Nephrology Dialysis Transplantation, Vol 14, Issue 90002 50-60, Copyright © 1999 by Oxford University Press
W Horl
Iron supplementation currently is The most widely used form of adjuvant
therapy; intravenous (i.v.) iron is required by The majority of
haemodialysis patients receiving epoetin. Measurement of hypochromic red
blood cells is The most direct way of assessing iron supply to The bone
marrow. During The correction phase, a dose of i.v. iron equivalent to 50
mg/day is recommended, with The total dose not exceeding 3 g. When
subclinical vitamin C deficiency is suspected, ascorbic acid may be given
orally (1-1.5 g/week) or i.v. (300 mg three times weekly at The end of
dialysis). The active vitamin D metabolites alfacalcidol and calcitriol
may, under some circumstances, improve anaemia and reduce epoetin dosage
requirements. Vitamin B6 requirements are increased during epoetin therapy,
and supplementation with 100-150 mg/week is recommended. Supplementation of
vitamin B12 is optional. Folic acid is supplemented routinely in
haemodialysis patients, though evidence that it increases The efficacy of
epoetin is limited. Low doses (2-3 mg/week) normally should be sufficient
to maintain optimal folic acid stores in epoetin treated patients, although
higher doses are necessary for patients with hyperhomocysteinaemia.
L-Carnitine supplementation may be appropriate in
some patients with anaemia of chronic renal failure (CRF) unresponsive to,
or requiring large doses of, epoetin. Androgens potentially could reduce
epoetin costs in countries with limited resources, but should only be used
in men older than 50 years, with a remnant kidney. Recent animal studies
indicate that The combination of epoetin and insulin-like growth factor 1
could be beneficial in CRF patients. High doses of angiotensin-converting
enzyme. (ACE) inhibitors should be reserved for dialysis patients whose
hypertension cannot be controlled by other agents, or who require an ACE
inhibitor for treatment of heart failure. Keywords:
ACE inhibitors; androgens; Lcarnitine;
cytokines; iron; vitamins
ORIGINAL ARTICLES
Chairman's workshop report. Is there a role for adjuvant therapy in patients being treated with epoetin?
Department of Nephrology, University of Vienna, Vienna, Austria; Correspondence address: Leiter der Abteilung fur Neprhologie und Dialyse, Medizinische Universitatsklinik III, Wahringer Gurtel 18-20, 1090 Wien, Austria
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