Anaemia of Chronic Kidney Disease Flashcards
What is anaemia of chronic disease?
Anaemia of chronic disease (ACD) is a common syndrome in which the anaemia is due to an inflammation-mediated reduction in red blood cell (RBC) production and sometimes in RBC survival.
How does chronic kidney disease (CKD) lead to anaemia of CKD?
Healthy kidney cells produced erythropoietin. Erythropoietin is the hormone that stimulates production of red blood cells. Damaged kidney cells in CKD cause a drop in erythropoietin. Therefore there is a drop in red blood cells and a subsequent anaemia.
How is anaemia of CKD treated?
- Treatment of underlying disease
- RBC transfusion
- Erythropoiesis-stimulating agents (ESAs)
- Supplemental iron
What is the role of erythropoiesis-stimulating agents (ESAs) in anaemia of CKD?
Anaemia can be treated with erythropoiesis stimulating agents such as exogenous erythropoeitin.
ESA use may be appropriate in a subset of ACD patients who have: an underlying disorder that is not responsive to treatment (or requires time to become manifest), a symptomatic anaemia, and/or would otherwise require continuing transfusions
What is the role in RBC transfusion in treating anaemia of CKD?
Transfusion is considered where the patient has symptomatic anaemia or a comorbid disorder for which a moderately low Hb imposes additional risk, such as heart failure, significant pulmonary disease, or cerebral vascular disease.
Risks of transfusions (e.g. volume overload, transfusion reaction, acute haemolysis with shock, delayed haemolytic transfusion reaction, transfusion-associated acute lung injury, allo-immunisation, iron overload) should be weighed against benefits.
Why should blood transfusions be limited in anaemia of CKD?
Blood transfusions should be limited as they can sensitise the immune system (“allosensitisation”) so that transplanted organs are more likely to be rejected.
What is the role of iron supplementation in anaemia of CKD?
Iron deficiency should be treated before offering erythropoetin.
Intravenous iron is usually given, particularly in dialysis patients. Oral iron is an alternative.
