Anemia in ckd patients

1. Dr. Hamed Ezzat El-Eraky
Nephrology Specialist
Mansoura International Hospital
Anemia
In CKD Patient

4. Presence of other type of anemia
point to another cause rather than CKD
(on top of CKD)
Anemia of CKD
• Normocytic Normochromic

5. Role of kidney in RBCs formation

6. Anemia In Chronic Renal Disease

8. Anemia in chronic renal failure
ANEMİA

9. 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

10. Nephrology Department
Mansoura International Hospital
Treatment of anemia
Adequate dialysis
Iron supplementation
Target
Hb/Hct Level
ERYTHROPOIETIN
Adequate nutrition
Prevention of inflammation

11. Nephrology Department
Mansoura International Hospital

12. Nephrology Department
Mansoura International Hospital
The patients should have sufficient iron
to achieve and maintain an Hb of 10 - 11.5g /dl
• Serum ferritin  > 100 ng/ml
OPTIMAL  200 -500 ng / ml
• Transferrin saturation  > 20
OPTIMAL  30-40
Target iron level

13. Nephrology Department
Mansoura International Hospital

15. Administration of supplemental iron

17. Nephrology Department
Mansoura International Hospital
Initial erythropoietin administrationSCIV
ESAs Initiation
Caution
(malignancy,
stroke history)
CKDND
 10 g/dl
(no treatment)
<10 g/dl
(according)
CKDHD
<10
g/dl
(treat)
Transfusion!!

18. Serum HbAfter 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

19. Nephrology Department
Mansoura International Hospital

20. Nephrology Department
Mansoura International Hospital

21. Nephrology Department
Mansoura International Hospital

22. Nephrology Department
Mansoura International Hospital

23. Nephrology Department
Mansoura International Hospital

24. Nephrology Department
Mansoura International Hospital
Avoid, when possible
Blood Transfusion
BloodTransfusion

25. Nephrology Department
Mansoura International Hospital
Avoid, when possible
BloodTransfusion

26. 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