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Friday, September 4, 2009

Anemia - Conditions Caused by Chronic Kidney Failure

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• decreased RBC (red blood cell) production
     • loss of functioning renal tissue (decreased EPO production)
     • vitamin deficiencies
     • iron deficiency
     • aluminum toxicity
• blood loss
     • abnormal bleeding
     • lab sampling
     • loss in dialyzer

• red blood cell (RBC) destruction
     • hemolysis during dialysis treatment
     • hemolytic anemia
     • Lupus, sickle cell
• bleeding abnormalities; prolonged bleeding
     • decreased number of platelets and platelet defects
     • severe anemia
     • Heparin therapy during hemodialysis
     • medications that decrease platelet adhesiveness

• Severe fatigue
• Shortness of breath
• Weakness
• Dizziness
• Mental confusion
• Feeling cold all the time
• Pallor (pale skin, gums, and nail beds)

Anemia in CKD is associated with a heart problem called left Veniricular Hyperthrophy (LVH). which is one of the leading causes of death in people with kidney disease. 

• Recombinant human erythropoietin (Eprex, Neo-Recormon, Procrit, EPOGEN) or darbcpoietin (Aranesp) with increased half-life and activity.
• Given sub-cuteneous (pre-D and PD) or IV (HD)
• Stimulates RBC production by bone marrow
• Pt must be iron repleted for these drugs to work efficiently : major cause of resistance to EPO therapy
• Other causes of resistance :
     - inflammation (infection, cancer, ..)
     - Pure Red Cell Aplasia (antibodies against EPO seen with SC Eprex)

     • Chemical to which oxygen and carbon dioxide bind for transport
     • Carries oxygen and carbon dioxide between lungs and tissues
     • Normal hemoglobin
     • Men- 14.4-16.6 g/dL
     •Women 12.7- 14.7 g/dL
• NKF-KDOQ1™ Target hemoglobin for dialysis patients 11-12 g/dL for men and women.

Anemia - Conditions Caused by Chronic Kidney Failure - Related Hemodialysis Article


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