Anemia Drug May Raise Stroke Risk in Kidney Patients

(HealthDay News) -- A drug designed to fight anemia appears to double the risk of stroke in patients with diabetes and kidney disease without substantially improving their quality of life, a new study finds.

Darbepoetin alfa, marketed as Aranesp and known as an erythropoiesis-stimulating agent (ESA), is often prescribed for diabetic patients with chronic kidney disease and mild anemia.

"The benefits we assumed we would have by treating anemia were less striking and the risks were more striking," said lead researcher Dr. Marc A. Pfeffer, a professor of medicine in the cardiovascular division of Brigham and Women's Hospital in Boston.

"This provides new data for doctors and patients to make their own risk-benefit assessment," he said. "There was a perception that treating anemia would make people feel so much better that we'll take risks, but the benefit in quality of life was not as great as we thought, and there was a clear doubling of your risk for a stroke."

The report was published in the Oct. 30 online edition of the New England Journal of Medicine to coincide with its scheduled presentation at the annual meeting of the American Society of Nephrology in San Diego.

For the study, Pfeffer's team randomly assigned more than 4,000 patients with diabetes, chronic kidney disease and anemia to receive Aranesp or placebo. During the study, 632 patients receiving Aranesp died or suffered a cardiovascular event, compared to 602 of the patients receiving placebo.

As well, 101 patients taking Aranesp had a fatal or non-fatal stroke compared with 53 of the placebo patients, the researchers found. In addition, patients taking Aranesp reported only a modest improvement in their fatigue, the researchers noted.

In earlier studies, Aranesp and a similar drug, epoetin alfa, marketed as Procrit or Epogen, were linked to increased risk of death in cancer and stroke patients.

Pfeffer believes that people with more severe kidney disease, such as those on dialysis, might still find Aranesp beneficial and the risk acceptable.

"People on dialysis generally feel even worse and generally have even more severe anemia, and this class of therapy has been very helpful to them," he said.

Because the drug was beneficial to these patients, doctors assumed it would help less severely anemic patients, Pfeffer said.

"But this use of ESAs exceeded the data," he said. "Now we have the data, and we will revisit how the drug is used now."

Dr. Phillip Marsden, a professor of medicine at the University of Toronto and author of an accompanying journal editorial, said these findings mean that doctors and patients will have to discuss whether or not to start the medication.

"For most of these patients, the modest improvement in quality of life will not be enough to subject themselves to the increased risk of stroke and death," he said.

ESAs have been used for two decades, Marsden noted. "It is a bit shocking that it took us 20 years to address whether or not these drugs were safe -- and now we know more."

Dr. Ajay Singh, clinical chief of the renal division and director of dialysis at Brigham and Women's Hospital, said this "landmark study" raises the fundamental question of whether epoetin or darbepoetin should routinely be used in treating anemia of chronic kidney disease.

"Earlier studies raised the specter of increased risk with ESA treatment. This study definitively confirms that there is meaningful risk with routine use of ESAs," said Singh, also an associate professor of medicine at Harvard Medical School.

"In my own practice, I will be cautious in using ESAs for most patients with chronic kidney disease, balancing risk with benefits and reserving treatment largely for patients who need frequent blood transfusions or who are candidates for a kidney transplant," he said.

SOURCES: Marc A. Pfeffer, M.D., Ph.D., professor of medicine, cardiovascular division, Brigham and Women's Hospital, Boston; Phillip Marsden, M.D., professor of medicine, University of Toronto, Canada; Ajay Singh, M.D., clinical chief, renal division, director, dialysis, Brigham and Women's Hospital, and associate professor, medicine, Harvard Medical School, Boston; Oct. 30, 2009, New England Journal of Medicine, online

Read more...

Tips Keeping Kidneys

Normally, no one wants to fall ill. But if you overdo the disease has come, do not dawdle, do the treatment immediately as optimal as possible. If allowed to drag on, the more severe illness, and greater treatment costs. In the case of kidney stone disease and urinary tract, severe kidney damage will force you to wash the blood throughout life. What should you do to deal with this disease?

The following steps will help you:

1. Pay attention to symptoms.

Not all back pain a sign of kidney stones. This disease has several characteristic symptoms that are related to each other. If these symptoms seem, you should be suspicious.

Common symptoms of kidney stone disease are:

Pain or aching in the back of the upper waist or rather under the last rib.

At some level of pain inflicted stabbing pain, radiating to the side to follow the urinary tract. Sometimes accompanied Anyang-anyangan. Not urinate smoothly. Desire exist but repeatedly issued back only slightly. Frequent urine reddish. This is a sign of urinary tract walls scratched or injured by stone chips. Sometimes it feels pain when urinate. The same time, the water there are pieces of art sand or small stones.

2. Medical Conduct

Treatment of kidney stone disease should be tailored to the severity of the disease. Simply put, there are three methods of treatment that can dilakukan.Meminum lots of water plus a traditional herb that has diuretic effects (launched urinate). This method works only deal with small stone berukuraan

diameter less than 4 mm. Drink lots of water will help dilute and dissolve the rock art to easily carry out the body during urination.

3. Actions destruction stone (liptotripsi)

This method is intended to stone size between 4-30 mm. Having crushed stone, then stone removed through a process of urinating or urinate.

Lithotrypsy can be done with various techniques. It's called ESWL (extra corporeal shock Lithotripsy), which destroys the stone with shock waves which are activated from outside the body. This way most convenient and very minimal pain. Other lithotrypsy technique is crushed stone with ultrasound firing on stone. Lutrasonik wave that enters the body through a hole made in the pelvis or through a small tube through the urinary dimasukkann to reach the location of the stone. The cost to do this lithotrypsy reached dozen million dollars.

4. Conducting Operations

These actions have done if the size of the stone more than 30 mm. Could also apply to the stones that are smaller when the patient's condition does not allow lipotripsi enforced. Operation requires no costs less, can reach 2-3 times the cost lithotrypsy. Sometimes, despite surgery, patients still need other treatment measures.

5. Treatment if relapse

If had been suffering from kidney stones, do not let this disease came over. Once or twice might not why. But for the long term, your kidney is at stake. Not a bit of kidney failure occurs begins with kidney stones treatment that is not perfect.

The following tips can help minimize the recurrence of kidney stones pain:

- Drink plenty of water

- Eat all things necessary, do not overdo it.

Many cases of kidney stones occur because the precipitation of vitamin C, uric acid, calcium, and magnesium excess.

- Expand the motion. Sitting or lying down too long to make the bones release calcium motivated.

This could trigger the formation of stones in the kidney and urinary tract.

Hopefully these tips can help us in maintaining our kidney health.

(From various sources. Pictur from medpics.findlaw.com)

Read more...