Usefulness of mid-week hemoglobin measurement for anemia management in patients undergoing hemodialysis: a retrospective cohort study

Effect of pentoxifylline on hepcidin and iron profile in hemodialysis patients: A randomized, double-blind, placebo-controlled clinical trial

BACKGROUND

Hemodialysis (HD) patients often have elevated levels of hepcidin hormone, which is a key regulator of systemic iron homeostasis. While pentoxifylline (PTX) has been demonstrated to have anti-inflammatory properties, it is unclear if these effects would also have an inhibitory effect on hepcidin. This study aimed to examine the potential role of PTX on hepcidin and its consequent effects on iron profile and anemia in HD patients.

METHODS

Eighty HD patients were randomly assigned 1:1 to the pentoxifylline group, receiving a daily dose of PTX (800mg), or the placebo group, receiving placebo capsules for 6-months. Different laboratory parameters, including hepcidin, hemoglobin (Hb), red blood cells (RBCs), hypoxia-inducible factor-2 alpha (HIF-2α), serum iron, total iron-binding capacity (TIBC), ferritin, transferrin saturation (TSAT), interleukin-6 (IL-6), and high-sensitivity C-reactive protein (hs.CRP), were used for evaluation the patients' response.

RESULTS

In the PTX-treated patients, the hepcidin levels reduced significantly (p=0.001) from 628.03 (334.4-800.85)ng/ml to 235.25 (192.8-508.76)ng/ml, and this reduction was also statistically significant as compared to the placebo group (p<0.001). Also, there were significant changes (p<0.001) regarding other iron hemostasis parameters including Hb, RBCs, serum iron, TIBC, TSAT, and HIF-2α. Levels of IL-6 and hs.CRP, as a reflection of inflammatory status, decreased significantly (p=0.002 and p=0.003, respectively) in the pentoxifylline group, and the percent reduction in these parameters was also statistically significant compared to the placebo group (p<0.001).

CONCLUSIONS

This study reveals that PTX reduces hepcidin levels and consequently provides an improvement in the iron profile and anemia in HD patients.

A Protocol of Intradialytic Exercise for Improvements in Inflammatory Status, Body Composition, and Functional Capacity

Skeletal muscle wasting has been well-documented among hemodialysis patients. This catabolic condition can be induced by numerous factors, including low-grade inflammation, and is associated with impairments in functional capacity and quality of life, as well as an increased mortality risk. We previously showed that 12 weeks of intradialytic resistance training increases lean mass, functional capacity, and the quality of life of hemodialysis patients. This chapter provides the details of a protocol of intradialytic exercise that leads to improvements in inflammatory status, body composition, and functional capacity.