Renal Disorders And Erythropoeisis Agents Flashcards
Why does anemia occur from CKD?
It occurs bc the kidneys produce the hormone erythropoietin needed by the bone marrow to create RBCs
So with CKD — kidneys don’t produce enough erythropoietin = bone marrow produces less RBCs = Anemia from CKD
Will also lead to:
- iron deficiency and
- decreased folic acid
What is the treatment for anemia associated with CKD?
With anemia present what other supplements will the pt be needing apart from erythropoesis stimulating agents darbopoetin?
Will need :
- folic acid
- iron
What are some AE associated with darbopoetin / epoetin (Eprex)?
- fever
- muscle aches
- bone pain
- flushing
- hypertension
- injection site reactions
- n&v
What is needed as a supplement with darbopoetin?
And when is darbopoetin often given?
- should be taken with iron
- often given after dialysis when pt is on dialysis
What are some contraindications for darbopoetin?
- uncontrolled HTN
- high hemoglobin > 130g/L for kidney disease pts
What is the indication for ferrous sulfate (Iron) in kidney disease?
To prevent or treat iron deficiency anemia
With CKD anemia — iron deficiency will follow so pts will take darbopoetin and iron together
What are some contraindications to taking ferrous sulfate (iron) supplements?
- KDA
- iron overload
What are some possible AE of ferrous sulfate (iron)?
- GI upset
- black stool
- gastric irritation
- n& v
- diarrhea / constipation
- stomach cramping
How should ferrous sulfate (iron) be taken?
- take with food to decrease GI upset (AVOID TAKING WITH MILK OR DAIRY PRODUCTS)
- needs to be taken with large amount of water or with glass of orange juice
- remain upright for up to 30min after to decrease esophageal irritation
- avoid taking with antacids and dairy products (if needed take at least 1-2hrs after iron)
- maintain diet high in iron (dark greens, leafy vegetables, dried fruits, beans, meats, eggs)
What are some drug interactions with ferrous sulfate (iron)?
- increased effect with :folic acid
- decreased effect with: antacids & calcium
- decrease absorption of : antibiotics (tetracyclines, quinolones)
Why is folic acid given in kidney disease ?
Given with CKD related anemia
Folic acid is needed to create RBCs
So with anemia, pts will also be taking folic acid supplements
What is the AE of folic acid?
Yellow discoloured urine
What are some drug interactions with folic acid (folate)?
cause folic acid deficiency with: -oral contraceptives
- corticosteroids
- sulfonamides
- antibiotic trimetoprim
How should folic acid (folate) be taken?
Should be taken with food
What is the Nutritional therapy with CKD?
- fluid restriction : urine output + 600mls
- protein restriction
- calories 30-35kcal/kg
- fat : most of caloric requirement
- carbs: most of caloric requirement
- potassium 2-3G
- sodium 1-3g
- phosphate 800-1000mg
- calcium varies
Mrs. W is prescribed the following diet:
- fluid restriction of 1.2L/day
- low sodium (1-2g/day)
What strategies/recommendations will you give to Mrs. W to help her adhere to this diet?
A) eat a vegetarian diet
B) take only sips of fluid at a time
C) avoid canned or prepared foods
D) avoid drinking coffee
C)
Very high In sodium and hard to keep track
A) is wrong bc does not change anything
B) is wrong bc if takes small sips but every 2min does not help calculate the amount can still go over
D) is wrong bc they can drink coffee just not in too large amounts (no need to completely avoid it)
What is a kidney friendly diet?
- protein: ingest lean proteins without excess fat (ex: eggs, skinless chicken) — protein is good but hard to filter by kidneys so we want it to be easier so lean proteins is better
- fats : choose healthy fats (raw olive oil instead of fried foods)
- sodium: use herbs to spice your food instead of salt, choose fresh or frozen vegetables instead of canned, choose low salt foods (high in sodium is hard on the kidneys so low sodium intake is necessary)
What are some teaching tips to help limit fluid intake?
- measure your fluids (1-2L/day)
- drink from a small cup to help you keep track of how much you drink
- limit sodium intake to decrease thirst
- when you feel thirsty: chew gum, rinse mouth with water and spit it out, suck on a piece of ice/mints/auger free hard candy
What are foods high in potassium?
- avocados,
- bananas,
- melons,
- oranges,
- prunes,
- spinach,
-potatoes, - tomatoes,
- granola
- beans
- brown or wild rice
What are foods low in potassium?
- apples
- grapes
- strawberries
- pineapple
- onions
- peppers
- lettuce
- white breads
- beef and chicken
- white rice
What are foods high in calcium and phosphate?
- almonds
- asparagus
- apricots
- artichokes
- hapricot
- blackberries
- bok choy
- cinnamon
- bread (whole meal)
- olives
- oranges
- soya milk
- tofu
Before administering epoetin Alfa to mrs. W, it is most important for you to assess which lab result?
A) blood urea nitrogen
B) WBC count
C) hemoglobin levels
D) urine specific gravity
C
Bc it can increase blood viscosity
When administering erythropoesis-stimulating agents, it is important for you to co administer which one of the following?
A) vitamin D
B) iron
C) Sevelamer (renagel)
D) calcium
B
