Imperial College London
Portrait Picture

ProfessorFrederickTam

Faculty of Medicine, Department of Immunology and Inflammation

Ken and Mary Minton Chair of Renal Medicine
 
 
 
//

Contact

 

+44 (0)20 3313 2354f.tam

 
 
//

Location

 

9N, 15C, Commonwealth BuildingHammersmith HospitalHammersmith Campus

//

Summary

 

Publications

Citation

BibTex format

@article{Hildebrand:2022:10.1111/hdi.13030,
author = {Hildebrand, S and Busbridge, M and Duncan, ND and Tam, FWK and Ashby, DR},
doi = {10.1111/hdi.13030},
journal = {Hemodialysis International},
pages = {519--526},
title = {Predictors of iron versus erythropoietin responsiveness in anemic hemodialysis patients},
url = {http://dx.doi.org/10.1111/hdi.13030},
volume = {26},
year = {2022}
}
Download

RIS format (EndNote, RefMan)

TY  - JOUR
AB  - Anemia protocols for hemodialysis patients usually titrate erythropoietin (ESA) according to hemoglobin and iron according to a threshold of ferritin, with variable response seen. A universally optimum threshold for ferritin may be incorrect, and another view is that ESA and iron are alternative anemia treatments, which should be selected based on the likely response to each. Hemodialysis patients developing moderate anemia were randomised to treatment with either an increase in ESA or a course of intravenous iron. Over 2423 patient-months in 197 patients, there were 133 anemia episodes with randomized treatment. Treatment failure was seen in 20/66 patients treated with ESA and 20/67 patients treated with iron (30.3 vs. 29.9%, p = 1.0). Successful ESA treatment was associated with lower C-reactive protein (13.5 vs. 28.6 mg/L, p = 0.038) and lower previous ESA dose (6621 vs. 9273 μg/week, p = 0.097). Successful iron treatment was associated with lower reticulocyte hemoglobin (33.8 vs. 35.5 pg, p = 0.047), lower hepcidin (91.4 vs. 131.0 μg/ml, p = 0.021), and higher C-reactive protein (29.5 vs. 12.6 mg/L, p = 0.085). A four-variable iron preference score was developed to indicate the more favorable treatment, which in a retrospective analysis reduced treatment failure to 17%. Increased ESA and iron are equally effective, though treatment failure occurs in almost 30%. Baseline variables including hepcidin can predict treatment response, and a four-variable score shows promise in allowing directed treatment with improved response rates.
AU  - Hildebrand,S
AU  - Busbridge,M
AU  - Duncan,ND
AU  - Tam,FWK
AU  - Ashby,DR
DO  - 10.1111/hdi.13030
EP  - 526
PY  - 2022///
SN  - 1492-7535
SP  - 519
TI  - Predictors of iron versus erythropoietin responsiveness in anemic hemodialysis patients
T2  - Hemodialysis International
UR  - http://dx.doi.org/10.1111/hdi.13030
UR  - https://onlinelibrary.wiley.com/doi/10.1111/hdi.13030
UR  - http://hdl.handle.net/10044/1/98340
VL  - 26
ER  -
Download