Iron Repletion in ESRD

Iron Repletion in ESRD - Iron Repletion in ESRD Saleem...

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Iron Repletion in ESRD Saleem Bharmal 2/9/10
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Case ESRD on maintenance hemodialysis who is noted to have a Hgb 10.6/TSAT 19%/Ferritin 617/iron 46/TIBC 238/on EPO 4000U/week What would you do in this situation in terms of ESA and iron? Patient EPO decreased to 3000U and started on Ferrilicit 125mgx8 doses(1000mg total) 1 month later Hgb 11.1 (iron not checked)
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Case 2 months later: Hgb 10.8/iron 36/TIBC 225/TSAT 16%/Ferritin 1075/on EPO 3000U/week What would you do in now? Kept patient on current dose of EPO no IV iron given One month later Hgb 10.7
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Case 2 months later: Hgb 9.9/iron 54/TIBC 230/TSAT 17%/Ferritin 706/on EPO 3000U/week What would you do now? Ferrilicit 125mgx8(total 1gram) given and kept on EPO 3000U 1 month later: Hgb 10.4 2 month later: Hgb 10.2/TSAT 31%/Ferritin 1120/EPO 3000U/week
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Anemia in ESRD According to the National Health and Nutrition Examination Survey (NHANES) and the Prevalence of Anemia in Early Renal Insufficiency (PAERI) study the suggested incidence of anemia in stage 5 CKD is more than 70% The most well-known causes are inadequate erythropoietin (EPO) production and iron deficiency.
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Iron Deficiency in Hemodialysis Patients Dialysis patients commonly suffer iron loss from gastrointestinal bleeding , blood drawing , and/or, most important with hemodialysis, the dialysis treatment itself . Hemodialysis patients lose an average of 1 to 2 g of iron per year.
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Type of Iron Dysfunction in HD patients Absolute iron deficiency Functional iron deficiency Inflammatory Block
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Absolute Iron Deficiency TSAT falls below 20% (plasma iron divided by total iron binding capacity x 100) Serum ferritin concentration is less than 200 ng/mL among hemodialysis patients. Fishbane S., J. Am. Soc. Nephrol. 1996 2654-2657
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Functional Iron Deficiency Characterized by the presence of adequate iron stores as defined by conventional criteria, but an inability to sufficiently mobilize this iron from the liver and other storage sites to adequately support erythropoiesis with the administration of erythrocyte stimulating agents (ESA). Serum ferritin level is either normal or elevated, but the TSAT typically is about 20% or less. The hallmark of functional iron deficiency is that it responds to iron supplements with an increase in hemoglobin and/or decrease in ESA requirements.
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Reticuloendothelial Blockade Inflammatory iron block occurs among patients with refractory anemia due largely to an underlying inflammatory state. Also characterized with TSAT < 20% and elevated Ferritin 100-800+ ng/ml Hepcidin, an acute phase reactant may play a role by preventing the release of iron from macrophages to circulating transferrin. Usually does not respond to iron therapy
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This note was uploaded on 12/24/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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Iron Repletion in ESRD - Iron Repletion in ESRD Saleem...

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