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Manajemen Anemia pd CKD predialitik dan dialitikDR. AZIZAH ARUM SARI DEWI
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Anemia
Asupan mknn ↓
↓ Prod EPO
↓Usia eritrosit
Kehilangan darah dr sal cerna, menstrua
si
Phlebotomi
berulang
Operasi blood access
Absorpsi zat besi
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Morfologi
• Defisiensi B12• Defisiensi asam folatMakrositik• Defisiensi FeMikrositik• Perdarahan • Penyakit kronik
Normositik
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Diagnosis
Konsensus
PERNEFRI
Hb ♂ <14 gr/dl
Hb ♀ < 12 gr/dl
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Evaluasi Hb (blm anemia)
• Tiap tahun
CKD stage 3
• 2x/tahun
CKD Stage 4-5 ND • 3 bln
Dialisis
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Evaluasi Hb (tanpa ESA)
CKD
stage
3-
5 ND
3 bln
se
kali
Diali
sisTia
p bu
lan
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Yang dievaluasi
Darah LengkapRetikulositSTFSVit B12Asam folat
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Anemia defisiensi besi
TSAT FSDef. Fe absolut < 20% < 100 ng/ml (PD)
< 200 ng/ml (D)Def. Fe fungsional < 20% > 100 ng/ml
< 200 ng/mlBesi cukup > 20% < 100 ng/ml (PD)
< 200 ng/ml (D)
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Status zat besi
Harus selalu diperiksa
Jika tidak
Hiporesponsif ESA
Oral : lambat dan kurang efisien
Terapi utama : Besi parenteral
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2 cara pemberian utama Besi•setelah periksa status besi periodic
•3 bulan sekali)Pemberian Fe yg teratur
• dosis kecil dan regular
• 100 mg dalam 2-6 minggu tergantung FS agar ST > 20%)
Pemeliharaan
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Perhatian!!!
sewaktu kejadian infeksi aktif
besi parentera
l
tidak boleh
dilakukan
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PERNEFRI : • Epoetin α• Epoetin β• CERA
ESA
• 2000-5000 iu• Atau 80-120 iu/kgBBDosis
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ESA
• 0,5-1,5 g/dl• Dalam 4
mgg↑Hb
• 10-12 gr/dlTarget Hb
• ↑ 25%• Bila
↑1,5gr/dl 4mgg ↓25%
Dosis blm
tercapai
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Stop ESA sementara
Hb> 13 gr/dl
s/d cek Hb 4 mgg
kemudian
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Transfusi darah
DIhindari• Indikasi Hb < 7 gr/d;•Hb< 8 gr dgn gjl KV (angina)
Terutama pasien rencana Tx
bertahap•seperlunya
Perdarahan
Perioperatif mendesak
Kondisi a. koronaria unstable
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Kesimpulan
Anemia•Penyulit pd pasien PGK•Proses adaptasi patofisiologis•Morbiditas bervariasi•↑ mortalitas
Terapi•Holistik•ESA, Besi, vitamin•Status gizi yg baik•Bebas infeksi
Hb optimal di 11,5 gr/dl•Minimalisir penyulit•↑ kualitas hidup•↑ kekuatan fisik (produktif
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Terimakasih