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Li D, Zheng X, Zhang Y, Li X, Chen X, Yin Y, Hu J, Li J, Guo M, Wang X. What Should Be Responsible for Eryptosis in Chronic Kidney Disease? Kidney Blood Press Res 2022; 47:375-390. [PMID: 35114677 DOI: 10.1159/000522133] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 01/21/2022] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Renal anemia is an important complication of chronic kidney disease (CKD). In addition to insufficient secretion of erythropoietin (EPO) and erythropoiesis disorders, the impact of eryptosis on renal anemia demands attention. However, a systemic analysis concerning the pathophysiology of eryptosis has not been expounded. SUMMARY The complicated conditions in CKD patients, including oxidative stress, osmotic stress, metabolic stress, accumulation of uremic toxins, and iron deficiency, affect the normal skeleton structure of red blood cells (RBCs) and disturbs ionic homeostasis, causing phosphatidylserine to translocate to the outer lobules of the RBC membrane that leads to early elimination and/or shortening of the RBC lifespan. Inadequate synthesis of RBCs cannot compensate for their accelerated destruction, thus exacerbating renal anemia. Meanwhile, EPO treatment alone will not reverse renal anemia. A variety of eryptosis inhibitors have so far been found, but evidence of their effectiveness in the treatment of CKD remains to be established. KEY MESSAGES In this review, the pathophysiological processes and factors influencing eryptosis in CKD were elucidated. The aim of this review was to underline the importance of eryptosis in renal anemia and determine some promising research directions or possible therapeutic targets to correct anemia in CKD.
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Affiliation(s)
- Dongxin Li
- Department of Nephrology, Clinical Medicine College & Affiliated Hospital of Weifang Medical University, Weifang Medical University, Weifang, China,
| | - Xujuan Zheng
- Health Science Centre, Shenzhen University, Shenzhen, China
| | - Yunxia Zhang
- Department of Nephrology, Clinical Medicine College & Affiliated Hospital of Weifang Medical University, Weifang Medical University, Weifang, China
| | - Xiangling Li
- Department of Nephrology, Clinical Medicine College & Affiliated Hospital of Weifang Medical University, Weifang Medical University, Weifang, China
| | - Xuexun Chen
- Department of Nephrology, Clinical Medicine College & Affiliated Hospital of Weifang Medical University, Weifang Medical University, Weifang, China
| | - Yonghua Yin
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences & Peking Union Medical College, Chengdu, China
| | - Jingwen Hu
- Department of Nephrology, Clinical Medicine College & Affiliated Hospital of Weifang Medical University, Weifang Medical University, Weifang, China
| | - Jialin Li
- Department of Nephrology, Clinical Medicine College & Affiliated Hospital of Weifang Medical University, Weifang Medical University, Weifang, China
| | - Min Guo
- Department of Nephrology, Clinical Medicine College & Affiliated Hospital of Weifang Medical University, Weifang Medical University, Weifang, China
| | - Xiangming Wang
- Department of Nephrology, Clinical Medicine College & Affiliated Hospital of Weifang Medical University, Weifang Medical University, Weifang, China
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Vignjević Petrinović S, Jauković A, Milošević M, Bugarski D, Budeč M. Targeting Stress Erythropoiesis Pathways in Cancer. Front Physiol 2022; 13:844042. [PMID: 35694408 PMCID: PMC9174937 DOI: 10.3389/fphys.2022.844042] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 05/09/2022] [Indexed: 11/13/2022] Open
Abstract
Cancer-related anemia (CRA) is a common multifactorial disorder that adversely affects the quality of life and overall prognosis in patients with cancer. Safety concerns associated with the most common CRA treatment options, including intravenous iron therapy and erythropoietic-stimulating agents, have often resulted in no or suboptimal anemia management for many cancer patients. Chronic anemia creates a vital need to restore normal erythropoietic output and therefore activates the mechanisms of stress erythropoiesis (SE). A growing body of evidence demonstrates that bone morphogenetic protein 4 (BMP4) signaling, along with glucocorticoids, erythropoietin, stem cell factor, growth differentiation factor 15 (GDF15) and hypoxia-inducible factors, plays a pivotal role in SE. Nevertheless, a chronic state of SE may lead to ineffective erythropoiesis, characterized by the expansion of erythroid progenitor pool, that largely fails to differentiate and give rise to mature red blood cells, further aggravating CRA. In this review, we summarize the current state of knowledge on the emerging roles for stress erythroid progenitors and activated SE pathways in tumor progression, highlighting the urgent need to suppress ineffective erythropoiesis in cancer patients and develop an optimal treatment strategy as well as a personalized approach to CRA management.
