Effect of erythropoietin and its combination with hypoxic altitude chamber training on the clinical and functional manifestations of chronic glomerulonephritis

  • Authors: Kaliev R1, Murkamilov IT1, Fomin VV2, Kaliev KR1, Aver'ianova NI3
  • Affiliations:
    1. Киргизская государственная медицинская академия им. И.К. Ахунбаева, Бишкек
    2. ГБОУ ВПО "Первый МГМУ им. И.М. Сеченова" Минздрава России
    3. ГОУ ВПО "Пермская государственная медицинская академия им. акад. Е.А. Вагнера" Минздрава России
  • Issue: Vol 86, No 10 (2014)
  • Pages: 40-46
  • Section: Editorial
  • URL: https://journals.rcsi.science/0040-3660/article/view/31572
  • ID: 31572

Cite item

Full Text

Abstract

AIM. To evaluate the efficiency of treatment for renal anemia in patients with chronic glomerulonephritis (CGN), by using erythropoietin and its combination with hypoxic altitude chamber training (HACT). MATERIALS AND METHODS. Sixty-three patients (41 men and 22 women) (mean age 37.1±13.3 years) with CGN during the predialysis phase of chronic kidney disease (CKD) complicated by anemia. Hemoglobin (Hb), packed cell volume (PCV), and red blood cell indices (mean corpuscular volume (MCV) and mean corpuscular hemoglobin concentration (MCHC)), platelet count, serum iron, fibrinogen, C-reactive protein (CRP) and creatinine levels were determined in all the patients at baseline and during a prospective follow-up. Glomerular filtration rate (GFR) was measured using with the Rehberg-Tareev test. Along with standard renal protective therapy, all the patients received either epoetin beta (n=31; Group 1) or its combination with HACT (n=32; Group 2). In Group 1 patients (n=31), erythropoietin (EPO) was given in an initial dose of 20-50 IU/kg thrice daily, followed by the dose being adjusted until the target Hb level was reached. Group 2 patients (n=32) received HACT cycles by the standard procedure in combination with EPO given in lower doses (20-50 IU/kg once weekly). A prospective follow-up of the patients was carried out during one year. RESULTS. Following one year, the number of patients who had achieved the target Hb level was 74.1% in Group 1 and 87.5% in Group 2. Over time, there were increases in the concentration of Hb (from 108.6±19.4 to 124.5±14.09 g/l; p<0.05), PCV, and red blood cell indices (MCV, MCHC) in the patients receiving EPO (Group 1). Besides an anti-anemic effect, there was a significant decrease in the concentrations of fibrinogen from 6655 (4884-7634) to 3776 (3330-4884) mg/dL; (p<0.05), serum creatinine from 159 (89-261) to 138 (79-258) µmol/l (p<0,05), proteinuria from 2.955 (1.024-6.745) to 2.069 (0.539-4.279) (p<0.05), which was accompanied by an increase in GFR from 62.3 (37.0-107.4) to 76.9 (46.0-96.0) ml/min (p<0.05). In Group 2, the rise in the concentration of Hb (from 114.1±11.7 to 132.0±16.5 g/l (p<0.05), PCV, MCV, and MCHC proved to be more pronounced than that in Group 1 (p<0.05) and accompanied by an elevation in the counts of platelets (from 222.7±19.8·109/l to 249.3±21.9·109/l (p<0.05)) and red blood cells (from 4.0±0.4·1012/l to 4.34±0.3·1012/l (p<0.05)). There was a more marked reduction in the degree of proteinuria from 3.092 (0.764-7.694) g at baseline to 1.600 (0.677-4.078) g one year later (p<0.05) than that in Group 1 (p<0.05). The increase in GFR from 60.1 (46.0-96.0) to 79.4 (44.0-120.0) ml/min (p<0.05) and the fall in the concentration of fibrinogen from 5555 (4884-7770) to 4107 (3776-5328) mg/dL (p<0.05) and serum creatinine from 166 (92-273) to 147 (92-152) µmol/L (p<0.05), which were observed in Group 2, were comparable to those in Group 1. CONCLUSION. Epoetin beta used in patients with CGN has an anti-anemic effect and leads to improved renal nitrogen-excretory function. Erythropoietin in combination with HACT used in CGN provides a higher anti-anemic efficacy and a more pronounced antiproteinuric effect.

