Pharm of CKD Anemia

Question 1

when to screen for Hgb

Answer 1

GFR less than 60 mL/min (CKD Stage 3)

• Stage 3= annually
• Stage 4/5= biannually
• Dialysis= every 3 months

Question 2

Diagnosis of anemia Hgb conc

Answer 2

Males= less than 13
Females= less than 12

Question 3

Goal TSAT in non-HD CKD

Answer 3

> 20%

Question 4

Goal TSAT in CKD-HD

Answer 4

> 20%

Question 5

Goal serum ferritin in non-HD CKD

Answer 5

> 100 ng/mL

Question 6

Goal serum ferritin in CKD-HD

Answer 6

> 200 ng/mL

Question 7

amt of elemental iron in ferrous sulfate

Answer 7

65 mg

Question 8

amt of elemental iron in ferrous fumarate

Answer 8

106 mg

Question 9

amt of elemental iron in ferrous gluconate

Answer 9

38 mg

Question 10

amt of elemental iron in polysaccharide iron complex

Answer 10

150 mg

Question 11

amt of elemental iron in heme iron peptide

Answer 11

12 mg

Question 12

which IV iron is assoc with anaphylactoid rxns?

Answer 12

iron dextran

Question 13

TSAT less than 20 and ferritin less than 100/200

Answer 13

1 gm IV iron in divided doses and 200 mg elemental iron PO daily

Question 14

TSAT less than 20 and ferritin >100= iron replacement

Answer 14

increase maintenance iron dose

PO to IV iron

Question 15

non-HD maintenance therapy (TSAT >20 and ferritin >100)

Answer 15

200 mg/day of elemental PO iron in divided doses

Question 16

HD maintenance therapy (TSAT >20 and ferritin >200)

Answer 16

• iron sucrose or iron dextran 25-100 mg/wk

- sodium ferric gluconate 62.5-125 mg/wk

Question 17

maintenance for ferritin >500 ng/dL

Answer 17

ESAs (erythropoietin stimulating agents)

Question 18

brand name for epoietin alfa

Answer 18

Epogen, Procrit

Question 19

starting dose for epoietin alfa

Answer 19

50-100 U/kg 1-3X per week

Question 20

brand name for darbepoetin alfa

Answer 20

Aranesp

Question 21

starting dose for darbepoetin alfa

Answer 21

0.45 mcg/kg once weekly

Question 22

goal Hgb increase in ESA therapy

Answer 22

1-2 g/dL per month (if faster than that then hold ESA or reduce dose)

Question 23

poor responders in ESA therapy

Answer 23

increase dose by 25%

Question 24

KDIGO guidelines recommendation of target Hgb for ESA

Answer 24

10-11.5 g/dL (not to exceed 11.5)

Question 25

what Hgb conc should you reduce or interrupt ESA dose?

Answer 25

11 g/dL= dialysis

10 g/dL= non-diaysis CKD