Anemia in ckd patients

Dr. Hamed Ezzat El-ErakyNephrology Specialist

Mansoura International Hospital

CME Director Of DMS

AnemiaIn CKD Patient

Meneit El-Nasr ISN Ambassador Project 16th February 2017



Presence of other type of anemia

point to another cause rather than CKD

(on top of CKD)

Anemia of CKD

• Normocytic Normochromic


Role of kidney in RBCs formation


Anemia In Chronic Renal Disease



Anemia in chronic renal failure

ANEMİA


Nephrology Department


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




Treatment of anemia

Adequate dialysis Iron supplementation

Target

Hb/Hct Level

ERYTHROPOIETIN


Adequate nutrition

Prevention of inflammation






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






Administration of supplemental iron





Initial erythropoietin administration

SC

IV

ESAs Initiation

Caution (malignancy,

stroke history)

CKDND

10 g/dl

(no treatment)

< 10 g/dl(according)

CKDHD

< 10 g/dl

(treat)

Transfusion!!


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



















Avoid, when possible

Blood Transfusion

Blood Transfusion




Avoid, when possible

Blood Transfusion




• 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



Education

Anemia in ckd patients