Pharm of CKD Anemia Flashcards
when to screen for Hgb
GFR less than 60 mL/min (CKD Stage 3)
- Stage 3= annually
- Stage 4/5= biannually
- Dialysis= every 3 months
Diagnosis of anemia Hgb conc
Males= less than 13 Females= less than 12
Goal TSAT in non-HD CKD
> 20%
Goal TSAT in CKD-HD
> 20%
Goal serum ferritin in non-HD CKD
> 100 ng/mL
Goal serum ferritin in CKD-HD
> 200 ng/mL
amt of elemental iron in ferrous sulfate
65 mg
amt of elemental iron in ferrous fumarate
106 mg
amt of elemental iron in ferrous gluconate
38 mg
amt of elemental iron in polysaccharide iron complex
150 mg
amt of elemental iron in heme iron peptide
12 mg
which IV iron is assoc with anaphylactoid rxns?
iron dextran
TSAT less than 20 and ferritin less than 100/200
1 gm IV iron in divided doses and 200 mg elemental iron PO daily
TSAT less than 20 and ferritin >100= iron replacement
increase maintenance iron dose
PO to IV iron
non-HD maintenance therapy (TSAT >20 and ferritin >100)
200 mg/day of elemental PO iron in divided doses
HD maintenance therapy (TSAT >20 and ferritin >200)
- iron sucrose or iron dextran 25-100 mg/wk
- sodium ferric gluconate 62.5-125 mg/wk
maintenance for ferritin >500 ng/dL
ESAs (erythropoietin stimulating agents)
brand name for epoietin alfa
Epogen, Procrit
starting dose for epoietin alfa
50-100 U/kg 1-3X per week
brand name for darbepoetin alfa
Aranesp
starting dose for darbepoetin alfa
0.45 mcg/kg once weekly
goal Hgb increase in ESA therapy
1-2 g/dL per month (if faster than that then hold ESA or reduce dose)
poor responders in ESA therapy
increase dose by 25%
KDIGO guidelines recommendation of target Hgb for ESA
10-11.5 g/dL (not to exceed 11.5)
