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NDT Advance Access originally published online on November 5, 2008
Nephrology Dialysis Transplantation 2009 24(4):1082-1088; doi:10.1093/ndt/gfn601
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© The Author [2008]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org


Potential mechanisms of adverse outcomes in trials of anemia correction with erythropoietin in chronic kidney disease

Nosratola D. Vaziri1 and Xin J. Zhou2

1 Division of Nephrology and Hypertension, Department of Medicine, Physiology and Biophysics, University of California, Irvine, CA 2 Department of Pathology, UT Southwestern Medical Center, Dallas, TX, USA

Correspondence and offprint requests to: Nosratola D. Vaziri, Division of Nephrology and Hypertension, UCI Medical Center, 101 The City Drive, Bldg 53 Rm 125 Rt 81, Orange, CA 92868, USA. Tel: +1-714-456-5142; Fax: +1-714-456-6034; E-mail: ndvaziri@uci.edu

Keywords: anemia; cardiovascular disease; erythropoietin; progression of CKD; vascular access thrombosis

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



   Introduction
 
Advanced chronic kidney disease (CKD, stages 3–5) is almost invariably associated with anemia that is primarily caused by depressed production of erythropoietin (EPO), oxidative stress and inflammation [1,2]. This can be compounded by iron deficiency that is caused by loss of blood from repetitive laboratory tests, residual blood remaining in the hemodialysis circuits, fistula puncture site bleeding and uremic platelet dysfunction. In addition, when present, hemolytic disorders, bone marrow suppression, nutritional deficiencies, drug toxicities and hereditary diseases exacerbate the CKD-associated anemia.

The EPO-deficiency and iron-deficiency components of anemia are routinely corrected with the use of recombinant human EPO and iron preparations. However, presence of severe oxidative stress and inflammation hampers efficacy of EPO and iron in promoting erythropoiesis. In this context, severe persistent anemia despite high doses of EPO and iron is commonly due to oxidative stress and inflammation that may actually be intensified by intravenous iron and . . . [Full Text of this Article]

Analysis of the link between anemia and adverse outcomes
Anemia correction versus drug toxicity as the cause of adverse outcomes
Non-erythropoietic effects of EPO
Effect of EPO on arterial pressure.
Effect of EPO on vascular cell growth.
Effects of EPO on the platelet and coagulation system.
Effect of EPO on the nitric oxide pathway.
Effect of EPO on the heart.
Effect of EPO on the kidney.
Potential contribution of non-erythropoietic actions of EPO to adverse outcomes


   Conclusions
 

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