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anemia of chronic kidney disease

ESA Glycosylation

There are numerous formulations of recombinant human erythropoietin, but only a few of which are used in the U.S.  Generally speaking, all of the formulations have the exact same 165 amino acid core sequence which encodes the human…

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iv iron preparations

Because of the generally poor GI absorption of iron in the setting of ESRD, iron supplementation in dialysis patients is now carried out by intravenous formulations of iron complexed to various carbohydrates. The idea is that these carbohydrate…

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Route of EPO Administration

In the U.S., erythropoietin is typically delivered as 3x/week intravenous injections in the ESRD population. This turns out to be a fairly significant cost, as Medicare-related payments for EPO comprise about 25% of the ESRD budget, which itself…

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hemojuvelin

Several months back I posted something on hepcidin–the 25 amino acid peptide secreted by the liver which appears to be the “master regulator” of iron metabolism, and whose levels appear to be perhaps increased in ESRD patients, providing…

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Pure Red Cell Aplasia

One of the rare but serious side effects of recombinant erythropoietin therapy is the possibility of pure red cell aplasia, an autoimmune condition in which antibodies against erythropoietin result in T-cell-mediated destruction of erythroid precursors.  It may be…

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What is hepcidin?

What is hepcidin and why is it important to nephrologists? Hepcidin is a 25-amino acid peptide (see left) secreted by the liver which seems to be the “master regulator” of iron metabolism. It works by binding to the…

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Erythropoietin and Sickle Cell Disease

Heard an interesting presentation at our Renal Grand Rounds today regarding a young patient with end-stage renal disease secondary to sickle cell disease who is continually admitted for sickle cell crises. The question arose whether or not erythropoietin…

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