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PHM601 AKI/CKD > Anemia in CKD > Flashcards

Anemia in CKD Flashcards

1
Q

Anemia in male Hgb value?

A

<13

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2
Q

Anemia in females Hgb value?

A

<12

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3
Q

What drives Anemia in kidney disease?

A

decrease in erythropoietin with GFR <45

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4
Q

Goals of therapy in Anemia

A
  • Increase Quality of Life
  • increase O2 carrying capacity
  • prevent/alleviate symptoms
  • decrease need for blood transfusion
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5
Q

What is the best measure of O2 carrying capacity?

A

Hgb

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6
Q

What to order for a patient on an ESA?

A

Iron panel
- serum ferritin
- transferrin saturation

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7
Q

What is serum ferritin?

A

The storage form of iron

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8
Q

What is transferrin saturation?

A

The amount of iron available for Erythropoiesis

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9
Q

Iron absorption is regulated by?

A

Hepcidin

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10
Q

What does hepcidin do?

A

inhibits ferroportin

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11
Q

How is hepcidin excreted?

A

By the kidney/renal elimination

***in CKD, hepcidin accumualtes

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12
Q

What is the most common cause of Erythropoietin resistance?

A

Iron Deficiency

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13
Q

True or False?

Correct Iron deficiency after ESA use

A

False

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14
Q

In ESRD, how often should you check iron panels?

A

Every 3 months

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15
Q

What is the response of iron deficiency treatment?

A
  • In 1-2 weeks, increase in Reticulocytes.
  • In 3-4 weeks, increase in Hgb/Hct
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16
Q

KDIGO Transferrin saturation goal?

A

> 30%

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17
Q

KDIGO serum ferritin goal?

A

> 500

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18
Q

IV Iron therapy concern/risk?

A

Iron overload
- Transferrin saturation >50%
- Serum ferritin >1200

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19
Q

Oral Iron issues

A
  • not well absorbed
  • GI side effects
  • poor adherence
  • slow iron replenish
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20
Q

IV iron issues

A
  • expensive
  • better absorbed
  • quick replenish
  • infusion/anaphylactic rxns
  • risk of iron overload
  • DO NOT USE IM***
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21
Q

Oral iron

A

Ferrous sulfate

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22
Q

IV iron

A

Ferric gluconate
Iron sucrose

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23
Q

Ferric gluconate brand name

A

Ferrlecit

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24
Q

Iron sucrose brand name

A

Venofer

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25
Ferric gluconate dosing
125 mg TIW 8x doses
26
Iron sucrose dosing
100 mg 1 - 3x weekly (total 1 g)
27
Drugs that decrease iron absorption
- Al, Mg, Ca antacids - Tetracyclines - H2 Antagonists - PPIs - Cholestyramine ***Separate by 2 hours
28
Drugs affected by iron
- Fluroquinolones - Levothyroxine - Tetracyclines - Mycophenolate - Methyldopa - Levodopa ***Separate by 2 hours
29
Avoid IV iron in which patients?
Patients with active systemic infection
30
Ferric gluconate elemental iron content
12.5mg/ml
31
Iron sucrose elemental iron content
20 mg/ml
32
What are ESA's
Erythropoietin stimulating Agents that promote differentiation of erythroid
33
Epoetin alfa vs Darbopoetin
Can be dosed less; longer 1/2 life 200:1 conversion
34
Epoetin alfa vs Mircera
Mircera is very expensive and longest acting
35
Epoetin alfa vs Epoetin alfa ebx
Biosimilar, 1:1 dose conversion cost savings = uses less drug
36
KDIGO ND-CKD ESA Initiation
<10
37
KDIGO ESRD ESA Initiation
9-10
38
FDA ND-CKD Initiation
<10
39
FDA ESRD ESA Initiation
<10
40
KDIGO ND-CKD Target
Do not exceed 11.5
41
KDIGO ESRD ESA Target
Do not exceed 11.5
42
FDA ND-CKD ESA Target
10 (avoid transfusions)
43
FDA ESRD ESA Target
9 - 10 (avoid transfusions)
44
ESA Dosing Goal change
1 - 2 g/dl/month
45
When should you dose adjust ESA's?
every 4 weeks
46
How should you dose adjust ESAs
increase or decrease by 25%
47
When should you reduce ESA dose?
When Hgb approaches 12g/dl OR If Hgb increases >1 g/dl in 2 weeks or less
48
When should you increase ESA dose?
If Hgb is below target after 4 weeks of treatment
49
ESA Hyporesponsiveness
- No increase after 4 weeks of appr dosing - 2 ESA dose increases after stable period to maintain Hgb
50
ESA Resistance
Target not reached after >500 unit/kg/week
51
Causes of ESA Resistance
- ACE inhibitor - Hyperparathyroidism - Malignancy - Infection - Iron deficiency - Aluminum toxicity - Trauma - Inflammation - B12/Folate Deficiency
52
ESA Adverse Effects
- Hypertension - Hypercoagulability (thrombosis-CVA,VTE,MI) - Hypersensitivity rxns - Pure red blood cell aplasia (No more RBC Production) - Malignancy Progression - HA/Fatigue/Edema
53
ESA Black Box Warning
Do not exceed Hgb of 11
54
ESA Monitoring Parameters
Iron panel monthly then quarterly Blood pressure @each dialysis Blood count (Hgb/Hct)
55
Goals of ESA therapy
1. Prevent blood transfusions 2. Increase quality of life
56
ESA Clinical Pearls
- Does not improve mortality - IV and SQ route (SQ has longer duration of action) - Contraindicated in - Active malignancy*** - High risk of CVA*** - Hgb >11***
57
When to give blood transfusion?
In severe anemia of Hgb <7
58
For every 1 unit of PRBC given...
- 1 g/dl increase in Hgb - 200 mg of elemental iron
59
Risks of blood transfusion
- TRALI: Transfusion related acute lung injury - Hypervolemia - Hypocalcemia - Hypersensitvity rxn - Immune activation
60
Which vitamins are depleted with dialysis?
Water soluble vitamins (B,C, Folic acid) ***Supplement after dialysis

PHM601 AKI/CKD (5 decks)

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