Pharmacologic adjuvants to epoetin in the treatment of anemia in patients on hemodialysis.
Anemia is a common complication of chronic kidney disease, particularly in patients who are on dialysis. The use of recombinant human erythropoietin has led to the eradication of severe anemia in the dialysis population. Correction of anemia in these patients has been associated with better quality of life and clinical outcomes. Some hemodialysis patients have anemia that either is relatively refractory to epoetin therapy or requires very high doses of epoetin (i.e., hyporesponsiveness), despite having adequate iron stores, and are thus unable to achieve or maintain target hemoglobin levels. Several pharmacologic agents have been studied for effects on improving response to epoetin, either to counter hyporesponsiveness or simply to reduce epoetin use for purely economic reasons. This review examines the available literature regarding the efficacy of these potential pharmacologic adjuvants to epoetin in the treatment of anemia in patients on maintenance hemodialysis, with special emphasis on androgens, vitamin C (ascorbic acid), and L-carnitine. A review of published guidelines and recommendations for use of these agents in hemodialysis patients is provided.
Berns
Jeffrey S
JS
Department of Medicine; Renal-Electrolyte and Hypertension Division, University of Pennsylvania School of Medicine, Presbyterian Medical Center, 51 N. 39th Street, Medical Office Building No. 240, Philadelphia, PA 19104, U.S.A. bernsj@uphs.upenn.edu
Mosenkis
Ari
A
D000277:Adjuvants, Pharmaceutic / Q000191:economics / Q000627:therapeutic use*; D000728:Androgens / Q000191:economics / Q000627:therapeutic use; D018798:Anemia, Iron-Deficiency / Q000188:drug therapy* / Q000209:etiology / Q000378:metabolism; D000975:Antioxidants / Q000191:economics / Q000627:therapeutic use; D001205:Ascorbic Acid / Q000191:economics / Q000627:therapeutic use; D002331:Carnitine / Q000191:economics / Q000627:therapeutic use; D004921:Erythropoietin / Q000191:economics / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007501:Iron / Q000378:metabolism; D007676:Kidney Failure, Chronic / Q000150:complications / Q000378:metabolism / Q000628:therapy*; D008297:Male; D017410:Practice Guidelines as Topic; D006435:Renal Dialysis; D016896:Treatment Outcome
D000277:Adjuvants, Pharmaceutic; D000728:Androgens; D000975:Antioxidants; D004921:Erythropoietin; D007501:Iron; D001205:Ascorbic Acid; D002331:Carnitine