1. 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

2. Mansoura International Hospital
16th December 2016

3. Mansoura International Hospital
16th December 2016

4. 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

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

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

7. Nephrology Department Mansoura International Hospital
16th December 2016

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

9. 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

10. 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

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

12. 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 g/dl
Serum ferritin  > 100 ng/ml
OPTIMAL  ng / ml
Transferrin saturation  > 20
OPTIMAL  30-40
Mansoura International Hospital
16th December 2016

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

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

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

16. 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

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

18. 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

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

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

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

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

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

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

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

26. 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

27. Nephrology Department Mansoura International Hospital
16th December 2016