anemia pres 20 feb 2017
TRANSCRIPT
Anemia in CKD
Hussein Sheashaa, MD, FACPProfessor of Nephrology, Urology and Nephrology Center and Director of
Medical E-Learning Unit, Mansoura University and Executive Director of ESNT-Virtual Academy: http://lms.mans.edu.eg/esnt/
Mansoura UNC, Feb 20th, 2017
1. Introduction
2. Iron
3. ESA
4. Adjuvants
5. ESA resistance
6. HIF Stabilizers
7. Special Issues
Corners
NCGC, AMCKD update, June 2015
Definition of Anemia
Impact of Anemia:2602 Japanese Patients
Clin Exp Nephrol (2016) 20:595–602
Quality-of-life Sexual function
Exercise capacity Endocrine function
cardiac output Immune function
Angina Muscle metabolism
LVH Hospitalizations
Bleeding tendency Transfusions
Brain / cognitive function Nutrition
Depression
Sleep patterns
Anemia Control:Benefits
Kidney International Supplements (2012), 299–310
CKD Associated Anemia:Potential Factors
ESA Deficiency
1. Introduction
2. Iron
3. ESA
4. Adjuvants
5. ESA resistance
6. HIF Stabilizers
7. Special Issues
Corners
NCGC, AMCKD update, June 2015
Diagnosis of Anemia:Iron Status
Am J Kidney Dis. 2016 March 2016 ;67(3):367-75.
Iron Therapy: Evolution
750 mg (IV)
NCGC, AMCKD update, June 2015
Oral Iron Preparations:Iron Contents
Parenteral Iron:
Doses
Am J Kidney Dis.November 2016;68(5):677-690
Iron Therapy:IV Versus Oral
Nephrol Dial Transplant (November 2016) 31: 1835–1845
IV Iron Therapy:Effects on Monocytes
Iron sucrose and sodium ferric gluconateFerric carboxymaltose and iron isomaltoside
IV Iron Therapy:Effects on Renal Function
BMC Nephrology (2017) 18:24
Phosphorus and Anemia
RCT 411 (FC: Active control), 52 W
Saving 2101 USD/P/Y
Nephrol Dial Transplant (December 2015) 30: 2019–2026
CRUISEContinuous Replacement Using Iron Soluble
Equivalents: Phase 3, RCT, n 599, 48 w
1. Introduction
2. Iron
3. ESA
4. Adjuvants
5. ESA resistance
6. HIF Stabilizers
7. Special Issues
Corners
Current ESAs
Am J Nephrol 2017;45:235–247 Published online: February 1, 2017
New Strategies:Stimulate Erythropoiesis
Am J Kidney Dis. 2016 Jan;67(1):133-42.
Refrigeration
Room Temperature Shelf Life
0
5
7
31
0 5 10 15 20 25 30 35
Darbepoetin alfa
Epoetin beta
Epoetin alfa
Days
C.E.R.A.
ESA Initiation
Conversion Among ESA
Short Acting ESA Therapy:Frequency
Cochrane Database of Systematic Reviews 2017, Issue 1. Art. No.: CD011690
The Cochrane Library 2014, Issue 12
Which ESA Therapy?
56 Studies, 15.596 Patients
The Cochrane Library 2014, Issue 12
Which ESA Therapy?
KDIGO 2012: ESA Strategy
VOLUME 2 | ISSUE 4 | AUGUST 2 2012
http://www.kidney-international.org
OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF NEPHROLOGY
KDIGO Clinical Practice Guideline for Anemia in Chronic Kidney Disease
KI_SuppCover_2.4.indd 1 7/11/12 12:00 PM
Transfusion and Apheresis Science 50 (2014) 16–19
ESA Therapy: Suggested Contraindications
Worsening of HTN
Seizure
Increased blood clotting
Slight decrease of Kt/ V
Impaired phosphorus balance
Hyperkalemia
Pure Red cell aplasia (PRCA)
Adverse Effects of ESA Therapy
ESA Route:Outcome
1. Introduction
2. Iron
3. ESA
4. Adjuvants
5. ESA resistance
6. HIF Stabilizers
7. Special Issues
Corners
Kidney International Supplements (2012), 299–310VOLUME 2 | ISSUE 4 | AUGUST 2 2012
http://www.kidney-international.org
OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF NEPHROLOGY
KDIGO Clinical Practice Guideline for Anemia in Chronic Kidney Disease
KI_SuppCover_2.4.indd 1 7/11/12 12:00 PM
KDIGO 2012: Adjuvant Therapy
1. Introduction
2. Iron
3. ESA
4. Adjuvants
5. ESA resistance
6. HIF Stabilizers
7. Special Issues
Corners
Am J Kidney Dis. November 2016;68(5):763-771
ESA Hyporesponsiveness
ESA Hypo-responsiveness:Effect of Hepcidin
Am J Nephrol 2017;45:187–199
Nephrol Dial Transplant (2015) 30: 682–689
ESA Hypo-responsiveness:Effect of Dialyzer Type
Seminars in Dialysis—Vol 28, No 5 (September–October) 2015 pp. 530–532
ESA Hypo-responsiveness:Effect of Graft Failure
1. Introduction
2. Iron
3. ESA
4. Adjuvants
5. ESA resistance
6. HIF Stabilizers
7. Special Issues
Corners
Nat. Rev. Nephrol. 11, 394–410 (2015); published online 9 June 2015
Anemia Control:Effect of Hypoxia
Am J Nephrol 2017;45:187–199
HIF Stabilizers
HIF Stabilizers
Clin J Am Soc Nephrol 11: 982–991, 2016
HIF Stabilizers: Roxadustat (Phase 2b)
J Am Soc Nephrol 27: 1225–1233, 2016
HIF Stabilizers: Roxadustat
1. Introduction
2. Iron
3. ESA
4. Adjuvants
5. ESA resistance
6. HIF Stabilizers
7. Special Issues
Corners
Nephrol Dial Transplant (Feb 2017) 32: 279–287
ESA Therapy:Reno-protection
Kidney International Supplements (2012), 299–310
Pure Red Cell Aplasia:2012 KDIGO Guidelines
VOLUME 2 | ISSUE 4 | AUGUST 2 2012
http://www.kidney-international.org
OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF NEPHROLOGY
KDIGO Clinical Practice Guideline for Anemia in Chronic Kidney Disease
KI_SuppCover_2.4.indd 1 7/11/12 12:00 PM
X
Critical Reviews in Oncology/Hematology 87 (2013) 132–139
ESA Therapy and Cancer Associated Anemia
ESA Therapy and Chemotherapy Induced Anemia
Onco Targets Ther. 2016 Oct 28;9:6689-6693
Nephrol Dial Transplant 2016, in press
ESA Therapy and Cancer
(n 4,983)
Br J Clin Pharmacol. 2012 Jul 16.
Hemoglobin Variability:Effect of Different ESA
Kidney International (2016) 90, 422–429
Anemia Control Model: ACM
J Am Soc Nephrol 27: 3129–3138, October 2016
Current Trends
15
14
10
11
12
13
9
Hb (
g/d
l)
2017 Target
Anemia Management:Hemoglobin Target
