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NDT Advance Access originally published online on June 25, 2007
Nephrology Dialysis Transplantation 2007 22(8):2129-2132; doi:10.1093/ndt/gfm384
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© The Author [2007]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Evidence and implications of haemoglobin cycling in anaemia management

Steven Fishbane1 and Jeffrey S. Berns2

1Division of Nephrology, Winthrop-University Hospital, Mineola, New York and 2Renal, Electrolyte, and Hypertension Division, University of Pennsylvania School of Medicine, Philadelphia, USA

Correspondence and offprint requests to: Jeffrey S. Berns, Renal, Electrolyte and Hypertension Division, University of Pennsylvania School of Medicine, 3400 Spruce Street, 1 Founders Pavilion, Philadelphia, PA 19104, USA. Email: Jeffrey.Berns@uphs.upenn.edu

Keywords: anaemia; chronic kidney disease; erythropoiesis-stimulating agents; haemoglobin

The first 150 words of the full text of this article appear below.



   Introduction
 
Treatment with erythropoietic-stimulating agents (ESA) has been a major advance for improving the lives of patients with chronic kidney disease (CKD). Treatment, however, differs greatly from normal erythropoietic biology. The ESA drugs are administered episodically, resulting in great fluxes in serum erythropoietin levels. While the erythropoietic efficacy of treatment is clear, there are aspects of pharmacological response that are important to consider if we are to optimize treatment. One such phenomenon recently described, haemoglobin (Hb) cycling, is the repeated, cyclical, up and down movement of Hb levels during ESA treatment. This review will describe the phenomenon of Hb cycling, highlighting potential contributing factors and discussing the possible clinical implications.



   Evidence for Hb cycling
 
Results from a recent study suggest that Hb cycling is a common occurrence in ESA-treated patients on haemodialysis [1]. Hb cycling can be defined as oscillations over time in measured Hb levels in individual patients, with Hb levels decreasing . . . [Full Text of this Article]



   Factors affecting Hb cycling
 
ESA management practices
Illness and Hospitalization
Fluid balance
Iron status and therapy


   Clinical consequences of Hb cycling
 


   Implications and future directions
 


   Conclusions
 

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