Anemia in CKD

Question 1

Anemia

Answer 1

M: <13 g/dl of HGB
F: < 12 g/dl of HGB

Question 2

Iron Deficiency

Answer 2

Iron deficiency is the most common cause of erythropoietin resistance

response to iron:
o ↑Reticulocyte count within 7-14 days
o ↑HGB and HCT within 3-4 weeks

Question 3

PO Iron

Answer 3

•Poor absorption
•GI complications: - nausea, constipation
-GI Upset –nausea, cramping, constipation
-Dark stool

Question 4

Parenteral Iron

Answer 4

o Dyspnea/wheezing, itching, myalgias
o Hypotension, flushing, edema
o Chest pain, cardiac arrest
o Injection site reaction, anaphylactoidand anaphylactic reactions
o	Infection

Question 5

Target HB dialysis vs not

Answer 5

non dialysis: 10

dialysis: 11

Question 6

Erythropoiesis Stimulating Agents Dosing

Answer 6

• Goal change in HGB: 1-2g/dL/month
• Dose adjustments at 4 weeks (steady-state)
• Reduce ESA dose by ≥25% as the patient’s HGB approaches 12g/dl or if HGB increases >1g/dL in 2 weeks or less
• Increase ESA dose by 25% if HGB is below target after 4 weeks of treatment
• In non dialysis pt’s hold the dose if it goes above 10
• In dialysis pts hold when it is 11-12

Question 7

epogen

Answer 7

Epoetic alfa

can be give SubQ uses 20% less drug

Question 8

Aronesp

Answer 8

Darbepoetin alfa

can eb given every 2 weeks

Question 9

Mircera

Answer 9

Methoxy polyethylene glycol epoetin beta

can be given every 4 weeks

Question 10

Retacrit

Answer 10

Epoetin Alfa epbx

33% cost saving

Question 11

Causes of ESA resistance

Answer 11

• Iron deficiency
• ACE- inhibitors
• Hyperparathyroidism
• Aluminum toxicity
• Folate and/or Vitamin B12 deficiency
• Infection
• Malignancy
• Trauma
• Inflammation

Question 12

ESA pearls

Answer 12

DO NO IMPROVE MORTALITY
IV preferred in dialysis

Do not use if:
o Active malignancy
o High risk of CVA
o HGB>11g/dL