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Ana Barreras Lopez

Specific goals of treatment

           The goal of treating anemia of any cause is to correct the hemoglobin deficit in order to increase oxygen at the tissue level. This is a frequent complication in those individuum with chronic kidney disease and the main cause is a deficit in erythropoietin and iron. With the use of erythropoiesis stimulant agents (ESAs) the production of red blood cells increases. Also, is important to supply the correct amount of iron in order to make efficient and functional erythrocytes (Anemia in Chronic Kidney Disease, 2022).

What drug therapy would you prescribed? Why?

           I will use Epoetin alfa (Epogen, Procrit) as ESAs starting with 100 units per Kg subcutaneous three times a week. This dose can be adjusted as needed according evolution and laboratory results. This is a version of human erythropoietin (EPO) that stimulates the production of red blood cells by bone narrow. Maintenance of systemic and cellular iron level is crucial. Is recommended 100 to 200 mg of elemental iron daily divided in two or more doses. However, extended releases tablets are also available for once daily dosage (Mikhail et al., 2017).

What are the parameters for monitoring success of therapy?

           To determine the severity of anemia the best marker is the hemoglobin level (Hb). The ESAs agent dosage is determinate by this value taking into account increases from the last dosage. To monitor progression is important to periodically repeat complete blood count, folate, Vitamin B12, iron, and serum ferritin levels. Iron storages reserves should be 200 ng/ml and Hb levels between 11.0 – 12 g/dl. At the beginning of therapy, the Hb levels should be monitoring weekly until stable, then can be change to a monthly basis (Gafter-Gvili et al., 2019).

Discuss specific patient education based on the prescribed therapy.

           Being consistent with the medication regimen and periodic monitoring of hematological indicators is of vital importance to success. This drug may cause heart attack, heart failure, and blood clots. That is why patients should be educated in recognizing the symptoms that accompany these events such as: chest pain, cool pale extremity, stroke alert, numbness unilateral, loss of consciousness, high blood pressure, fever, dizziness, nausea, etc. Training on self-administration if a prefilled syringe will be use. Use a new needle and syringe each time, do not overdose, if you use a multidose vial it should be refrigerated after use and throw away after 21 days of use. Do no shake. Do not use if change of color occurs or particles are visible. Follow instruction of eat an iron rich diet with eggs, cereals, meats, and vegetables. These substances can be consumed as supplements. Take supplements with food to avoid stomach problems but always remember that milk, caffeine, antacids or calcium supplements can decrease absorption of iron, Vitamin C increases absorption of iron (Fishbane & Spinowitz, 2018).

List one or two adverse reactions for the selected agent that would cause you to change therapy.

           Anaphylactic reaction to Epoetin alfa is the worse event that leads to a change of therapy as well as injections site reactions (pain, tenderness, and irritation). Also, it can worse hypertension or suddenly becomes ineffective after a time of use. By the other hand, iron supplements can cause constipation, upset stomach and heartburn with a variety of severity (Mikhail et al., 2017) .

What over-the-counter and/or alternative medications would be appropriate

           Others supplements such as Vitamin B12 and folate can be prescribed because they help on the production of red blood cells. Novel anemia strategies can be implemented such as: hypoxia inducible factor stabilizers, propyl hydroxylase inhibitors, and dialysate-delivered iron supplements have been used but still more research is needed to prove efficacy and safety. Another option is blood transfusion when anemia becomes severe or when the ESA therapy is contraindicated or fail (Fishbane & Spinowitz, 2018).

What dietary and lifestyle changes

           Iron can be absorbed from meats more easily than from vegetables or other foods. Results beneficiary eat more red meat specially beef or liver. Others good sources of iron are spinach, dark green leafy vegetables, tofu. Peas, lentils, etc. Protection of the kidneys becomes a priority and implementation of certain measures will help: reduction the intake of sodium, phosphorus, potassium. Maintain diabetes and high blood pressure under control. Reduction of stress, regular glucose monitoring, healthy diet and exercises (Anemia in Chronic Kidney Disease, 2022).

.

References

Anemia in Chronic Kidney Disease. (2022, January 7). National Institute of Diabetes and Digestive and Kidney Diseases.
https://www.niddk.nih.gov/health-information/kidney-disease/anemia#:%7E:text=Anemia%20is%20a%20common%20complication,also%20cause%20other%20health%20problems
.

