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    Anemia in CKD: Ppds Sp1 Divisi Ginjal Hipertensi Bagian Ilmu Penyakit Dalam Rsup Dr. Mohammad Hoesin Palembang 2021

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    Richard 151289
    Anemia is defined as a hemoglobin level below 13 g/dL in men and 12 g/dL in women for CKD patients according to KDIGO guidelines. Several factors contribute to anemia in CKD including decreased erythropoietin production and iron deficiency. Treatment of anemia in CKD involves administration of erythropoiesis-stimulating agents and iron supplementation to maintain hemoglobin levels between 10-12 g/dL. Blood transfusions should be avoided but may be necessary if hemoglobin drops below certain thresholds.

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    Anemia in CKD: Ppds Sp1 Divisi Ginjal Hipertensi Bagian Ilmu Penyakit Dalam Rsup Dr. Mohammad Hoesin Palembang 2021

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    Richard 151289
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    Anemia is defined as a hemoglobin level below 13 g/dL in men and 12 g/dL in women for CKD patients according to KDIGO guidelines. Several factors contribute to anemia in CKD including decreased erythropoietin production and iron deficiency. Treatment of anemia in CKD involves administration of erythropoiesis-stimulating agents and iron supplementation to maintain hemoglobin levels between 10-12 g/dL. Blood transfusions should be avoided but may be necessary if hemoglobin drops below certain thresholds.

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    Anemia is defined as a hemoglobin level below 13 g/dL in men and 12 g/dL in women for CKD patients according to KDIGO guidelines. Several factors contribute to anemia in CKD including decreased erythropoietin production and iron deficiency. Treatment of anemia in CKD involves administration of erythropoiesis-stimulating agents and iron supplementation to maintain hemoglobin levels between 10-12 g/dL. Blood transfusions should be avoided but may be necessary if hemoglobin drops below certain thresholds.

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    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    126 views31 pages

    Anemia in CKD: Ppds Sp1 Divisi Ginjal Hipertensi Bagian Ilmu Penyakit Dalam Rsup Dr. Mohammad Hoesin Palembang 2021

    Uploaded by

    Richard 151289
    Anemia is defined as a hemoglobin level below 13 g/dL in men and 12 g/dL in women for CKD patients according to KDIGO guidelines. Several factors contribute to anemia in CKD including decreased erythropoietin production and iron deficiency. Treatment of anemia in CKD involves administration of erythropoiesis-stimulating agents and iron supplementation to maintain hemoglobin levels between 10-12 g/dL. Blood transfusions should be avoided but may be necessary if hemoglobin drops below certain thresholds.

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    ANEMIA in CKD

    PPDS SP1 DIVISI GINJAL HIPERTENSI


    BAGIAN ILMU PENYAKIT DALAM
    RSUP DR. MOHAMMAD HOESIN PALEMBANG
    2021
    Defenition of Anemia in CKD
    The 2012 KDIGO guideline define anemia in patients with CKD as :
    • Hb < 13 gr/dL in males
    • Hb < 12 gr/dL in females

    The 2011 Indonesian Society of Nephrology define anemia in patients


    with CKD as :
    • Hb < 14 gr/dL in males
    • Hb < 12 gr/dL in females

    Anemia is defined here as any hb velue below the fifth percentile for
    adult, gender specific population

    Konsensus Manajemen Anemia pada PGK. PERNEFRI 2011


    KDIGO Clinical Pratice Guideline for Anemia in CKD (2012)
    Anemia as a Complication
    of CKD
    Perspective
    Factors That Contribute to
    Anemia in CKD
    Prevalence of Anemia* in
    Patients With CKD by GFR
    Prevalance of anemia in CKD

    Update on Anemia. American Journal of Kidney Diseases. 2018


    Erythropoiesis

    Koury, M. J., & Haase, V. H. (2015). Nature reviews. Nephrology, 11(7), 394–410.


    Erythropoiesis

    Koury, M. J., & Haase, V. H. (2015). Nature reviews. Nephrology, 11(7), 394–410.


    Causes of anaemia in CKD
    Hepcidin and HIF
    Regulation in Chronic
    Disease
    Management of Anemia in
    CKD
    KDOQI Guidelines
    Algoritm
    Why Treat Iron-Deficient
    Anemia in CKD?
    Pengkajian Status Besi

    • Sebelum terapi ESA hrs dilakukan pemeriksaan status besi


    • Status besi harus cukup agar respon eritropoiesis optimal
    • Status besi yg diperiksa meliputi SI, TIBC, ST, FS.

