anemia in ckd patients
Post on 12-Apr-2017
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Dr. Hamed Ezzat El-ErakyNephrology Specialist
Mansoura International Hospital
CME Director Of DMS
AnemiaIn CKD Patient
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Meneit El-Nasr ISN Ambassador Project 16th February 2017
Meneit El-Nasr ISN Ambassador Project 16th February 2017
Presence of other type of anemia
point to another cause rather than CKD
(on top of CKD)
Anemia of CKD
• Normocytic Normochromic
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Role of kidney in RBCs formation
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Anemia In Chronic Renal Disease
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Anemia in chronic renal failure
ANEMİA
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Nephrology Department
Mansoura International Hospital
Reticulocyte count :
If > 130,000/l → look for: blood loss or
hemolysis (endoscopy, colonoscopy, hemolysis screen)
Fe Deficiency when:
S. Ferritin 500 ng/ml
S.TSAT 30%
Initial Evaluation of the patient
Occult blood in stool
CRP: Exclude infection
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Nephrology Department
Mansoura International Hospital
Treatment of anemia
Adequate dialysis Iron supplementation
Target
Hb/Hct Level
ERYTHROPOIETIN
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Adequate nutrition
Prevention of inflammation
Nephrology Department
Mansoura International Hospital
Meneit El-Nasr ISN Ambassador Project 16th February 2017
Nephrology Department
Mansoura International Hospital
The patients should have sufficient iron
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
Target iron level
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Nephrology Department
Mansoura International Hospital
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Administration of supplemental iron
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Nephrology Department
Mansoura International Hospital
Initial erythropoietin administration
SC
IV
ESAs Initiation
Caution (malignancy,
stroke history)
CKDND
10 g/dl
(no treatment)
< 10 g/dl(according)
CKDHD
< 10 g/dl
(treat)
Transfusion!!
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Serum Hb After 2 weeks of starting initiation
If Hb increases >1 g/dL
Decrease dose by 25%
If Hb increase by less than 1g/dL
Increase dose by 25%Repeat serum Hb after another 2 weeks
If Hb increase by less than 1g/dL
Increase dose by 25%
Titration of ESA
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Nephrology Department
Mansoura International Hospital
Meneit El-Nasr ISN Ambassador Project 16th February 2017
Nephrology Department
Mansoura International Hospital
Meneit El-Nasr ISN Ambassador Project 16th February 2017
Nephrology Department
Mansoura International Hospital
Meneit El-Nasr ISN Ambassador Project 16th February 2017
Nephrology Department
Mansoura International Hospital
Meneit El-Nasr ISN Ambassador Project 16th February 2017
Nephrology Department
Mansoura International Hospital
Meneit El-Nasr ISN Ambassador Project 16th February 2017
Nephrology Department
Mansoura International Hospital
Avoid, when possible
Blood Transfusion
Blood Transfusion
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Nephrology Department
Mansoura International Hospital
Avoid, when possible
Blood Transfusion
Meneit El-Nasr ISN Ambassador Project 16th February 2017
Nephrology Department
Mansoura International Hospital
• Normalizing the Hb level of patients with CKD with ESAs is associated with poor outcomes• It is better to get a Hb target 10 to 11.5 gm/dL.
• Don’t target Hb rise at initiation more than 1-2
g/dl/month
Anemia due to CKD develops when
GFR declines to less than 30 mL/min
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Meneit El-Nasr ISN Ambassador Project 16th February 2017
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