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Anemia in Hemodialysis Patients: Changing Concepts in Management

Anemia in Hemodialysis Patients: Changing Concepts in Management Abstract The association between anemia and chronic renal failure has been recognized since the early 19th century. With the introduction of regular dialysis treatment, an understanding of all aspects of this uremic complication has become of great importance, including an appreciation of the hazards of multiple blood transfusions. This analysis of hemoglobin levels and transfusion requirements in 84 dialysis patients focuses specific attention on hemolytic mechanisms, blood loss, and the effect of bilateral nephrectomy on erythropoiesis. Because no replacement for renal erythropoietin is available, particular attention must be paid to less important, but partially correctable factors that contribute to anemia. Blood transfusion requirements can then be reduced to a minimum, together with the risks of hypersplenism, hepatitis, and sensitization of the patient to alloantigens. (Arch Intern Med 137:172-176, 1977) References 1. Bright R: Cases and observations illustrative of renal disease accompanied with the secretion of albuminous urine . Guys Hosp Rep 1:338-400, 1836. 2. Brown GE, Roth GM: The anemia of chronic nephritis . Arch Intern Med 30:817-840, 1922.Crossref 3. Parsons L, Ekola-Strolberg M: Anemia in azotemia . Am J Med Sci 185:181-190, 1933.Crossref 4. Kaye M: The anemia associated with renal disease . J Lab Clin Med 52:83-100, 1958. 5. Loge JP, Lange RD, Moore CV: Characterization of the anemia of chronic renal insufficiency . J Clin Invest 29:830-831, 1950. 6. Jacobson LO, Goldwasser E, Fried W, et al: Role of the kidney in erythropoiesis . Nature 179:633-634, 1957.Crossref 7. Eschbach JW, Funk D, Adamson J, et al: Erythropoiesis in patients with renal failure undergoing chronic dialysis . N Engl J Med 276:653-658, 1967.Crossref 8. Merrill JP, Hampers CL: Uremia . N Engl J Med 282:953-961, 1014-1021, 1970.Crossref 9. Eschbach JW, Adamson JW, Cook JD: Disorders of red cell proliferation in uremia . Arch Intern Med 126:812-815, 1970.Crossref 10. McLeod LE, Mandin H, Davidman M, et al: Intermittent hemodialysis in terminal chronic renal failure . Can Med Assoc J 94:318-327, 1966. 11. Van Ypersele de Strihou C, Stragier A: Effect of bilateral nephrectomy on transfusion requirements of patients undergoing chronic dialysis . Lancet 2:705-707, 1969.Crossref 12. Laurent C, Wittek M, Vereerstraeten P, et al: Red cells life span, splenic sequestration and transfusion requirements in chronic renal failure treated by hemodialysis: Effects of bilateral nephrectomy . Clin Nephrol 2:35-40, 1970. 13. Kominami N, Lowrie EG, Ianhez LE, et al: The effect of total nephrectomy on hematopoiesis in patients undergoing chronic hemodialysis . J Lab Clin Med 78:524-532, 1971. 14. Ulan RA, Hill JR, Silverberg DS: Erythrocyte survival and splenic sequestration in chronic dialysis patients . Abstracts of the 5th International Congress of Nephrology, Mexico City, 1972 , p 27. 15. Hoffman GL: Human erythropoiesis following kidney transplantation . Ann NY Acad Sci 149:504-508, 1968.Crossref 16. Hampers CL, Streiff R, Nathan DG, et al: Megaloblastic hematopoiesis in uremia and in patients on long-term hemodialysis . N Engl J Med 276:551-554, 1967.Crossref 17. Lawson DH, Boddy K, King PC, et al: Iron metabolism in patients with chronic renal failure on regular dialysis treatment . Clin Sci 41:345-351, 1971. 18. Strickland ID, Chaput de Saintonge DM, Boulton FE, et al: A trial of oral iron in dialysis patients . Clin Nephrol 2:13-17, 1974. 19. Hocken AG, Marwah PK: Iatrogenic contribution to anemia of renal failure . Lancet 1:164-165, 1971.Crossref 20. Lindsay RM, Burton JA, Edward N, et al: Dialyzer blood loss . Clin Nephrol 1:29-34, 1973. 21. Yawata Y, Kjellstrand C, Buselmeier T, et al: Hemolysis in dialyzed patients: Tap-water-induced red cell metabolic deficiency . Trans Am Soc Artif Intern Organs 18:301-304, 1972.Crossref 22. Kjellstrand CM, Eaton JW, Yawata Y, et al: Hemolysis in dialyzed patients caused by chloramines . Nephron 13:427-433, 1974.Crossref 23. Hartley LCJ, Innis MD, Morgan TO, et al: Splenectomy for anaemia in patients on regular haemodialysis . Lancet 2:1343-1345, 1971.Crossref 24. Bischel MD, Neiman RS, Berne TV, et al: The elimination by splenectomy of blood transfusion requirements leukopaenia and thrombocytopaenia in the patient on RDT , in Cameron JS (ed): Proceedings of the European Dialysis and Transplant Association . New York, Pitman Publishing Corp, 1971, vol 8, p 81. 25. Stenzel KH, Cheigh JS, Sullivan JF, et al: Clinical effects of bilateral nephrectomy . Am J Med 58:69-75, 1975.Crossref 26. DeGowin RL, Lavender AR, Forland M, et al: Erythropoiesis and erythropoietin in patients with chronic renal failure treated with hemodialysis and testosterone . Ann Intern Med 72:913-918, 1970.Crossref 27. Eschbach JW, Adamson JW: Improvement in the anemia of chronic renal failure with fluoxymesterone . Ann Intern Med 78:527-532, 1973.Crossref 28. Richardson JR, Weinstein MB: Erythropoietic response of dialyzed patients to testosterone administration . Ann Intern Med 73:403-407, 1970.Crossref 29. Shaldon S, Koch KM, Opperman F, et al: Testosterone therapy for anemia in maintenance dialysis . Br Med J 3:212-214, 1971.Crossref 30. Williams JS, Stein JH, Ferris TF: Nandrolone decanoate therapy for patients receiving hemodialysis . Arch Intern Med 134:289-292, 1971.Crossref 31. Dombeck DH, Lindholm DD, Vieira JA: Lipid metabolism in uremia and the effects of dialysate glucose and oral androgen therapy . Trans Am Soc Artif Intern Organs 19:150-153, 1973.Crossref 32. Johnson FL, Feagler JR, Lerner KG, et al: Association of androgenic-anabolic steroid therapy with development of hepato-cellular carcinoma . Lancet 2:1273-1278, 1972.Crossref 33. Hislop A (ed): The Proverbs of Scotland , ed 3. Edinburgh, Scotland, E & S Livingstone. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

