Anemia in ckd patients
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This document discusses anemia in chronic kidney disease patients. It notes that anemia is typically normocytic and normochromic in CKD patients. The kidneys play an important role in red blood cell formation, and their dysfunction leads to anemia. The document outlines guidelines for evaluating and treating anemia in CKD patients, including ensuring adequate iron levels through supplementation and targeting a hemoglobin level of 10-11.5 g/dL through erythropoietin administration and iron therapy. Blood transfusions should be avoided when possible.
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Anemia in ckd patients
- 1. Dr. Hamed Ezzat El-Eraky Nephrology Specialist Mansoura International Hospital CME Director Of DMS Anemia In CKD Patient Meneit El-Nasr ISN Ambassador Project 16th February 2017
- 2. Meneit El-Nasr ISN Ambassador Project 16th February 2017
- 3. Meneit El-Nasr ISN Ambassador Project 16th February 2017
- 4. Presence of other type of anemia point to another cause rather than CKD (on top of CKD) Anemia of CKD • Normocytic Normochromic Meneit El-Nasr ISN Ambassador Project 16th February 2017
- 5. Role of kidney in RBCs formation Meneit El-Nasr ISN Ambassador Project 16th February 2017
- 6. Anemia In Chronic Renal Disease Meneit El-Nasr ISN Ambassador Project 16th February 2017
- 7. Meneit El-Nasr ISN Ambassador Project 16th February 2017
- 8. Anemia in chronic renal failure ANEMİA Meneit El-Nasr ISN Ambassador Project 16th February 2017
- 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 Meneit El-Nasr ISN Ambassador Project 16th February 2017
- 10. Nephrology Department Mansoura International Hospital Treatment of anemia Adequate dialysis Iron supplementation Target Hb/Hct Level ERYTHROPOIETIN Meneit El-Nasr ISN Ambassador Project 16th February 2017 Adequate nutrition Prevention of inflammation
- 11. Nephrology Department Mansoura International Hospital Meneit El-Nasr ISN Ambassador Project 16th February 2017
- 12. 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 Meneit El-Nasr ISN Ambassador Project 16th February 2017
- 13. Nephrology Department Mansoura International Hospital Meneit El-Nasr ISN Ambassador Project 16th February 2017
- 14. Meneit El-Nasr ISN Ambassador Project 16th February 2017
- 15. Administration of supplemental iron Meneit El-Nasr ISN Ambassador Project 16th February 2017
- 16. Meneit El-Nasr ISN Ambassador Project 16th February 2017
- 17. Nephrology Department Mansoura International Hospital Initial erythropoietin administrationSCIV ESAsInitiation Caution (malignancy, stroke history) CKDND 10 g/dl (no treatment) < 10g/dl (according) CKDHD < 10 g/dl (treat) Transfusion!! Meneit El-Nasr ISN Ambassador Project 16th February 2017
- 18. 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 Meneit El-Nasr ISN Ambassador Project 16th February 2017
- 19. Nephrology Department Mansoura International Hospital Meneit El-Nasr ISN Ambassador Project 16th February 2017
- 20. Nephrology Department Mansoura International Hospital Meneit El-Nasr ISN Ambassador Project 16th February 2017
- 21. Nephrology Department Mansoura International Hospital Meneit El-Nasr ISN Ambassador Project 16th February 2017
- 22. Nephrology Department Mansoura International Hospital Meneit El-Nasr ISN Ambassador Project 16th February 2017
- 23. Nephrology Department Mansoura International Hospital Meneit El-Nasr ISN Ambassador Project 16th February 2017
- 24. Nephrology Department Mansoura International Hospital Avoid, when possible Blood Transfusion BloodTransfusion Meneit El-Nasr ISN Ambassador Project 16th February 2017
- 25. Nephrology Department Mansoura International Hospital Avoid, when possible BloodTransfusion Meneit El-Nasr ISN Ambassador Project 16th February 2017
- 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 Meneit El-Nasr ISN Ambassador Project 16th February 2017
- 27. Meneit El-Nasr ISN Ambassador Project 16th February 2017