Anemia of Aging: The Role of Chronic Inflammation and Cancer
Aging is associated with increased incidence and prevalence of anemia, leading to a number of adverse health outcomes. These include death, functional dependence, increased risk of therapeutic complications, falls, and dementia. In approximately 30% of cases, anemia in older individuals is due to ei...
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Veröffentlicht in: | Seminars in hematology 2008-10, Vol.45 (4), p.242-249 |
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description | Aging is associated with increased incidence and prevalence of anemia, leading to a number of adverse health outcomes. These include death, functional dependence, increased risk of therapeutic complications, falls, and dementia. In approximately 30% of cases, anemia in older individuals is due to either relative or absolute erythropoietin (EPO) deficiency. Absolute EPO deficiency may be primary or secondary to declining renal function. Relative EPO deficiency is due to an age-related pro-inflammatory status that reduces the sensitivity of erythropoietic precursors to EPO. Despite this condition of EPO deficiency, the management of anemia of aging with erythropoiesis-stimulating agents (ESAs) is controversial, unless the anemia is due to renal insufficiency. The main concern related to this treatment arises from eight studies of ESAs in cancer, suggesting that ESAs may reduce patient survival in addition to increasing the risk of deep vein thrombosis. The results of these studies contrast with a host of other trials showing the safety of ESAs. The discrepancy may be explained in part by the fact that, in the trials suggesting a detrimental effect of ESAs, the goal was to obtain hemoglobin (Hb) levels higher than 12 g/dL. Because of this concern, correction of anemia in elderly individuals with relative EPO insufficiency should not be attempted outside clinical trials. |
doi_str_mv | 10.1053/j.seminhematol.2008.06.001 |
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These include death, functional dependence, increased risk of therapeutic complications, falls, and dementia. In approximately 30% of cases, anemia in older individuals is due to either relative or absolute erythropoietin (EPO) deficiency. Absolute EPO deficiency may be primary or secondary to declining renal function. Relative EPO deficiency is due to an age-related pro-inflammatory status that reduces the sensitivity of erythropoietic precursors to EPO. Despite this condition of EPO deficiency, the management of anemia of aging with erythropoiesis-stimulating agents (ESAs) is controversial, unless the anemia is due to renal insufficiency. The main concern related to this treatment arises from eight studies of ESAs in cancer, suggesting that ESAs may reduce patient survival in addition to increasing the risk of deep vein thrombosis. The results of these studies contrast with a host of other trials showing the safety of ESAs. The discrepancy may be explained in part by the fact that, in the trials suggesting a detrimental effect of ESAs, the goal was to obtain hemoglobin (Hb) levels higher than 12 g/dL. 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These include death, functional dependence, increased risk of therapeutic complications, falls, and dementia. In approximately 30% of cases, anemia in older individuals is due to either relative or absolute erythropoietin (EPO) deficiency. Absolute EPO deficiency may be primary or secondary to declining renal function. Relative EPO deficiency is due to an age-related pro-inflammatory status that reduces the sensitivity of erythropoietic precursors to EPO. Despite this condition of EPO deficiency, the management of anemia of aging with erythropoiesis-stimulating agents (ESAs) is controversial, unless the anemia is due to renal insufficiency. The main concern related to this treatment arises from eight studies of ESAs in cancer, suggesting that ESAs may reduce patient survival in addition to increasing the risk of deep vein thrombosis. The results of these studies contrast with a host of other trials showing the safety of ESAs. The discrepancy may be explained in part by the fact that, in the trials suggesting a detrimental effect of ESAs, the goal was to obtain hemoglobin (Hb) levels higher than 12 g/dL. Because of this concern, correction of anemia in elderly individuals with relative EPO insufficiency should not be attempted outside clinical trials.