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Publisher
American Medical Association
Copyright
Copyright © 1977 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1977.03630140028009
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Abstract

Abstract The association between anemia and chronic renal failure has been recognized since the early 19th century. With the introduction of regular dialysis treatment, an understanding of all aspects of this uremic complication has become of great importance, including an appreciation of the hazards of multiple blood transfusions. This analysis of hemoglobin levels and transfusion requirements in 84 dialysis patients focuses specific attention on hemolytic mechanisms, blood loss, and the effect of bilateral nephrectomy on erythropoiesis. Because no replacement for renal erythropoietin is available, particular attention must be paid to less important, but partially correctable factors that contribute to anemia. Blood transfusion requirements can then be reduced to a minimum, together with the risks of hypersplenism, hepatitis, and sensitization of the patient to alloantigens. (Arch Intern Med 137:172-176, 1977) References 1. Bright R: Cases and observations illustrative of renal disease accompanied with the secretion of albuminous urine . Guys Hosp Rep 1:338-400, 1836. 2. Brown GE, Roth GM: The anemia of chronic nephritis . Arch Intern Med 30:817-840, 1922.Crossref 3. Parsons L, Ekola-Strolberg M: Anemia in azotemia . Am J Med Sci 185:181-190, 1933.Crossref 4. Kaye M: The anemia associated with renal disease . J Lab Clin Med 52:83-100, 1958. 5. Loge JP, Lange RD, Moore CV: Characterization of the anemia of chronic renal insufficiency . J Clin Invest 29:830-831, 1950. 6. Jacobson LO, Goldwasser E, Fried W, et al: Role of the kidney in erythropoiesis . Nature 179:633-634, 1957.Crossref 7. Eschbach JW, Funk D, Adamson J, et al: Erythropoiesis in patients with renal failure undergoing chronic dialysis . N Engl J Med 276:653-658, 1967.Crossref 8. Merrill JP, Hampers CL: Uremia . N Engl J Med 282:953-961, 1014-1021, 1970.Crossref 9. Eschbach JW, Adamson JW, Cook JD: Disorders of red cell proliferation in uremia . Arch Intern Med 126:812-815, 1970.Crossref 10. McLeod LE, Mandin H, Davidman M, et al: Intermittent hemodialysis in terminal chronic renal failure . Can Med Assoc J 94:318-327, 1966. 11. Van Ypersele de Strihou C, Stragier A: Effect of bilateral nephrectomy on transfusion requirements of patients undergoing chronic dialysis . Lancet 2:705-707, 1969.Crossref 12. Laurent C, Wittek M, Vereerstraeten P, et al: Red cells life span, splenic sequestration and transfusion requirements in chronic renal failure treated by hemodialysis: Effects of bilateral nephrectomy . Clin Nephrol 2:35-40, 1970. 13. Kominami N, Lowrie EG, Ianhez LE, et al: The effect of total nephrectomy on hematopoiesis in patients undergoing chronic hemodialysis . J Lab Clin Med 78:524-532, 1971. 14. Ulan RA, Hill JR, Silverberg DS: Erythrocyte survival and splenic sequestration in chronic dialysis patients . Abstracts of the 5th International Congress of Nephrology, Mexico City, 1972 , p 27. 