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

Mansoura International Hospital 16th December 2016

Mansoura International Hospital 16th December 2016

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

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

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

Nephrology Department Mansoura International Hospital 16th December 2016

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

Mansoura International Hospital Mansoura International Hospital Nephrology Department Mansoura International Hospital Initial Evaluation of the patient 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% Occult blood in stool CRP: Exclude infection Mansoura International Hospital 16th December 2016

Mansoura International Hospital Mansoura International Hospital 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 16th December 2016

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

Mansoura International Hospital Mansoura International Hospital Nephrology Department Mansoura International Hospital Target iron level 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 Mansoura International Hospital 16th December 2016

Mansoura International Hospital Mansoura International Hospital Nephrology Department Mansoura International Hospital Mansoura International Hospital 16th December 2016

Mansoura International Hospital Mansoura International Hospital Nephrology Department Mansoura International Hospital Mansoura International Hospital 16th December 2016

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

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

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

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

Mansoura International Hospital Mansoura International Hospital Nephrology Department Mansoura International Hospital Mansoura International Hospital 16th December 2016

Mansoura International Hospital Mansoura International Hospital Nephrology Department Mansoura International Hospital Mansoura International Hospital 16th December 2016

Mansoura International Hospital Mansoura International Hospital Nephrology Department Mansoura International Hospital Mansoura International Hospital 16th December 2016

Mansoura International Hospital Mansoura International Hospital Nephrology Department Mansoura International Hospital Mansoura International Hospital 16th December 2016

Mansoura International Hospital Mansoura International Hospital Nephrology Department Mansoura International Hospital Mansoura International Hospital 16th December 2016

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

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

it is better to get a Hb target in the 9.0 to 11.5 gm/dL. Nephrology Department Mansoura International Hospital Anemia due to CKD develops when GFR declines to less than 30 mL/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/dL. • don’t target Hb rise at initiation more than 1-2 g/dl/month Mansoura International Hospital 16th December 2016

Nephrology Department Mansoura International Hospital 16th December 2016