diabetes, CV disease, advanced CKD, transplant recipients, RAAS inhibitors
Which CKD patients have the highest risk of hyperkalemia? (5)
immunosuppression meds keep risk high
Why do transplant recipients have a high risk of hyperkalemia?
single episode; 1
A ________ of hyperkalemia in patients with CKD increases the odds of mortality within ______ day of the event.
>50% decrease in kidney function; GFR <60ml/min
When does anemia usually develop in patients with CKD?
Hematocrit
- the percentage that RBCs make up in blood composition
Mean corpuscular volume (MCV)
-average size of individual RBC
alterations in RBC count/size, decreased HB, decreased: TSat, ferritin; increased hepcidin
What labs do we look at when assessing a patient for Anemia? (5)
d
Transports iron in the plasma & ECF.
a) ferritin
b) transferrin receptor
c) hepcidin
d) transferrin
c
Regulates iron absorption in GI and releases it from storage.
a) ferritin
b) transferrin receptor
c) hepcidin
d) transferrin
b
Binds the transferrin-iron complex and internalizes it.
a) ferritin
b) transferrin receptor
c) hepcidin
d) transferrin
a
An iron-storage protein that sequesters iron and keeps it readily
available.
a) ferritin
b) transferrin receptor
c) hepcidin
d) transferrin
liver, bone marrow, spleen, muscles
Where is most iron stored? (4)
increased RBC destruction; deficient/defective erythropoiesis, inflammatory cytokines
What is the most common pathophysiology behind Anemia? (3)
RBCs are normal size, but there are decreased in number& decrease iron storage capacity
What Normocytic/Normochromic EPO?
hypoxia; iron
EPO production is stimulated by _______ and can be inhibited by ________.
false; doesn't increase RBC lifespan
EPO-R activation regulates erythropoiesis and increases RBC lifespan.
T/F?
cause the upregulation of hepcidin; causes iron trapping within macrophages and hepatocytes; results in lower serum iron
How do inflammatory cytokines affect Anemia?
uremia, folate/VitB12/Fe deficiency, dysfunctional platelets, blood loss via hemodialysis
What are the uncommon mechanisms behind Anemia? (4)
RBC deformity; hemolysis
Uremia leads to _______ responsible for ______.
impaired erythropoiesis; upregulated hepcidin
Deficiencies in folate, vitamin b12, and iron can cause __________ and _______.
reticuloendothelial cell iron blockade
- a disorder where iron is not released from body stores
Iron supplementation, directly agonizing production of EPO, indirect increase of EPO levels
What are the strategies for treating Anemia in CKD? (3)
Epoetin alfa, Darbapoetin alfa, Methoxy PEG-epoetin beta
Which medications are Direct-Agonists of EPO? (3)
daprodustat
Which medication indirectly increases EPO levels?
ferrous, ferric, iron-complexes
Which Iron supplements are used in Anemia? (3)
5-10 days; 2-4 weeks
How long does it take for reticulocytosis to occur in iron supplementation?
How long does it take for hemoglobin to increase?
3-10 days
What is the onset of action for Iron supplementation?
darkening of stools, GI pain, N/V/D, constipation, heartburn
What are AE's of Iron supplements? (5)
b
Which is the recombinant human EPO?
a) Darbepoetin alfa
b) Epoetin alfa
c) Methoxy PEG-epoetin beta
a
Which has enhanced activity in vivo?
a) Darbepoetin alfa
b) Epoetin alfa
c) Methoxy PEG-epoetin beta
a
Which has a higher half-life due to 2 additional glycosylation moieties?
a) Darbepoetin alfa
b) Epoetin alfa
c) Methoxy PEG-epoetin beta
c
Which has a PEGylation that extends its half-life?
a) Darbepoetin alfa
b) Epoetin alfa
c) Methoxy PEG-epoetin beta
a,c
Which has BBW for increased risk of death by CV?
a) ESA's
b) Iron supplements
c) Daprodustat
HTN, skin rash, athralgia, fever, cough
What are the AE's of ESA's? (5)
inhibits HIF hydroxylate ; resulting in stabilization/nuclear accumulation of HIF-1a/Hif-2a transcription factors
Daprodustat MOA?
a
Which has BBW for increased risk of death via CKD & shortened survival
with cancer?
a) ESA's
b) Iron supplements
c) Daprodustat
HTN, gastric erosion, thrombotic event, malignancy
What are AE's of Daprodustat?
Jesduvroq
Daprodustat Brand Name?