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Affiliation(s)
- Sanja Vignjević Petrinović
- Laboratory for Neuroendocrinology, Institute for Medical Research, National Institute of Republic of Serbia, University of Belgrade, Belgrade, Serbia
| | - Aleksandra Jauković
- Laboratory for Experimental Hematology and Stem Cells, Institute for Medical Research, National Institute of Republic of Serbia, University of Belgrade, Belgrade, Serbia
| | - Maja Milošević
- Laboratory for Neuroendocrinology, Institute for Medical Research, National Institute of Republic of Serbia, University of Belgrade, Belgrade, Serbia
| | - Diana Bugarski
- Laboratory for Experimental Hematology and Stem Cells, Institute for Medical Research, National Institute of Republic of Serbia, University of Belgrade, Belgrade, Serbia
| | - Mirela Budeč
- Laboratory for Neuroendocrinology, Institute for Medical Research, National Institute of Republic of Serbia, University of Belgrade, Belgrade, Serbia
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Alshamsi I. Extended Literature Review of the role of erythropoietin stimulating agents (ESA) use in the management of post renal transplant anaemia. TRANSPLANTATION REPORTS 2022. [DOI: 10.1016/j.tpr.2022.100097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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van Oosten MJM, Logtenberg SJJ, Edens MA, Hemmelder MH, Jager KJ, Bilo HJG, Stel VS. Health claims databases used for kidney research around the world. Clin Kidney J 2020; 14:84-97. [PMID: 33564408 PMCID: PMC7857833 DOI: 10.1093/ckj/sfaa076] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 04/07/2020] [Indexed: 12/16/2022] Open
Abstract
Health claims databases offer opportunities for studies on large populations of patients with kidney disease and health outcomes in a non-experimental setting. Among others, their unique features enable studies on healthcare costs or on longitudinal, epidemiological data with nationwide coverage. However, health claims databases also have several limitations. Because clinical data and information on renal function are often lacking, the identification of patients with kidney disease depends on the actual presence of diagnosis codes only. Investigating the validity of these data is therefore crucial to assess whether outcomes derived from health claims data are truly meaningful. Also, one should take into account the coverage and content of a health claims database, especially when making international comparisons. In this article, an overview is provided of international health claims databases and their main publications in the area of nephrology. The structure and contents of the Dutch health claims database will be described, as well as an initiative to use the outcomes for research and the development of the Dutch Kidney Atlas. Finally, we will discuss to what extent one might be able to identify patients with kidney disease using health claims databases, as well as their strengths and limitations.