</description><subject>Aged</subject><subject>Anemia - drug therapy</subject><subject>Anemia - etiology</subject><subject>Drug Therapy</subject><subject>Erythrocyte Transfusion</subject><subject>Erythropoietin - metabolism</subject><subject>Hematinics - therapeutic use</subject><subject>Hematology, Oncology and Palliative Medicine</subject><subject>Humans</subject><subject>Inflammation - complications</subject><subject>Inflammation - drug therapy</subject><subject>Neoplasms - complications</subject><subject>Neoplasms - drug therapy</subject><subject>Radiotherapy</subject><issn>0037-1963</issn><issn>1532-8686</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2008</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkl9rFDEUxYModq1-BRl88G3Gm8wmkxQpLFv_FAqC1ueQzdzsZp1JajJb6Lc3wy5affIpITn3nMvvXkLeUGgo8Pbdvsk4-rDD0UxxaBiAbEA0APQJWVDesloKKZ6SBUDb1VSJ9oy8yHkPwGhHxXNyRqUEBWq5IO9XoXiZKrpqtfVhe1Hd7rD6Ggecn9a7FIO31XVwgxlLnI-hMqGv1iZYTC_JM2eGjK9O5zn5_vHD7fpzffPl0_V6dVNbAWKqDcjOoLOWKwadE67jasOldOiYsksUTjBuO7WRkvaMCd7z-c5Qdh0KIdtzcnn0vTtsRuwthimZQd8lP5r0oKPx-u-f4Hd6G-81E0sullAM3p4MUvx5wDzp0WeLw2ACxkPWQnGphJyTLo5Cm2LOCd3vEAp6hq_3-jF8PcPXIHSBX4pfP27zT-mJdhFcHQVYYN17TDpbj4Vk7xPaSffR_1_O5T82dvBlTGb4gQ-Y9_GQQhmHpjozDfrbvAbzFoAs1dBC-wuNzbFe</recordid><startdate>20081001</startdate><enddate>20081001</enddate><creator>Ferrucci, Luigi</creator><creator>Balducci, Lodovico</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20081001</creationdate><title>Anemia of Aging: The Role of Chronic Inflammation and Cancer</title><author>Ferrucci, Luigi ; Balducci, Lodovico</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c606t-a087aefcc59207f6f759b588fef29c4e6f625c79b881d2265d59b882e877e6683</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2008</creationdate><topic>Aged</topic><topic>Anemia - drug therapy</topic><topic>Anemia - etiology</topic><topic>Drug Therapy</topic><topic>Erythrocyte Transfusion</topic><topic>Erythropoietin - metabolism</topic><topic>Hematinics - therapeutic use</topic><topic>Hematology, Oncology and Palliative Medicine</topic><topic>Humans</topic><topic>Inflammation - complications</topic><topic>Inflammation - drug therapy</topic><topic>Neoplasms - complications</topic><topic>Neoplasms - drug therapy</topic><topic>Radiotherapy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ferrucci, Luigi</creatorcontrib><creatorcontrib>Balducci, Lodovico</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Seminars in hematology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ferrucci, Luigi</au><au>Balducci, Lodovico</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Anemia of Aging: The Role of Chronic Inflammation and Cancer</atitle><jtitle>Seminars in hematology</jtitle><addtitle>Semin Hematol</addtitle><date>2008-10-01</date><risdate>2008</risdate><volume>45</volume><issue>4</issue><spage>242</spage><epage>249</epage><pages>242-249</pages><issn>0037-1963</issn><eissn>1532-8686</eissn><abstract>Aging is associated with increased incidence and prevalence of anemia, leading to a number of adverse health outcomes. These include death, functional dependence, increased risk of therapeutic complications, falls, and dementia. In approximately 30% of cases, anemia in older individuals is due to either relative or absolute erythropoietin (EPO) deficiency. Absolute EPO deficiency may be primary or secondary to declining renal function. Relative EPO deficiency is due to an age-related pro-inflammatory status that reduces the sensitivity of erythropoietic precursors to EPO. Despite this condition of EPO deficiency, the management of anemia of aging with erythropoiesis-stimulating agents (ESAs) is controversial, unless the anemia is due to renal insufficiency. The main concern related to this treatment arises from eight studies of ESAs in cancer, suggesting that ESAs may reduce patient survival in addition to increasing the risk of deep vein thrombosis. The results of these studies contrast with a host of other trials showing the safety of ESAs. The discrepancy may be explained in part by the fact that, in the trials suggesting a detrimental effect of ESAs, the goal was to obtain hemoglobin (Hb) levels higher than 12 g/dL. Because of this concern, correction of anemia in elderly individuals with relative EPO insufficiency should not be attempted outside clinical trials.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>18809094</pmid><doi>10.1053/j.seminhematol.2008.06.001</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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subjects | Aged Anemia - drug therapy Anemia - etiology Drug Therapy Erythrocyte Transfusion Erythropoietin - metabolism Hematinics - therapeutic use Hematology, Oncology and Palliative Medicine Humans Inflammation - complications Inflammation - drug therapy Neoplasms - complications Neoplasms - drug therapy Radiotherapy |
title | Anemia of Aging: The Role of Chronic Inflammation and Cancer |
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