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