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37 Cards in this Set
- Front
- Back
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What stage of Chronic Kidney Disease do patients start to experience anemia?
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Stage 3
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What GFR will anemia of CKD appear?
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GFR < 60
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What is #1 cause of anema in CKD?
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The decreased kidney production of erythropoietin (EPO)
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90% of EPO is produced in the __________ and 10% is produced in the ________________.
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Kidneys and Liver
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What is responsible for stimulating the proliferation & differentiation of RBCs in the bone marrow?
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Erythropoietin (EPO)
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How often should patients with CKD check Hgb?
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Annually
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HgB is what?
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Hemoglobin
(Target is about 11 to 12 g/dL) |
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HcT is what?
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Hematocrit
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EPO is produced by the kidney in response to _________?
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Hypoxia
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True or False?
RBC's produced in CKD patients have a shorter lifespans than in normal patients. |
True, the environment in the Bonemarrow in pts with CKD is uremic. Production is blocked and they are more difficult for the body to make. Their lifespan is 30 to 60% of a normal patient.
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When should we investigate Anema in Men?
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HgB < 13.5
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When should we investigate anemia in women?
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HgB < 12 mg/dL
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What are the most common iron saturation tests for patients with anemia in CKD?
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Ferritin, % transferrin saturation (Tsat%) or content of Hb in reticulocytes (CHr)
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What is the difference between Ferritin and Transferrin?
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Transferrin (glycoprotein that binds & transports iron) = immediately
available iron; Ferritin = stored iron |
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What clinical practice guidelines do we use in treatinganemia of CKD?
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KDOQI
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There are 3 steps in treating anemia of CKD, what is step 1?
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Treat Iron deficiency.
If the patient is anemic and doesn't have enough iron the epo treatment doesn't work. |
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True or false.
A patient with CKD preseting with a TSAT of 15% and a ferritin of 70 ng/ml is iron deficient. |
TRUE
TSAT goal > 20% and ferritin in CKD is > 100ng/ml |
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True or False
A PD patient with a TSAT of 22% and a ferritin of 102 ng/ml is iron deficient. |
FALSE
For PD patients: TSAT goal > 20% and ferritin > 100ng/ml |
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True or False
A CKD patient with a TSAT of 21% and a ferritin of 88ng/ml should be treated for iron deficiency. |
True.
for CKD patients give full iron treatment anytime: % transferrin saturation falls below 20% OR ferritin falls below 100 ng/ml (PD or CKD) or below 200 ng/ml (HD) |
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PD is abbreviated for:
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peritoneal dialysis
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What is the main disadvantage of giving Iron Dextran IV?
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Need to give a test dose due to anaphylaxis and other side effects such as dyspnea and wheezing, hypotension and backpain
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What are some brand names of iron dextran IV?
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DexFerrum, INfeD
*need to give a test dose due to possible serious adverse effects* |
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What's the main advantage of iron dextran IV?
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It's cheap.
*need to give a test dose due to serious adverse effects* |
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What is step 2 in treating anemia of CKD?
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Erythropoetin therapy
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What is erythropoetin?
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glycoprotein which stimulates production of red blood cells.
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What two types of erythropoietin do we have to treat patients?
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Epoetin alpha and darbepetin alpha
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When do we consider therapy with erythropoetin (Epo)?
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Consider therapy once Hgb falls to <11 g/dL
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Which erythropoetin is manufactured by recombinant DNA technology, and has the same biological effects as endogenous erythropoietin
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epoetin alfa
Procrit®, Epogen® |
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What is erythropoetin?
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glycoprotein which stimulates production of red blood cells.
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Why do we care if red blood cells aren't stimulated.
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Red blood cells carry oxygen to cells
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What happens if cells don't get oxygen?
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Cells die if they don't get oxygen and if enough of them die, then we die.
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Which population of patients should receive Epogen subcutaneously?
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CKD patients not on dialysis or on peritoneal dialysis
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Which form of epoietin alpha is dosed every week or every other week?
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Darbepoietin
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What is step 3 in treating anemia in ckd?
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Maintenance Iron
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True or False
Patients love taking oral iron. |
False.
Patients hate taking it due to gi side effects. (CONSTIPATION!!) Plus need to take 325mg tid if taking orally to get 200mg elemental iron per day. |
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True or False
Giving patients oral iron is a good way to get them to stay compliant. |
False.
Patients HATE taking iron orally. |
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How is maintenance iron usually administered?
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Usually given IV because patients hate taking it orally. Still need to do iron studies.
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