of supportive measures, dopaminergic drugs, gabapentinoids, opioids, or benzodiazepines. Good sleep hygiene can help prevent development of insomnia related to RLS. Avoiding alcohol and reducing caffeine intake is recommended. If iron stores are low, iron supplementation may improve symptoms. The main pharmacologic options for RLS management are dopaminergic agonists (eg, pramipexole and ropinirole); gabapentinoids also are good options. Patients may experience augmentation, an increase in RLS symptom severity with increasing drug dosage, which is the main complication of dopaminergic drugs. There is no evidence to support use of vibratory devices that provide stimulation to the lower extremities.
[Mh] Termos MeSH primário: Dopaminérgicos/uso terapêutico
Síndrome das Pernas Inquietas/diagnóstico
Síndrome das Pernas Inquietas/terapia
Higiene do Sono
Vibração/uso terapêutico
[Mh] Termos MeSH secundário: Europa (Continente)
Feminino
Hematínicos/uso terapêutico
Seres Humanos
Masculino
América do Norte
Modalidades de Fisioterapia
Polissonografia
Síndrome das Pernas Inquietas/tratamento farmacológico
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Dopamine Agents); 0 (Hematinics)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171026
[Lr] Data última revisão:
171026
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170829
[St] Status:MEDLINE


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[PMID]:28841235
[Au] Autor:Mesgarpour B; Heidinger BH; Roth D; Schmitz S; Walsh CD; Herkner H
[Ad] Endereço:Cochrane Iran Associate Centre, National Institute for Medical Research Development (NIMAD), Tehran, Iran.
[Ti] Título:Harms of off-label erythropoiesis-stimulating agents for critically ill people.
[So] Source:Cochrane Database Syst Rev;8:CD010969, 2017 08 25.
[Is] ISSN:1469-493X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Anaemia is a common problem experienced by critically-ill people. Treatment with erythropoiesis-stimulating agents (ESAs) has been used as a pharmacologic strategy when the blunted response of endogenous erythropoietin has been reported in critically-ill people. The use of ESAs becomes more important where adverse clinical outcomes of transfusing blood products is a limitation. However, this indication for ESAs is not licensed by regulatory authorities and is called off-label use. Recent studies concern the harm of ESAs in a critical care setting. OBJECTIVES: To focus on harms in assessing the effects of erythropoiesis-stimulating agents (ESAs), alone or in combination, compared with placebo, no treatment or a different active treatment regimen when administered off-label to critically-ill people. SEARCH METHODS: We conducted a systematic search of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, PsycINFO via OvidSP, CINAHL, all evidence-based medicine (EBM) reviews including IPA and SCI-Expanded, Conference Proceedings Citation Index- Science, BIOSIS Previews and TOXLINE up to February 2017. We also searched trials registries, checked reference lists of relevant studies and tracked their citations by using SciVerse Scopus. SELECTION CRITERIA: We considered randomized controlled trials (RCTs) and controlled observational studies, which compared scheduled systemic administration of ESAs versus other effective interventions, placebo or no treatment in critically-ill people. DATA COLLECTION AND ANALYSIS: Two review authors independently screened and evaluated the eligibility of retrieved records, extracted data and assessed the risks of bias and quality of the included studies. We resolved differences in opinion by consensus or by involving a third review author. We assessed the evidence using GRADE and created a 'Summary of findings' table. We used fixed-effect or random-effects models, depending on the heterogeneity between studies. We fitted three-level hierarchical Bayesian models to calculate overall treatment effect estimates. MAIN RESULTS: Of the 27,865 records identified, 39 clinical trials and 14 observational studies, including a total of 945,240 participants, were eligible for inclusion. Five studies are awaiting classification. Overall, we found 114 adverse events in 33 studies (30 RCTs and three observational studies), and mortality was reported in 41 studies (32 RCTs and nine observational studies). Most studies were at low to moderate risk of bias for harms outcomes. However, overall harm assessment and reporting were of moderate to low quality in the RCTs, and of low quality in the observational studies. We downgraded the GRADE quality of evidence for venous thromboembolism and mortality to very low and low, respectively, because of risk of bias, high inconsistency, imprecision and limitations of study design.It is unclear whether there is an increase in the risk of any adverse events (Bayesian risk ratio (RR) 1.05, 95% confidence interval (CI) 0.93 to 1.21; 3099 participants; 9 studies; low-quality evidence) or venous thromboembolism (Bayesian RR 1.04, 95% CI 0.70 to 1.41; 18,917 participants; 18 studies; very low-quality evidence).There was a decreased risk of mortality with off-label use of ESAs in critically-ill people (Bayesian RR 0.76, 95% CI 0.61 to 0.92; 930,470 participants; 34 studies; low-quality evidence). AUTHORS' CONCLUSIONS: Low quality of evidence suggests that off-label use of ESAs may reduce mortality in a critical care setting. There was a lack of high-quality evidence about the harm of ESAs in critically-ill people. The information for biosimilar ESAs is less conclusive. Most studies neither evaluated ESAs' harm as a primary outcome nor predefined adverse events. Any further studies of ESA should address the quality of evaluating, recording and reporting of adverse events.
[Mh] Termos MeSH primário: Anemia/tratamento farmacológico
Estado Terminal
Eritropoese/efeitos dos fármacos
Hematínicos/efeitos adversos
Uso Off-Label
[Mh] Termos MeSH secundário: Anemia/sangue
Anemia/mortalidade
Medicamentos Biossimilares/efeitos adversos
Seres Humanos
Estudos Observacionais como Assunto
Ensaios Clínicos Controlados Aleatórios como Assunto
Tromboembolia Venosa/induzido quimicamente
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; RESEARCH SUPPORT, NON-U.S. GOV'T; REVIEW
[Nm] Nome de substância:
0 (Biosimilar Pharmaceuticals); 0 (Hematinics)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170919
[Lr] Data última revisão:
170919
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170826
[St] Status:MEDLINE
[do] DOI:10.1002/14651858.CD010969.pub2


