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Flashcards in Anemia of CKD Deck (16)
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1

Why do we use Ca binders for PO4?

Ca is cheap
Because you take the binder with a meal, most of it will stay in your GI tract and be excreted, not absorbed systemically

2

Lower levels of Hb in CKD patients are associated with what things

CV risk
CHF
LV hypertrophy
Mortality
Progression of renal dysfunction

3

What kind of anemia is in CKD?

Normocytic, normochromic, hypoproliferative
Normal cells, just fewer of them!

4

3 reasons why CKD patients are anemic

1. EPO deficiency/lack of responsiveness to hypoxia
2. Iron abnormalities (loss, impaired absorption, functional)
3. Shortened RBC survival

5

How does EPO work?

It inhibits the apoptosis of erythroblasts

6

HIFs

Hypoxia inducible factors
Always around, but when you have normal O2 content you break them down
If you're hypoxic, they're stabilized and promote transcription of EPO
Now there are drugs that do this

7

Why is EPO decreased in CKD patients?

EPO is made in peritubular capillary cells (fewer healthy cells = less EPO)
Cells also stop responding to EPO
Not as much, and doesnt work well

8

What is
1. Transferrin
2. Ferritin

1. Iron form for use
2. Storage form of iron

9

Iron loss in CKD/dialysis patients

Frequent blood sampling
Uremic bleeding/coagulopathy
Hemodialysis circuit losses
Procedures
GI loss

10

Hepcidin function

Inflammation leads to high hepcidin levels
Reduces gut reabsorption of Fe
Hepcidin blocks Fe transporters (locks ferritin stored in liver, spleen, and macrophages)

11

3 mechanisms for decreased RBC survival

Decreased EPO effect
Chronic inflammation
Uremic milieu

12

What is the main problem with CKD patients getting blood transfusions?

Transfusion is a potentially sensitizing event
Makes it harder to find a kidney match if they need a transplant

13

What is the problem with IV Fe?

It bypasses normal regulatory systems because it is not taken up through the gut

14

Why is there an infection risk with iron?

Iron is a key nutrient for bacteria
We sequester iron in storage tissues during infections
Fe impairs host immune response by decreasing function of leukocytes
Iron should be held in patients with active infection

15

ESA

EPO stimulating agent

16

Why do ESAs increase cancer?

It is an anti-apoptotic hormone
Use should be avoided in active malignancy