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Renal Week_1209 11/30/09 12:10 PM Page 1 14 Renal & Urology News DECEMBER 2009 s Renal Week 2009, San Diego A Possible Reason Hepcidin May Help Manage For ESA Resistance Anemia PLASMA HEPCIDIN may be a ESA, we identified significantly high- more useful guide to anemia manage- The articles on these pages and er levels of inflammatory markers ment in hemodialysis (HD) patients on page 16 report on studies CRP and IL-6, which could be in the than traditional iron parameters, ac- presented at the American causal pathway for adverse outcomes cording to British investigators. Society of Nephrology’s Renal associated with high-dose ESA,” she They found that plasma hepcidin Week conference in San Diego. said. “Whether elevated inflamma- levels predict hemoglobin (Hb) tory biomarkers are directly caused response to IV iron loading and may by higher ESA doses or are simply a reflect adequate iron availability or rel- Damien Ashby, MD BY JODY A. CHARNOW marker of a sicker patient popula- ative erythropoietin deficiency. Hepci- RESEARCHERS HAVE recently tion—who require higher doses— din—a hormone made in the liver— erythropoietin dose, C-reactive pro- found evidence that could help remains to be determined.” inhibits iron absorption and recycling. tein, and albumin. explain why some anemic CKD Dr. Inrig noted that the study is the Damien Ashby, MD, of the Imperial In a separate study of six healthy patients are resistant to treatment first to reveal in vivo a direct relation- College Kidney and Transplant Insti- individuals, the same research team with an erythropoiesis stimulating ship between ESA dose and soluble tute, Hammersmith Hospital, London, found that erythropoietin administra- agents (ESA). Epo receptor as a potential modu- and colleagues measured plasma hep- tion is associated with a profound Jula K. Inrig, MD, MPH, Assistant lator of erythropoietic response to cidin levels in 67 stable HD patients reduction in circulating hepcidin. In Professor of Medicine at the ESA therapy. Although a recombi- before IV iron loading, which was indi- the study, Dr. Ashby’s group measured University of Texas Southwestern nant form of sEpoR was shown to act cated by subthreshold levels of ferritin plasma iron parameters at multiple Medical Center in Dallas, and collab- (below 400 ng/mL) or iron (less than timepoints before and after a single orators studied 32 CKD patients 10 nmol/mL). Patients then received injection of erythropoietin and meas- receiving anemia treatment with dar- A lower pill 200 mg iron sucrose IV at each of the ured hepcidin with a recently devel- bepoetin-α: 21 who were receiving burden for patients next five HD sessions, with Hb re- oped radioimmunoassay. usual doses (mean 49.7 mcg/week) sponse assessed the following month. In all subjects, erythropoietin in- and 11 who were receiving high may be possible, Of the 67 subjects, 43 (64%) were jection was followed by a marked doses (94.1 mcg/week). The patients in the two groups had similar base- researcher says. responders, defined as patients whose Hb increased after iron loading. reduction in circulating hepcidin last- ing more than 14 days; erythropoie- line characteristics, although the Plasma hepcidin levels at baseline were tin levels returned to baseline by high-dose group had lower three- as an antagonist of Epo in in vitro and significantly higher in subsequent non- seven days. In addition, levels of circu- month average hemoglobin levels. in vivo studies of Epo-EpoR biology responders than in responders, the
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