About the authors

R Kaliev

Киргизская государственная медицинская академия им. И.К. Ахунбаева, Бишкек

I T Murkamilov

Киргизская государственная медицинская академия им. И.К. Ахунбаева, Бишкек

Email: murkamilov.i@mail.ru

V V Fomin

ГБОУ ВПО "Первый МГМУ им. И.М. Сеченова" Минздрава России

K R Kaliev

Киргизская государственная медицинская академия им. И.К. Ахунбаева, Бишкек

N I Aver'ianova

ГОУ ВПО "Пермская государственная медицинская академия им. акад. Е.А. Вагнера" Минздрава России

References

  1. Мухин Н.А. Снижение скорости клубочковой фильтрации общепопуляционный маркер неблагоприятного прогноза. Тер арх 2007; 6: 5-10.
  2. Collins A.J. Influence of target hemoglobin in dialysis patients on morbidity and mortality. Kidney Int 2002; 61 (Suppl. 80): S44-S48.
  3. Macdougall I.C., Walker R., Provenzano R. et al. ARCTOS Study Investigators. C.E.R.A. corrects anemia in patients with chronic kidney disease not on dialysis: results of a randomized clinical trial. Clin J Am Soc Nephrol 2008; 3 (2): 337-347.
  4. Besarab A., Goodkin D.A., Nissenson A.R. The Normal Hematocrit. Study Follow-up. N Engl J Med 2008; 358: 433-434.
  5. Thorp M.L., Johnson E.S. Effect of anemia on mortality, Cardiovascular Hospitalizations and End Stage Renal Disease among patients with chronic renal disease. Nephrology 2009; 14: 240-246.
  6. Lau J.H., Gangji A.S., Rabbat C.G. et al. Impact of haemoglobin and erythropoietin dose changes on mortality: a secondary analysis of results from a randomized anaemia management trial. Nephrol Dial Transplant 2010; 25 (12): 4002-4009.
  7. Миррахимов М.М., Мейманалиев Т.С. Высокогорная кардиология. Фрунзе: Кыргызстан1984; 316.
  8. Макешова А.Б., Эралиева., Левина А.А. и др. Особенности эритропоэза в условиях высокогорья и возможности использования гипоксической гипоксии для лечения больных с депрессиями кроветворения. Воен-мед журн 2013; 7: 48-45.
  9. Миррахимов М.М., Федосеев Г.Б., Успенская Е.А. Бронхиальная астма и ее лечение гипобарической гипоксией. Л 1983; 200.
  10. Бримкулов Н.Н. Высокогорная климатотерапия больных бронхиальной астмой. Тер арх 1991; 8: 25-30.
  11. Новиков В.С., Лустин С.И., Долгов Г.В. Гипобарическая гипоксия в лечении хронической анемии. Воен-мед журн 1995; 11: 36-39.
  12. Гипоксия. Адаптация, патогенез, клиника. Руководство для врачей. Под ред Ю.Л. Шевченко. СПб: ЭЛБИ-СПб 2000; 384.
  13. Агаджанян Н.А., Елфимов А.И. Функции организма в условиях гипоксии и гиперкапнии. М: Медицина 1986; 272.
  14. Тареевa И.Е. Нефрология: руководство для врачей. М: Медицина 2000; 688.
  15. Kidney Disease: Improving Global Outcomes (KDIGO) Anemia Work Group. KDIGO Clinical Practice Guideline for Anemia in Chronic Kidney Disease. Kidney Int 2012; 2: 114-164.
  16. Успенская В.П., Воляник М.Н., Меерсон Ф.З. и др. Лечение больных бронхиальной астмой в барокамере пониженного давления (гипобаротерапия). Метод рекоменд М: МЗ СССР 1991.
  17. Hue J.L., St Peter W.R., Ebben J.P. et al. Anemia treatment in the pre-ESRD period and associated mortality in elderly patients. Am J Kidney Dis 2002; 40: 1153-1161.
