Karakteristik Pasien Anemia pada End Stage Renal Disease (ESRD) dengan Hemodialisis di Instalasi Hemodialisis RSUD Dr. Soetomo

Abstrak Latar belakang: Anemia merupakan salah satu komplikasi yang sering terjadi pada pasien dengan penyakit ginjal kronis dan sering mengakibatkan terjadinya penurunan kualitas hidup pasien, peningkatan morbiditas dan mortalitas pasien, serta meningkatkan laju progresivitas pada PGK. Pada pasien PGK stadium terminal, biasa disebut ESRD. Terapi pengganti ginjal untuk pasien ESRD salah satunya adalah hemodialisis. Tujuan: Untuk mendeskripsikan karakteristik pasien anemia pada ESRD dengan hemodialiasis di Instalasi Hemodialisis RSUD Soetomo Surabaya. Metode: Penelitian ini merupakan penelitian deskriptif observasional dengan metode cross sectional menggunakan data sekunder dari rekam medis pasien di Instalasi Hemodialisis RSUD Dr. Soetomo Surabaya. Hasil: Data dari 80 subjek penelitian, terdapat 17 orang (21,3%) berusia 18-40 tahun, berusia 41-60 dengan jumlah 53 orang (66,3%), dan usia > 60 tahun sebanyak 10 orang (12,5%) dengan hasil rerata usia 48,08 ± 10,598. Berdasarkan jenis kelamin pada pria ada 39 orang (48,8%), dan pada wanita 41 orang (51,2%), rerata jenis kelamin pria 9,46 ± 1,592 dan wanita 9,04 ± 1,329. Jenis penyakit komorbid yang paling banyak adalah hipertensi sebesar 49 orang (61,3%) dan yang paling sedikit adalah penyakit autoimun (lupus) dan glomerulonefritis serta urolithiasis yaitu 2 orang (2,5%).Total Saturasi Transferin (ST) terbanyak dengan kadar ST > 20% sejumlah 52 orang (65%) dan pada ST < 20% sebanyak 28 orang (35%). Subjek penelitian yang mendapatkan terapi eritropoietin (EPO) yaitu terdapat 55 orang (68,75%). Subjek penelitian yang mendapatkan terapi zat besi intravena (IV) sebesar 25 orang (31,25%). Kesimpulan: Pasien anemia pada ESRD terbanyak pada interval usia 41-60 tahun, dengan jenis kelamin dominan pada wanita, dengan penyakit komorbid terbesar adalah hipertensi, dengan hasil ST dominan yaitu ST > 20, dan terdapat lebih banyak pasien yang menerima terapi EPO dibandingkan dengan menerima terapi zat besi intravena (dialifer). ---- Abstract Background: Anemia is a one of complication that often occurs in patients with chronic kidney disease and often results in a decrease in the patient's quality of life, an increase in patient morbidity and mortality, and an increase in the rate of progression of CKD. In patients with terminal stage CKD, it is known as ESRD. One of the renal replacement therapies for ESRD patients is hemodialysis. Objective: To describe the characteristics of anemia patients in ESRD with hemodialiasis at the Hemodialysis Installation of Dr. Soetomo General Hospital Surabaya. Methods: This research is a descriptive observational study with a cross sectional method using secondary data from the medical records of patients at the Hemodialysis Installation in Dr. Soetomo General Hospital Surabaya. Results: Data from 80 research subjects, there are 17 people (21.3%) aged 18-40 years, aged 41-60 with a total of 53 people (66.3%), and age > 60 years as many as 10 people (12.5 %) with a average age of 48.08 ± 10.598. Based on gender, there were 39 men (48.8%), and 41 women (51.2%), the average gender was 9.46 ± 1.592 for men and 9.04 ± 1.329 for women. The most common type of comorbid disease was hypertension by 49 people (61.3%) and the least was autoimmune disease (lupus) and glomerulonephritis and urolithiasis, namely 2 people (2.5%). ST > 20% a total of 52 people (65%) and on ST <20% as many as 28 people (35%). The research subjects who received erythropoietin (EPO) therapy were 55 people (68.75%). The research subjects who received intravenous (IV) iron therapy were 25 people (31.25%). Conclusion: The most anemia patients in ESRD were at the age interval of 41-60 years, with the dominant gender in women, with the largest comorbid disease being hypertension, with a dominant ST result of ST > 20, and there were more patients receiving EPO therapy compared to receiving intravenous iron therapy (dialifer).