15. Hoffman GL: Human erythropoiesis following kidney transplantation . Ann NY Acad Sci 149:504-508, 1968.Crossref 16. Hampers CL, Streiff R, Nathan DG, et al: Megaloblastic hematopoiesis in uremia and in patients on long-term hemodialysis . N Engl J Med 276:551-554, 1967.Crossref 17. Lawson DH, Boddy K, King PC, et al: Iron metabolism in patients with chronic renal failure on regular dialysis treatment . Clin Sci 41:345-351, 1971. 18. Strickland ID, Chaput de Saintonge DM, Boulton FE, et al: A trial of oral iron in dialysis patients . Clin Nephrol 2:13-17, 1974. 19. Hocken AG, Marwah PK: Iatrogenic contribution to anemia of renal failure . Lancet 1:164-165, 1971.Crossref 20. Lindsay RM, Burton JA, Edward N, et al: Dialyzer blood loss . Clin Nephrol 1:29-34, 1973. 21. Yawata Y, Kjellstrand C, Buselmeier T, et al: Hemolysis in dialyzed patients: Tap-water-induced red cell metabolic deficiency . Trans Am Soc Artif Intern Organs 18:301-304, 1972.Crossref 22. Kjellstrand CM, Eaton JW, Yawata Y, et al: Hemolysis in dialyzed patients caused by chloramines . Nephron 13:427-433, 1974.Crossref 23. Hartley LCJ, Innis MD, Morgan TO, et al: Splenectomy for anaemia in patients on regular haemodialysis . Lancet 2:1343-1345, 1971.Crossref 24. Bischel MD, Neiman RS, Berne TV, et al: The elimination by splenectomy of blood transfusion requirements leukopaenia and thrombocytopaenia in the patient on RDT , in Cameron JS (ed): Proceedings of the European Dialysis and Transplant Association . New York, Pitman Publishing Corp, 1971, vol 8, p 81. 25. Stenzel KH, Cheigh JS, Sullivan JF, et al: Clinical effects of bilateral nephrectomy . Am J Med 58:69-75, 1975.Crossref 26. DeGowin RL, Lavender AR, Forland M, et al: Erythropoiesis and erythropoietin in patients with chronic renal failure treated with hemodialysis and testosterone . Ann Intern Med 72:913-918, 1970.Crossref 27. Eschbach JW, Adamson JW: Improvement in the anemia of chronic renal failure with fluoxymesterone . Ann Intern Med 78:527-532, 1973.Crossref 28. Richardson JR, Weinstein MB: Erythropoietic response of dialyzed patients to testosterone administration . Ann Intern Med 73:403-407, 1970.Crossref 29. Shaldon S, Koch KM, Opperman F, et al: Testosterone therapy for anemia in maintenance dialysis . Br Med J 3:212-214, 1971.Crossref 30. Williams JS, Stein JH, Ferris TF: Nandrolone decanoate therapy for patients receiving hemodialysis . Arch Intern Med 134:289-292, 1971.Crossref 31. Dombeck DH, Lindholm DD, Vieira JA: Lipid metabolism in uremia and the effects of dialysate glucose and oral androgen therapy . Trans Am Soc Artif Intern Organs 19:150-153, 1973.Crossref 32. Johnson FL, Feagler JR, Lerner KG, et al: Association of androgenic-anabolic steroid therapy with development of hepato-cellular carcinoma . Lancet 2:1273-1278, 1972.Crossref 33. Hislop A (ed): The Proverbs of Scotland , ed 3. Edinburgh, Scotland, E & S Livingstone.

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Feb 1, 1977

References