Iron in CKD | Iron Replacement in Hemodialysis and Dialysis Patients | Risks and Benefits of Iron in ESRD
Patients with chronic kidney disease (CKD) or end stage renal disease (ESRD) are frequently anemic. Anemia implies a low hemoglobin or red blood cell level. Many patients become anemic from blood loss (examples include heavy menstruation,or
chronic blood loss through the colon from colitis or colon cancer).
With chronic kidney disease, a different or additional cause of anemia is a work. As blood flows through the kidneys to be cleansed of waste products and excess water, sensing mechanisms in the kidney detect anemia. Normally functioning kidneys produce a hormone, erythropoeitin, that stimulates the bone marrow to produce more red blood cells if the level of hemoglobin level is too low.
Diseased kidneys become scarred and unable to produce erythropoeitin (EPO). Erythropoeitin stimulating agents (ESAs) can be given to CKD or ESRD patients to trigger more red blood cell production. But iron is also required to make hemoglobin (it is the iron that makes our red blood cells red and why anemic patients often look 'pale').
Iron can be supplemented or replaced in CKD and dialysis patients in a number of ways and with a variety of iron products. As with most medications, there are risks and benefits to iron supplementation.
Iron supplementation may reduce the amount of ESAs necessary to improve hemoglobin levels. Some patients develop anaphylaxis (an allergic reaction) to iron. Please discuss your iron needs with your kidney or dialysis health care providers.
New Feature from Hemodialysis.com: Hemodialysis or Chronic Kidney Disease Abstract of the Week
Association of Cumulatively Low or High Serum Calcium Levels with Mortality in Long-Term Hemodialysis Patients.
Am J Nephrol. 2010 Sep 3;32(5):403-413.
Miller JE, Kovesdy CP, Norris KC, Mehrotra R, Nissenson AR, Kopple JD, Kalantar-Zadeh K.
Harold Simmons Center for Kidney Disease Research and Epidemiology,Torrance, Calif., USA.
Abstract
Background: The outcome-predictability of baseline and instantaneously changing serum calcium in hemodialysis patients has been examined. We investigated the mortality-predictability of time-averaged calcium values to reflect the 'cumulative' effect of calcium burden over time. Methods: We employed a Cox model using up-to-5-year (7/2001-6/2006) time-averaged values to examine the mortality-predictability of cumulative serum calcium levels in 107,200 hemodialysis patients prior to the use of calcimimetics, but during the time where other calcium-lowering interventions, including lower dialysate calcium, were employed.
Results: Both low (<9.0 mg/dl) and high (>10.0 mg/dl) calcium levels were associated with increased mortality (reference: 9.0 to <9.5 mg/dl). Whereas mortality of hypercalcemia was consistent, hypocalcemia mortality was most prominent with higher serum phosphorus (>3.5 mg/dl) and PTH levels (>150 pg/ml).
Higher paricalcitol doses shifted the calcium range associated with the greatest survival to the right, i.e. from 9.0 to <9.5 to 9.5 to <10.0 mg/dl. African-Americans exhibited the highest death hazard ratio of hypocalcemia <8.5 mg/dl, being 1.35 (95% CI: 1.22-1.49). Both a rise and drop in serum calcium over 6 months were associated with increased mortality compared to the stable group.
Conclusions: Whereas in hemodialysis patients cumulatively high or low calcium levels are associated with higher death risk, subtle but meaningful interactions with phosphorus, PTH, paricalcitol dose and race exist.
Hemodialysis | Kidney Disease | Dialysis Resources and Educational Materials
100 Q&A About Kidney Disease and Hypertension
Raymond R. Townsend, MD
High blood pressure is one of the leading causes of kidney failure. Each year, high blood pressure causes more than 25,000 new cases of kidney failure in the United States. 100 Questions & Answers About Kidney Disease and Hypertension offers authoritative, up-to-date, practical answers about kidney disease, end-stage renal disease, transplants, and dialysis. The book is an invaluable resource for anyone coping with the physical and emotional turmoil of this condition.
Handbook of Dialysis Therapy
Here's an in-depth, quick-reference, problem-solving resource for those involved in the care of dialysis patients. More than 120 world-class authorities discuss dialysis techniques, mechanical considerations, and complications related to various diseases for both pediatric and adult patients. Selected annotated references and excellent cross-referencing between chapters help you find answers fast, and more than 100 photos, drawings, charts, and tables, mostly in color, clarify complex topics. Providing practical, immediately useful guidelines that can be applied directly to patient care, this book is a "must-have" for all dialysis caregivers.
Certified Hemodialysis Technologist/Technician Exam Secrets Study Guide: CHT Test Review for the Certified Hemodialysis Technologist/Technician Exam
Certified Hemodialysis Technologist/Technician Exam Secrets helps you ace the Certified Hemodialysis Technologist/Technician Exam, without weeks and months of endless studying. Our comprehensive Certified Hemodialysis Technologist/Technician Exam Secrets study guide is written by our exam experts.....
Dialysis and Hemodialysis Book and Descriptions from Amazon.com
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