Efficacy and safety of ferric derisomaltose (FDI) compared with iron sucrose (IS) in patients with iron deficiency anemia after bariatric surgery

Purpose Iron deficiency is common following bariatric surgery, and treatment with intravenous iron is often required. This post hoc analysis of data from two randomized, open-label, multicenter trials evaluated the efficacy and safety of ferric derisomaltose (FDI; formerly iron isomaltoside 1000) versus iron sucrose (IS) over 4 weeks in adults with iron deficiency anemia (IDA) resulting from prior bariatric surgery. Materials and methods Data were pooled for participants who received FDI or IS in the PROVIDE or FERWON-IDA trials for the treatment of IDA post bariatric surgery. Efficacy outcomes included changes in hemoglobin (Hb) and iron parameters; safety outcomes included the incidence of adverse drug reactions (ADRs), serious or severe hypersensitivity reactions (HSRs), and hypophosphatemia. Results The analysis included 159 patients. Mean (standard deviation) cumulative iron doses were 1199 (± 347) mg for FDI and 937 (± 209) mg for IS. Compared with IS, FDI resulted in a faster and more pronounced Hb response, and a higher proportion of responders (Hb level increase ≥ 2 g/dL from baseline) at all time points. The incidence of ADRs was similar with FDI and IS (15.1% and 18.2%, respectively), with no serious ADRs or serious or severe HSRs reported. The incidence of hypophosphatemia was low and similar in both treatment groups, with no cases of severe hypophosphatemia observed. Conclusions In patients with IDA resulting from bariatric surgery, FDI produced a faster and more pronounced Hb response than IS. Both FDI and IS were well tolerated. Graphical abstract

Iron deficiency anaemia: pathophysiology, assessment, practical management

The WHO has recognised iron deficiency anaemia (IDA) as the most common nutritional deficiency in the world, with 30% of the population being affected with this condition. Although the most common causes of IDA are gastrointestinal bleeding and menstruation in women, decreased dietary iron and decreased iron absorption are also culpable causes. Patients with IDA should be treated with the aim of replenishing iron stores and returning the haemoglobin to a normal level. This has shown to improve quality of life, morbidity, prognosis in chronic disease and outcomes in pregnancy. Iron deficiency occurs in many chronic inflammatory conditions, including congestive cardiac failure, chronic kidney disease and inflammatory bowel disease. This article will provide an updated overview on diagnosis and management of IDA in patients with chronic conditions, preoperative and in pregnancy. We will discuss the benefits and limitations of oral versus intravenous iron replacement in each cohort, with an overview on cost analysis between the different iron formulations currently on the market.

Preoperative intravenous iron treatment reduces postoperative complications and postoperative anemia in preoperatively anemic patients with colon carcinoma

Purpose Anemia is common among patients with colorectal cancer and is associated with an increased risk of complications and poorer survival rate. The main objective of our study was to determine the effect of preoperative intravenous iron supplementation therapy on the need for red blood cell transfusions, other postoperative complications, and length of hospital stay in colon cancer patients undergoing colon resection. Methods In this retrospective cohort study, data were collected from medical records of all 549 colon carcinoma patients who underwent a colon resection in Helsinki University Hospital during the years 2017 and 2018. The patients were divided into two cohorts: one with anemic patients treated with preoperative intravenous iron supplementation therapy (180 patients) and one with anemic patients without preoperative intravenous iron supplementation therapy (138 patients). Non-anemic patients and patients requiring emergency surgery were excluded (231 patients). Results Patients treated with intravenous iron had less postoperative complications (33.9% vs. 45.9%, p = 0.045) and a lower prevalence of anemia at 1 month after surgery (38.7% vs. 65.3%, p < 0.01) when compared with patients without preoperative iv iron treatment. No difference was found in the amount of red blood cell transfusions, length of stay, or mortality between the groups. Conclusion This is the first study demonstrating a significant decrease in postoperative complications in anemic colon cancer patients receiving preoperative intravenous iron supplementation therapy. This treatment also diminishes the rate of postoperative anemia, which is often associated with a facilitated recovery.