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[PMID]:28818807
[Au] Autor:Cogle CR; Reddy SR; Chang E; Papoyan E; Broder MS; McGuire M; Binder G
[Ad] Endereço:Division of Hematology and Oncology, Department of Medicine, College of Medicine, University of Florida, 1600 SW Archer Rd, Box 100278, Gainesville, FL 32610, USA. Electronic address: christopher.cogle@medicine.ufl.edu.
[Ti] Título:Early treatment initiation in lower-risk myelodysplastic syndromes produces an earlier and higher rate of transfusion independence.
[So] Source:Leuk Res;60:123-128, 2017 Sep.
[Is] ISSN:1873-5835
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Myelodysplastic syndromes (MDS) are characterized by ineffective hematopoiesis resulting in refractory cytopenias. Red blood cell (RBC) transfusions can improve anemia; however, prolonged transfusion dependence (TD) is associated with increased morbidity and mortality. Disease-modifying therapy (DMT) for MDS can reduce transfusion requirements, although the optimum timing of DMT initiation is unclear. This retrospective study analyzed linked SEER registry and Medicare claims (2006-2012) to estimate the impact of DMT-initiation (azacitidine, decitabine, or lenalidomide) timing (≤ 3 vs.>3months from start of TD) on the likelihood of achieving transfusion independence (TI) among 508 TD patients with MDS. Mean time to DMT was 28days for early initiators (n=351) and 187days for late initiators (n=157). Fewer early initiators used erythropoiesis-stimulating agents before achieving TI versus late initiators (61.5% vs. 73.9%; P=0.007). In multivariate analyses, early DMT initiation predicted TI achievement (HR, 1.69; P<0.001); patients who met minimum active therapy-exposure requirements were more likely to achieve TI (HR, 2.12; P<0.001). Higher rates of TI were associated with reduced time between onset of TD and DMT initiation. Similarly, patients meeting the minimum treatment-exposure threshold had higher TI rates.
[Mh] Termos MeSH primário: Transfusão de Sangue/utilização
Síndromes Mielodisplásicas/terapia
Prevenção Secundária
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Azacitidina/análogos & derivados
Azacitidina/uso terapêutico
Feminino
Hematínicos/uso terapêutico
Seres Humanos
Masculino
Meia-Idade
Estudos Retrospectivos
Talidomida/análogos & derivados
Talidomida/uso terapêutico
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Hematinics); 4Z8R6ORS6L (Thalidomide); 776B62CQ27 (decitabine); F0P408N6V4 (lenalidomide); M801H13NRU (Azacitidine)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171031
[Lr] Data última revisão:
171031
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170819
[St] Status:MEDLINE