  18. Cody J., Daly C., Campbell M. et al. Recombinant human erythropoietin for chronic renal failure anemia in pre-dialysis patients. Cochrane Database Syst Rev 2005; 3: СD 003266.
  19. Rossert J., Levin A., Roger C.R. et al. Effect of larsy correction of anemia on the progression of chronic kidney disease. Am J Kidney Dis 2006; 47: 738-750.
  20. Jie K.E., Verhaar M.C., Cramer M.J. et al. Erythropoietin and the cardiorenal syndrome: Cellular mechanisms on the cardiorenal connectors. Am J Physiol Renal Physiol 2006; 291: 932-944.
  21. Милованов Ю.С., Козловская Л.В., Милованова Л.Ю. Лечение анемии у больных хронической почечной недостаточностью на додиализном этапе. Леч врач 2006; 7: 12-23.
  22. Калиев Р.Р. Эффективность прерывистой барокамерной гипоксической тренировки, мевакора и их сочетанного применения при нефротическом гломерулонефрите. Нефрол диал 2004; 6 (3): 243-246.
  23. Швецов М.Ю., Иванов А.А., Попова О.П. и др. Взаимосвязи почечной экспрессии фактора, индуцируемого гипоксией, с выраженностью нефросклероза и анемии при хроническом гломерулонефрите. Клин мед 2009; 2: 66-70.
  24. Semenza G.L. HIF-1 and human disease: one highly involved factor. Genev Dev 2000; 14: 1983-1991.
  25. Левина А.А., Макешова А.Б., Мамукова Ю.И. и др. Регуляция гомеостаза кислорода. Фактор, индуцированный гипоксией (HIF) и его значение в гомеостазе кислорода. Педиатрия 2009; 87 (4): 92-97.
  26. Appelhoff R.Y., Tian Y.M., Raval R.R. et al. Differential function of the prolyl hydroxylases PHD 1, PHD 2, and PHD 3 in the regulation of hypoxia - inducible factor. J Biol Chem 2004; 279: 38458-38465.
  27. Revised European Best Practice Guidelines for the Management of anemia in Patients with сhronic Renal Failure. Nephrol Dial Transplant 2004; 19 (Suppl. 2): ii2-ii45.
  28. Fehr T., Ammann P., Garzoni D. et al. Interpretation of erythropoietin levels in patients with various degrees of renal insufficiency and anemia. Kidney Int 2004; 66: 1206-1244.
  29. Ряснянский В., Шостка Г. Нефрогенная анемия - индивидуальный подход к лечению. Врач 2012; 6: 23-26.
  30. Mc Clellan W., Aronoff S.L., Bolton W.K. et al. The prevalence of anemia in patients with chronic kidney disease. Curr Med Ress Opion 2004; 20: 1501-1510.
  31. Orbador G.T., Roberts T., St Peter W.L. et al. Trends in anemia at initiator of dialysis in the United States. Kidney Int 2001; 60: 1875-1884.
  32. Левина А.А., Раимжанов А.Р., Джайлобаева Н.К. и др. Железодефицитные состояния у женщин, проживающих на различных высотах Тянь-Шаня. Пробл гематол и перелив крови 2001; 4: 45-48.
  33. Mancia G., Fagard R., Narkiewicz K. et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J 2013; 34: (28): 2159.
  34. Fishbane S. Erythropoiesis-stimulating agent treatment with full anemia correction: a new perspective. Kidney Int 2009; 75 (4): 358-365.
  35. Калиев Р.Р., Сыдыкова А.Т., Будайчиева А.Б. Влияние гипобарической гипоксии на течение нефротического гломерулонефрита. Современная медицина на рубеже XX-XXI веков. Сб науч труд междунар науч-практ конф. Бишкек 2000; 14-19.

Copyright (c) 2014 Consilium Medicum

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
 
 


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies