Treatment of Anemia in Elderly Patients with CKD

Recombinant human erythropoietin (epoetin) therapy revolutionized the treatment of anemia in patients on dialysis with CKD not receiving dialysis (44, 45). More recently, a longer-acting darbepoetin alfa erythro-poiesis stimulating agent (ESA) has become available (46-49), and soon, newer form with varying mechanisms of action will likely become available for clinical use (46, 50). The risks and benefits of epoetin and darbepoetin therapy in the general population of patients with CKD have been...

Stages in the Development of Iron Deficiency

As shown in Table 3.2, the appearance of iron deficiency requires a progressive sequence of stages before there is frank anemia. The first stage is negative iron balance during which there is more iron leaving the body than is coming in. If this state persists, there is a gradual loss of iron stores and that will be reflected in a fall in the serum ferritin. Throughout this period, iron is being mobilized to support hemoglobin synthesis and there are no changes in the serum iron and the percent...

References

Izaks GJ, Westendorp RG, Knook DL The definition of anemia in older persons. JAMA 281 1714-1717, 1999 2. Chaves PH, Xue QL, Guralnik JM, Ferrucci L, Volpato S, Fried LP What constitutes normal hemoglobin concentration in community-dwelling disabled older women J Am Geriatr Soc 52 1811-1816, 2004 3. Eschbach JW The anemia of chronic renal failure pathophysiology and the effects of recombinant erythropoietin. Kidney Int 35 134-148, 1989 4. Stiveleman J, Fishbane S, Nissenson AR Erythropoietin...

The Role of Damage Response Pathways in Stem Cell Aging

Fasl Induced Calcium

If one accepts the premise that stem cell depletion contributes to aging, inhibition of checkpoints that regulate cellular damage by shunting such cells into pathways ending in apoptosis or senescence may preserve stem Fig. 1.4. Homeostatic balance between stem cell replication and carcinogenesis. The balance between malignancy and stem cell frequency is tightly regulated by cell cycle checkpoints and DNA damage sensors. This pathway demonstrates the upregulation of p21 in response to...

Anemia Associated with Physical Decline

There are now several lines of evidence illustrating that anemia is a significant predictor of physical decline and disability in older adults. The effect of anemia on mobility in elderly women has been assessed in two longitudinal population-based studies, the Women's Health and Aging Studies WHAS I and II that evaluated the onset and progression of disability in community-dwelling elderly women 8 . In these studies, the relationship between anemia and subsequent progression of disability was...

Anemia Treatment

For iron, B12, or folate deficiency, one should initiate supplementation. Except for iron deficiency, it remains unknown how likely or beneficial an etiologic investigation will be. For other anemias lacking a correctable chronic condition, three choices can be pursed watchful waiting, red blood cell transfusions, or erythropoietin stimulating proteins ESP . No controlled Table 6.3. Use of anemia therapies in nursing home residents Red blood cell transfusion 2.3 Nr Erythropoietin stimulating...

Anemia Prevalence

As in other settings, anemia prevalence depends on the population and anemia definition. Estimates of anemia ascertained by ICD codes 280-284 have suggested a very low frequency. In the 1999 National Nursing home survey, only 2.4 of residents carried a diagnosis of anemia ICD codes 280-284 13_152.pdf . Examining the minimum data set MDS and anemia chart diagnoses, an 18.8 prevalence was reported among 43,510 NH residents 65 years and older in Missouri 2 . Direct measures of hemoglobin Hb...

Introduction

This chapter explores the management of anemia in older cancer patients. Cancer is a disease of aging more than 50 of all malignancies currently occur in the 12 of the population aged 65 and over by the year 2030 older individuals are expected to account for 20 of the population and 70 of all cancer cases 1 . Though not unique of older individuals, anemia is a common manifestation of cancer, especially of advanced cancer 2 . The elderly are expected to suffer disproportionately of...