Anemia In CKD Dr Hamed Ezzat ElEraky Patient

Mansoura International Hospital 16 th December 2016

Anemia of CKD • Normocytic Normochromic Presence of other type of anemia point to

Nephrology Department Mansoura International Hospital Role of kidney in RBCs formation Mansoura International Hospital

Nephrology Department Mansoura International Hospital Anemia in chronic renal failure Mansoura International Hospital 16

Nephrology Department Mansoura International Hospital 16 th December 2016

Nephrology Department Mansoura International Hospital Anemia in chronic renal failure ANEMİA Mansoura International Hospital

Nephrology Department Mansoura International Hospital Initial Evaluation of the patient Fe Deficiency when: S.

Nephrology Department Mansoura International Hospital Treatment of anemia Adequate dialysis Iron supplementation Adequate nutrition

Nephrology Department Mansoura International Hospital No Hematology work-up Mansoura International Hospital 16 th December

Nephrology Department Mansoura International Hospital Target iron The patients should have sufficient iron level

Nephrology Department Mansoura International Hospital Administration of supplemental iron Mansoura International Hospital 16 th

Nephrology Department Mansoura International Hospital Initial erythropoietin administration SC ESAs Initiation Caution (malignancy, stroke

Nephrology Department Mansoura International Hospital Titration of erythropoietin dosage Mansoura International Hospital 16 th

Nephrology Department Mansoura International Hospital Titration of ESA Serum Hb After 2 weeks of

Nephrology Department Mansoura International Hospital Blood Transfusio Blood n Transfusion Avoid, when possible Mansoura

Nephrology Department Mansoura International Hospital Blood Transfusio n Avoid, when possible Mansoura International Hospital

Nephrology Department Mansoura International Hospital Anemia due to CKD develops when GFR declines to

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Anemia In CKD Dr. Hamed Ezzat El-Eraky Patient Nephrology Specialist Mansoura International Hospital 16 th December 2016

Mansoura International Hospital 16 th December 2016

Anemia of CKD • Normocytic Normochromic Presence of other type of anemia point to another cause rather than CKD Mansoura International Hospital (on top of CKD) 16 th December 2016

Nephrology Department Mansoura International Hospital Role of kidney in RBCs formation Mansoura International Hospital 16 th December 2016

Nephrology Department Mansoura International Hospital Anemia in chronic renal failure Mansoura International Hospital 16 th December 2016

Nephrology Department Mansoura International Hospital 16 th December 2016

Nephrology Department Mansoura International Hospital Anemia in chronic renal failure ANEMİA Mansoura International Hospital 16 th December 2016

Nephrology Department Mansoura International Hospital Initial Evaluation of the patient Fe Deficiency when: S. Ferritin 500 ng/ml S. TSAT 30% Reticulocyte count : If > 130, 000/ l → look for: blood loss or hemolysis (endoscopy, colonoscopy, hemolysis screen) Occult blood in stool CRP: Exclude infection Mansoura International Hospital 16 th December 2016

Nephrology Department Mansoura International Hospital Treatment of anemia Adequate dialysis Iron supplementation Adequate nutrition Target Hb/Hct Level Prevention of inflammation ERYTHROPOIETIN Mansoura International Hospital 16 th December 2016

Nephrology Department Mansoura International Hospital No Hematology work-up Mansoura International Hospital 16 th December 2016

Nephrology Department Mansoura International Hospital Target iron The patients should have sufficient iron level to achieve and maintain an Hb of 10 - 11. 5 g/dl • Serum ferritin > 100 ng/ml OPTIMAL 200 -500 ng / ml • Transferrin saturation > 20� OPTIMAL 30 -40 Mansoura International Hospital 16 th December 2016

Nephrology Department Mansoura International Hospital 16 th December 2016

Nephrology Department Mansoura International Hospital Administration of supplemental iron Mansoura International Hospital 16 th December 2016

Nephrology Department Mansoura International Hospital Initial erythropoietin administration SC ESAs Initiation Caution (malignancy, stroke history) IV CKD ND 10 g/dl (no treatment) Transfusio n!! CKD HD < 10 g/dl (accordin g) < 10 g/dl (treat) Mansoura International Hospital 16 th December 2016

Nephrology Department Mansoura International Hospital Titration of erythropoietin dosage Mansoura International Hospital 16 th December 2016

Nephrology Department Mansoura International Hospital Titration of ESA Serum Hb After 2 weeks of starting initiation If Hb increases >1 g/d. L Decrease dose by 25% If Hb increase by less than 1 g/d. L Repeat. Increase serum Hb after dose byanother 25% 2 weeks If Hb increase by less than 1 g/d. L Increase dose by 25% Mansoura International Hospital 16 th December 2016

Nephrology Department Mansoura International Hospital 16 th December 2016

Nephrology Department Mansoura International Hospital Blood Transfusio Blood n Transfusion Avoid, when possible Mansoura International Hospital 16 th December 2016

Nephrology Department Mansoura International Hospital Blood Transfusio n Avoid, when possible Mansoura International Hospital 16 th December 2016

Nephrology Department Mansoura International Hospital Anemia due to CKD develops when GFR declines to less than 30 m. L/min • normalizing the Hb level of patients with CKD with ESAs is associated with poor outcomes • it is better to get a Hb target in the 9. 0 to 11. 5 gm/d. L. • don’t target Hb rise at initiation more than 12 g/dl/month Mansoura International Hospital 16 th December 2016

Nephrology Department Mansoura International Hospital 16 th December 2016