    ST = SI/TIBC x 100%

    Konsensus Manajemen Anemia pada PGK. PERNEFRI 2011


    Pengkajian Status Besi (2)

    Konsensus Manajemen Anemia pada PGK. PERNEFRI 2011


    Pengkajian Status Besi (4)

    Konsensus Manajemen Anemia pada PGK. PERNEFRI 2011


    Erythropoiesis-Stimulating Agent

    Konsensus Manajemen Anemia pada PGK. PERNEFRI 2011


    Therapy ESA

    Konsensus Manajemen Anemia pada PGK. PERNEFRI 2011


    Terapi ESA

    Konsensus Manajemen Anemia pada PGK. PERNEFRI 2011


    Goals
    • Dimulai terapi jika kadar HB<10 g/dL
    • Target Hb pada pasien PGK-HD, PGK-PD, dan PGK nonD yang
    mendapat terapi ESA adalah 10-12 g/dL
    • Kadar HB tidak boleh >13 gr/dL

    Update on Anemia. American Journal of Kidney Diseases. 2018


    Konsensus Manajemen Anemia pada PGK. PERNEFRI 2011
    Monitor of Hb
    For CKD patients without anemia, measure
    hemoglobin concentration when clinically indicated
    • at least annually in patients with CKD 3
    • at least twice per year in patients with CKD4-5 ND
    • at least every 3 months in patients with CKD5 HD and CKD5
    PD

    For CKD patients with anemia not being treated with an


    ESA, measure Hb concentration when clinically indicated
    and
    • at least every 3 months in patients with CKD3-5 ND and
    CKD5 PD
    • at least monthly in patients with CKD5 HD

    KDIGO Clinical Pratice Guideline for Anemia in CKD (2012)


    Preparation
    Preparat Besi1
    • Parental : Iron Sucrose, Iron Dextran
    • Oral : Ferrous Gluconate, ferrous sulphate, ferrous
    fumarate, iron polysaccharida.

    Erythropoietin Analogues1
    • Epoetin alfa (Hemapo, Renogen, Binocrit, Eprex)
    • Epoetin beta (Recormon)
    • Epoetin alfa biosimilar
    • Pegylated epoetin beta

    Prolyl Hydroxylase Inhibitors – HIF Agonist (new)

    Konsensus Manajemen Anemia pada PGK. PERNEFRI 2011


    1
    Preparat Besi
    • Parental (untuk PGK-HD): Iron Sucrose (Venofer), Iron Dextran
    (Cosmofer)
    • Oral (unutk PGK-NonHD dan PGK-PD): Ferrous Gluconate,
    ferrous sulphate, ferrous fumarate, iron polysaccharida.

    • Efek samping  Hipersensitivitas, mual, muntah,

    Konsensus Manajemen Anemia pada PGK. PERNEFRI 2011


    Erythropoietin Analogues
    • Epoetin alfa (Hemapo, Renogen, Binocrit, Eprex)
    • Epoetin beta (Recormon)
    • Epoetin alfa biosimilar
    • Pegylated epoetin beta

    Konsensus Manajemen Anemia pada PGK. PERNEFRI 2011


    Erythropoietin Analogues
    • Kontraindikasi : Hipersentivitas terhadap ESA
    • Keadaan yang perlu diperhatikan : tekanan darah tinggi,
    hiperkoagulasi

    Konsensus Manajemen Anemia pada PGK. PERNEFRI 2011


    Erythropoietin Analogues
    Efek samping
    • Hipertensi
    • Trombosis
    • Kejang
    • Pure Red Cell Aplasia (PRCA)

    Konsensus Manajemen Anemia pada PGK. PERNEFRI 2011


    Prolyl Hydroxylase Inhibitors – HIF Agonist
    • Roxadustat, Daprodustat
    Respon tidak Adekuat Terhadap ESA
    • Apabila pada dosis 8000-10.000 IU/minggu SC
    • Gagal mencapai target kenaikan Hb 0.5-1/5 g/dL dalam 4 minggu berturut
    turut selama 12 minggu (fase koreksi)
    • Gagal mempertahankan Hb dalam rentang target pemeliharaan

    Konsensus Manajemen Anemia pada PGK. PERNEFRI 2011


    Transfusi Darah
    Sebaiknya dihindari hanya diberikan jika memenuhi indikasi
    transfuse darah
    • Hb <7 gr/dL dengan atau tanpa gejala anemia
    • Hb <8 gr/dL dengan gangguan kardiovaskuler yang nyata
    • Perdarahan akut dengan gejala hemodinamik
    • Pasien akan menjalani operasi

    Target Hb dengan transfuse 7-9 gr/dl

    Cara pemberian tranfusi darah


    • Dianjurkan dalam jumlah kecil dan bertahap dengan kecepatan 1
    ml/menit pada 15 menit pertama lalu 4 ml/menit
    • Pada pasien HD diberikan saat HD

    Konsensus Manajemen Anemia pada PGK. PERNEFRI 2011


    Terima Kasih

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