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Affiliation(s)
- Manon J M van Oosten
- Department of Medical Informatics, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Mireille A Edens
- Diabetes Research Center and Department of Epidemiology and Statistics, Isala Hospital, Zwolle, The Netherlands
| | - Marc H Hemmelder
- Dutch Renal Registry (Renine), Nefrovisie Foundation, Utrecht, The Netherlands.,Department of Internal Medicine, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Kitty J Jager
- Department of Medical Informatics, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Henk J G Bilo
- Diabetes Research Center and Department of Epidemiology and Statistics, Isala Hospital, Zwolle, The Netherlands.,Department of Internal Medicine, University Medical Center, Groningen, The Netherlands.,Faculty of Medicine, Groningen University, Groningen, The Netherlands
| | - Vianda S Stel
- Department of Medical Informatics, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
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Pedrini LA, Zawada AM, Winter AC, Pham J, Klein G, Wolf M, Feuersenger A, Ruggiero P, Feliciani A, Barbieri C, Gauly A, Canaud B, Stuard S. Effects of high-volume online mixed-hemodiafiltration on anemia management in dialysis patients. PLoS One 2019; 14:e0212795. [PMID: 30794672 PMCID: PMC6386285 DOI: 10.1371/journal.pone.0212795] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 02/08/2019] [Indexed: 12/16/2022] Open
Abstract
Background Anemia is a major comorbidity of patients with end-stage renal disease and poses an enormous economic burden to health-care systems. High dose erythropoiesis-stimulating agents (ESAs) have been associated with unfavorable clinical outcomes. We explored whether mixed-dilution hemodiafiltration (Mixed-HDF), based on its innovative substitution modality, may improve anemia outcomes compared to the traditional post-dilution hemodiafiltration (Post-HDF). Methods We included 174 adult prevalent dialysis patients (87 on Mixed-HDF, 87 on Post-HDF) treated in 24 NephroCare dialysis centers between January 2010 and August 2016 into this retrospective cohort study. All patients were dialyzed three times per week and had fistula/graft as vascular access. Patients were matched at baseline and followed over a one-year period. The courses of hemoglobin levels (Hb) and monthly ESA consumption were compared between the two groups with linear mixed models. Results Mean baseline Hb was 11.9±1.3 and 11.8±1.1g/dl in patients on Mixed- and Post-HDF, respectively. While Hb remained stable in patients on Mixed-HDF, it decreased slightly in patients on Post-HDF (at month 12: 11.8±1.2 vs 11.1±1.2g/dl). This tendency was confirmed by our linear mixed model (p = 0.0514 for treatment x time interaction). Baseline median ESA consumption was 6000 [Q1:0;Q3:16000] IU/4 weeks in both groups. Throughout the observation period ESA doses tended to be lower in the Mixed-HDF group (4000 [Q1:0;Q3:16000] vs 8000 [Q1:0;Q3:20000] IU/4 weeks at month 12; p = 0.0791 for treatment x time interaction). Sensitivity analyses, adjusting for differences not covered by matching at baseline, strengthened our results (Hb: p = 0.0124; ESA: p = 0.0687). Conclusions Results of our explorative study suggest that patients on Mixed-HDF may have clinical benefits in terms of anemia management. This may also have a beneficial economic impact. Future studies are needed to confirm our hypothesis-generating results and to provide additional evidence on the potential beneficial effects of Mixed-HDF.
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Affiliation(s)
- Luciano A. Pedrini
- Department of Nephrology and Dialysis, NephroCare-ASST Bergamo-Est, Bolognini Hospital, Seriate, Italy
| | - Adam M. Zawada
- Fresenius Medical Care Deutschland GmbH, Clinical and Epidemiological Research, Bad Homburg, Germany
- * E-mail:
| | - Anke C. Winter
- Fresenius Medical Care Deutschland GmbH, Clinical and Epidemiological Research, Bad Homburg, Germany
| | - Jenny Pham
- Fresenius Medical Care Deutschland GmbH, Clinical and Epidemiological Research, Bad Homburg, Germany
| | - Gudrun Klein
- Fresenius Medical Care Deutschland GmbH, Clinical and Epidemiological Research, Bad Homburg, Germany
| | - Melanie Wolf
- Fresenius Medical Care Deutschland GmbH, Clinical and Epidemiological Research, Bad Homburg, Germany
| | - Astrid Feuersenger
- Fresenius Medical Care Deutschland GmbH, Clinical and Epidemiological Research, Bad Homburg, Germany
| | - Pio Ruggiero
- Department of Nephrology and Dialysis, NephroCare-ASST Bergamo-Est, Bolognini Hospital, Seriate, Italy
| | - Annalisa Feliciani
- Department of Nephrology and Dialysis, NephroCare-ASST Bergamo-Est, Bolognini Hospital, Seriate, Italy
| | | | - Adelheid Gauly
- Fresenius Medical Care Deutschland GmbH, Clinical and Epidemiological Research, Bad Homburg, Germany
| | - Bernard Canaud
- Fresenius Medical Care Deutschland GmbH, Medical Office EMEA, Bad Homburg, Germany
| | - Stefano Stuard
- Fresenius Medical Care Deutschland GmbH, Clinical &Therapeutical Governance, Bad Homburg, Germany
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