  9 / 3827 MEDLINE  
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[PMID]:28778295
[Au] Autor:O'Malley P
[Ad] Endereço:Department of Nursing Research, Premier Health, Center of Nursing Excellence, 1 Wyoming Street, Dayton, OH 45409, USA; School of Nursing, Indiana University East, 2325 Chester Boulevard, Richmond, IN 47374, USA. Electronic address: pomalley@premierhealth.com.
[Ti] Título:Hidden Anemias in the Critically Ill.
[So] Source:Crit Care Nurs Clin North Am;29(3):363-368, 2017 Sep.
[Is] ISSN:1558-3481
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:With increasing knowledge of the risks associated with receiving blood transfusions, a new paradigm of bloodless medicine is needed. Principles of bloodless medicine include careful monitoring for obvious and hidden anemias, rapid intervention, minimizing blood losses from laboratory testing and procedures, and careful management of bleeding diatheses. As evidence is revealed and refined, standard treatment of anemia in the intensive care unit will include erythropoietin-stimulating agents, iron, folate, and vitamin B12, which will reduce risks associated with blood transfusions.
[Mh] Termos MeSH primário: Anemia/terapia
Transfusão de Sangue/métodos
Procedimentos Médicos e Cirúrgicos de Sangue/métodos
Estado Terminal
[Mh] Termos MeSH secundário: Anemia/tratamento farmacológico
Anemia/etiologia
Enfermagem de Cuidados Críticos
Epoetina alfa/uso terapêutico
Insuficiência Cardíaca/terapia
Hematínicos/uso terapêutico
Seres Humanos
Unidades de Terapia Intensiva
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Hematinics); 64FS3BFH5W (Epoetin Alfa)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171010
[Lr] Data última revisão:
171010
[Sb] Subgrupo de revista:N
[Da] Data de entrada para processamento:170806
[St] Status:MEDLINE


  10 / 3827 MEDLINE  
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[PMID]:28682026
[Au] Autor:Rivera RF; Alibrandi MTS; Di Lullo L; Fioccari F
[Ad] Endereço:U.O. Nefrologia e Dialisi, Ospedale San Gerardo, ASST Monza, Italy.
[Ti] Título:[Clinical management of anemia in patients with CKD].
[So] Source:G Ital Nefrol;34(Suppl 69):20-35, 2017 Mar.
[Is] ISSN:1724-5990
[Cp] País de publicação:Italy
[La] Idioma:ita
[Ab] Resumo:Anemia is a frequent complication in chronic kidney disease (CKD), and it is often accompanied by various clinical symptoms. The primary cause of anemia in CKD patients is the reduction in the erythropoietin production, which results in a decrease of signaling molecule that stimulates red blood cell production. Other possible causes of anemia in CKD include iron deficiency, inflammation, and the accumulation of uremic toxin. This chapter focuses the discussion on the strategy of the management of anemia in patients with CKD. Erythropoiesis-stimulating agents (ESAs) and adjuvant iron therapy represent the primary treatment for anemia in chronic kidney disease. The introduction of ESAs into clinical practice was a success goal, mediating an increase in hemoglobin concentrations without the risk for recurrent blood transfusions and improving quality of life substantially.
[Mh] Termos MeSH primário: Anemia/etiologia
Anemia/terapia
Insuficiência Renal Crônica/complicações
[Mh] Termos MeSH secundário: Anemia/diagnóstico
Transfusão de Sangue
Hematínicos/uso terapêutico
Hematócrito
Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Hematinics)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171024
[Lr] Data última revisão:
171024
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170707
[St] Status:MEDLINE



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