A COMPARATIVE STUDY OF INTRAVENOUS IRON SUCROSE VERSUS ORAL IRON THERAPY IN IRON DEFICIENCY ANEMIA DURING POSTPARTUM PERIOD

Introduction: Anemia is the commonest major contributing factor in maternal mortality and morbidity in developing countries and according to World Health Organization (WHO) criteria, it contributes to 20% of maternal deaths. Anemia in pregnancy defined as hemoglobin level <11 gm/dl (7.45 mmol/L) and hematocrit less than 33% (WHO). Aim: To compare the efficacy of oral iron ferrous sulphate therapy with intravenous iron sucrose therapy in the treatment of iron deficiency anemia during postpartum period. Material & Methods: This was a prospective randomized comparative clinical trial single center study conducted on 200 postpartum women aged >18 years (after normal delivery or LSCS) within 10 days of delivery with Hb level more or equal to 6 gm/dl but less than 10 gm/dl were included in the study. This was a one year study conducted during 1st December 2018 to 30th November 2019. Results : There was a significant increase in the hemoglobin level in both the groups i.e. in IV iron group, from 8.26 ±1.03gm/dl on day 1 to 11.62±0.94gm/dl on day 45 as compared to oral iron group, from 8.24±1.09gm/dl on day 1 to 11.07±1.14gm/dl on day 45; and serum ferritin level from 41.69±40.45ng/ml on day 1 to 77.34±41.60ng/ml on day 45 in IV iron group as compared to the oral iron group from 22.20±8.82ng/ml on day 1 to 31.72±9.72 ng/ml on day 45. So, there was a rapid increase in both hemoglobin and serum ferritin levels in IV iron group as compared to the oral iron group. Conclusion: Intravenous iron sucrose administration increases the hemoglobin level and serum ferritin more rapidly in compare to the oral intake of ferrous sulphate in women with iron deficiency anemia in postpartum women in our study. Keywords: Iron deficiency anemia, Intravenous iron sucrose, Serum ferritin, Maternal mortality.

Hereditary hemorrhagic telangiectasia (HHT): a practical guide to management

Hereditary hemorrhagic telangiectasia (HHT), the second most common inherited bleeding disorder, is associated with the development of malformed blood vessels. Abnormal blood vessels may be small and cutaneous or mucosal (telangiectasia), with frequent complications of bleeding, or large and visceral (arteriovenous malformations [AVMs]), with additional risks that can lead to significant morbidity and even mortality. HHT can present in many different ways and can be difficult to recognize, particularly in younger patients in the absence of a known family history of disease or epistaxis, its most common manifestation. HHT is commonly diagnosed using the established Curaçao clinical criteria, which include (1) family history, (2) recurrent epistaxis, (3) telangiectasia, and (4) visceral AVMs. Fulfillment of 3 or more criteria provides a definite diagnosis of HHT, whereas 2 criteria constitute a possible diagnosis of HHT. However, these criteria are insufficient in children to rule out disease due to the age-dependent development of some of these criteria. Genetic testing, when positive, can provide definitive diagnosis of HHT in all age groups. Clinical course is often complicated by significant epistaxis and/or gastrointestinal bleeding, leading to anemia in half of adult patients with HHT. The management paradigm has recently shifted from surgical approaches to medical treatments aimed at control of chronic bleeding, such as antifibrinolytic and antiangiogenic agents, combined with aggressive iron replacement with intravenous iron. Guidelines for management of HHT, including screening and treatment, were determined by expert consensus and originally published in 2009 with updates and new guidelines in 2020.

A Randomized controlled trial of the Effect of intraVenous iron on Anaemia in Malawian Pregnant women (REVAMP): Statistical analysis plan

Background: Anaemia affects more than half of Africa’s pregnancies. Standard care, with oral iron tablets, often fails to achieve results, with compliance and gastrointestinal side-effects being a significant issue. In recent years, intravenous iron formulations have become safe, effective, and quick to administer, allowing the complete iron requirements of pregnancy to be provided in one 15-minute infusion. The Randomized controlled trial of the Effect of intraVenous iron on Anaemia in Malawian Pregnant women (REVAMP) will evaluate whether a modern intravenous iron formulation, ferric carboxymaltose (FCM), given once during the second trimester is effective and safe in improving maternal and neonatal outcomes for treatment of moderate to severe anaemia in sub-Saharan Africa. The objective was to publish the detailed statistical analysis plan for the REVAMP trial prior to unblinding the allocated treatments and performing the analysis. Methods: REVAMP is a multicentre, two-arm, open-label, parallel-group randomized control trial (RCT) in 862 pregnant women in their second trimester. The trial statistician developed the statistical analysis plan in consultation with the trial management team based on the protocol, data collection forms, and study outcomes available in the blinded study database. Results: The detailed statistical analysis plan will support the statistical analyses and reporting of the REVAMP trial after unblinding the treatment allocations. Conclusions: A statistical analysis plan allows for transparency as well as reproducibility of reporting and statistical analyses.