Case Study
Jorge Tase
Advanced Pharmacology
Professor Dr. Vardah Seraphin DNP, PMHNP-BC, FNP-C, APRN
Florida National University
Anemia of Chronic Kidney Disease
Anemia is a common complication of chronic kidney disease (CKD). CKD means the kidneys are damaged and ca not filter blood the way they should which cause wastes and fluid to build up in the body. A damaged kidneys produce less erythropoietin (EPO) which is directly related to red blood cells, providing less oxygen is delivered to the organs and tissues. In addition, the red blood cells of people with anemia due to CKD tend to live in the bloodstream for a shorter time than normal (Lerma, 2018). The goals of treatment in CKD include the improvement of oxygen-carrying capacity of blood, the detection and corrective action for the underlying cause. In a situation where end organ damage may be imminent and overactive cardiac compensatory mechanisms may lead to deleterious consequences, urgent treatment obviates the poor prognostic outcome associated with anemia.
The drug therapy integrates the objectives of improving renal function and measures effectiveness at increasing red blood cells production. Recombinant human erythropoietin and darbepoetin alfa are the two ESAs generally used in the management of anemia in CKD. Patients with CKD have increased risk of iron deficiency, due to impaired dietary iron absorption, chronic bleeding due to platelet dysfunction from uremia, frequent phlebotomy, and blood trapping in the dialysis apparatus. Treatments for anemia due to chronic kidney disease may include iron, vitamin B12, blood transfusions, or erythropoiesis–stimulating agents (Babitt & Lin, 2019). The two main lines of drug therapy consider:
1. Aranesp (darbepoetin alfa) 0.45 mcg/kg intravenously or subcutaneously weekly
2. Procrit (epoetin alfa) if less than or equal to 110 Kg 10,000 units every week subcutaneously following the schema of treatment
Among the parameters for monitoring success of therapy are episodes of high blood pressure, heart attack/stroke, seizure disorder, severe anemia caused by antibodies to past erythropoietin-type treatments. When initiating or adjusting therapy, monitor hemoglobin levels at least weekly until stable, it is necessary to monitor at least monthly during the complete therapy. When adjusting therapy, it is essential to consider hemoglobin rate of rise, rate of decline, ESA responsiveness and hemoglobin variability. A single hemoglobin excursion may not require a dosing change (Lerma, 2018)
Specific patient education based the drug therapy and health condition should include the evaluation of transferrin saturation and serum ferritin prior to and during treatment. It is important also to contact the healthcare provider for new-onset neurologic symptoms or change in seizure frequency. Similarly, the practitioner will show how much of each medication use, how to inject it, how often it should be injected, and how to safely throw away the used vials, syringes, and needles. During treatment with the drug therapy schema, the patient must continue to follow the healthcare provider's instructions for diet and medicines (Woo & Robinson, 2015).
Among the adverse reactions for the selected treatment, it is possible to consider coughing, shortness of breath, abdominal pain, swelling of the arms or legs, hypertension, severe skin reactions, seizures, and chest pain or signs of an allergic reaction. More complex side effects can consider myocardial Infarction, stroke, and thromboembolism. A second line of intervention considers the OTC and alternative medication which are iron supplements, blood transfusions, and vitamins such as Vitamin B12 and folate (B9). In addition, changes to the diet can serve to get the blood-building nutrients the patient needs, including iron-rich foods, red meat, and protein and phosphorus for people with CKD (Babitt & Lin, 2019).
In terms of dietary and lifestyle changes for patient with anemia due to CKD, it is important to point toward the stop of smoking, the balance and healthy diet, the restriction of salt intake, the incorporation of regular routine of exercises, the lose of weight, and the management until elimination of alcohol intake as well the control of medication such as NSAIDs (Woo & Robinson, 2015).
References
Babitt, J.L., & Lin, H.Y. (2019). Mechanisms of anemia in CKD. Journal of the American Society of Nephrology. 12(10):131–134.
Lerma, E.V. (2018). Anemia of chronic disease and renal failure. Medscape. Retrieved from https://emedicine.medscape.com/article/1389854-overview
Woo, T. M., & Robinson, M. V. (2015). Pharmacotherapeutics for Advanced Practice Nurse Prescribers. 4th E Davis