Treatment of Anemi

Question 1

Common complications of CKD

Answer 1

Poor quality of life
Increased hospitalizations
Development of other complications

Question 2

Screening for Hgb when GFR is less than 60 =

Answer 2

Stage 3: annually
Stage 4: biannually
Dialysis: Every 3 months

Question 3

Diagnosis of anemia and further work up required:

Answer 3

Males with Hgb

Question 4

***Desired Outcomes of Therapy

Answer 4

• Increased oxygen-carrying capacity
• Decreased signs/symptoms of anemia (dyspnea and fatigue)
• Improved quality of life
• Decreased need for blood transfusions
• Prevent long term consequences

Question 5

TSat for Non- HD CKD and CKD HD

Answer 5

> 20%

Question 6

Serum Ferritin for Non-HD CKD

Answer 6

> 100 ng/mL

Question 7

Serum Ferritin for CKD HD

Answer 7

> 200 ng/mL

Question 8

***Oral Iron Goal

Answer 8

~200 mg elemental iron DAILY

- Decreased absorptions with food and achlorhydria

Question 9

IV Iron ADRs

Answer 9

Anaphylactoid reaction
Hypotension
Risk of overload
Risk of infection

Question 10

IV Iron names

Answer 10

Iron dextran
Ferric gluconate
Iron sucrose (venofer)
Ferumoxytol

Question 11

***Which IV iron requires a test dose?

Answer 11

Iron dextrose bc risk of analyphylatic ADR

Question 12

TSat

Answer 12

1 gm IV iron in divided doses

200 mg elemental iron PO daily

Question 13

TSat 100 ng/dL (>200 in HD)

Answer 13

Increase MD of iron

Function iron deficiency (PO to IV treatment)

Question 14

TSat >20% and ferritin >100 ng/dL (>200 in HD) Non-HD

Answer 14

200 mg/ady of elemental PO iron in divided doses

Question 15

TSat >20% and ferritin >100 ng/dL (>200 in HD) HD

Answer 15

Sucrose or dextrose 25-100 mg/wk

Sodium ferric gluconate 62.5-125 mg/wk

Question 16

Epoetin alfa

Answer 16

Epogen, Procrit

50-100 units/kg/dose 1-3X per week (or biweekly)

Question 17

Darbapoetin alfa

Answer 17

Aranesp

0.45 mcg/kg once weekly (or 2 weeks or increase the dose 25-50% and give4 weeks)

Question 18

ESA Monitoring

Answer 18

At least weekly until stable and then monthly

Question 19

ESA Goal

Answer 19

Increase hgb 1-2 g/dL each month
- hgb >1-2 g/dL, decrease dose or hold
hgb less than 1-2 g/dL, increase dose 25%

Question 20

What is the most common ESA Adverse Effects

Answer 20

Hypertension
Seizures
Thrombosis

Question 21

Hypertension

Answer 21

Attempt dose reduction while maintaining Hgb target

- Manage with antiHTN and/or dialysis

Question 22

Seizures

Answer 22

Within the first 90 days of starting therapy

Not contraindicated in patients with a seizure history

Question 23

Thrombosis

Answer 23

Around IV catheters and access sites
No need for increased heparin in HD patients
Monitor, no actions

Question 24

***If Hgb

Answer 24

Consider initiation of ESA in all CKD patients

Epoetin alfa or Darbepoetin alfa in ALL CKD patients

Question 25

***If Hgb approaches or exceeds 11 g/dL in dialysis or 10 g/dL in non-dialysis CKD:

Answer 25

Reduce or interrupt ESA dose

Question 26

****Now recommended for ESAs

Answer 26

* ***- Increased cardiovascular events (stroke, thrombosis, and death) seen with Hgb >11 g/dL - Use lowest effective dose of ESA to reduce the need for transfusion - Individualize dosing for each patient - Carefully weigh benefits and risks of using ESAs and higher Hgb values

Question 27

RBC Transfusion Goal

Answer 27

Prevent inadequate tissue oxygenation or cardiac failure

Question 28

RBC Transfusions Usages

Answer 28

Acute management of symptomatic anemia Significant acute blood loss Prior to surgical procedures with high risk of blood loss

Question 29

Androgen usage

Answer 29

DO NOT USE as an adjunct to ESA treatment

Question 30

L-carnitine, Vit C IV, Statins, Pentoxyphylline

Answer 30

DO NOT USE