Fishbane, S., & Spinowitz, B. (2018). Update on Anemia in ESRD and Earlier Stages of CKD: Core Curriculum 2018. American Journal of Kidney Diseases, 71(3), 423–435.
https://doi.org/10.1053/j.ajkd.2017.09.026

Gafter-Gvili, A., Schechter, A., & Rozen-Zvi, B. (2019). Iron Deficiency Anemia in Chronic Kidney Disease. Acta Haematologica, 142(1), 44–50.
https://doi.org/10.1159/000496492

Mikhail, A., Brown, C., Williams, J. A., Mathrani, V., Shrivastava, R., Evans, J., Isaac, H., & Bhandari, S. (2017). Renal association clinical practice guideline on Anaemia of Chronic Kidney Disease. BMC Nephrology, 18(1).
https://doi.org/10.1186/s12882-017-0688-1

 

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Reply

 Gioconda A. Orellana

Anemia Case Discussion 11

Anemia is a widespread complication of chronic kidney disease (CKD), as CKD decreases the production of erythropoietin, a hormone involved in the synthesis of red blood cells (RBCs). Specific treatment goals for M.W. include the improvement of kidney function and the increased production of erythrocytes (Shaikh & Aeddula, 2021). M.W. should administer an erythropoiesis-stimulating drug such as darbepoetin alfa to increase RBC synthesis. This agent has a longer half-life than its counterpart (recombinant human erythropoietin), allowing it to take less often (Shaikh & Aeddula, 2021). The success of this therapy can be monitored by the hemoglobin level in the blood and the hematocrit (Shaikh & Aeddula, 2021). These parameters should be checked every week until the patient’s condition is stable. Specific education for M.W. includes the proper route of medication administration, duration of treatment, and possible adverse reactions. Darbepoetin alfa is administered intravenously or subcutaneously every 4 weeks; the optimal initial dosage is 0.45 mcg/kg (Drugs, 2021). The minimal duration of treatment is three months. This medication’s most common side effects include hypertension and shortness of breath; the most severe adverse reactions include hypersensitivity and arteriovenous graft thrombosis (Drugs, 2021). The patient should take ferrous gluconate to increase the hemoglobin level more rapidly because it is an over-the-counter iron supplement usually well-tolerated. It is available in tablet form, and the optimal starting dosage for individuals with CKD is 1600 mg/day BID without food (Drugs, 2021). M.W. should not take any other over-the-counter agents or alternative supplements because they may interact with the selected medications and decrease the therapy effectiveness. A proper lifestyle is an essential part of managing CKD and CKD-associated anemia. M.W. should take his iron supplementation regularly, exercise, control his diabetes and hypertension to slow down the progression of kidney failure, quit smoking, and avoid alcohol. To accelerate the recovery from anemia, M.W. should consume iron-rich foods such as kidney beans, liver, and pomegranates.

 

 

References

Drugs. (2021, October 13). Darbepoetin Alfa. Retrieved March 11, 2022, from
https://www.drugs.com/monograph/darbepoetin-alfa.html

Drugs. (2021, September 24). Ferrous gluconate dosage. Retrieved March 11, 2022, from
https://www.drugs.com/dosage/ferrous-gluconate.html

Shaikh, H., & Aeddula, N. R. (2021). Anemia of chronic renal disease. In StatPearls. StatPearls Publishing.
https://www.ncbi.nlm.nih.gov/books/NBK539871/
 

 

 

 

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Anemia of Chronic Kidney Disease

 

Amniellys Rodriguez Diaz

1. List specific goals of treatment for M.W.

            The specific goals of the treatment would be to reduce the negative symptoms that are associated with the anemia, such as fatigue, shortness of breath, and weakness. 

2. What drug therapy would you prescribed? Why?

            The drug therapy that would be prescribed would be erythropoiesis-stimulating agent (ESA). Such medications instruct the bone marrow in the body to make more red blood cells. This is because of how chronic kidney disease (CKD) can result in the red blood cells to be lowered and this causes anemia (Gafter-Gvili et al., 2019). ESAs work to help increase the red cells. 

3. What are the parameters for monitoring success of therapy?

            The parameters for monitoring the success of therapy would be to conduct a blood test and look for the red blood cell count. If the red blood cells increase, it means that the therapy is working. 

4. Discuss specific patient education based on the prescribed therapy.

            It would be important to talk to the patient and to tell them that ESAs can increase the likelihood of stroke as well as blood clots (Karaboyas et al., 2020). This is why it is important for the patient to monitor any such symptoms and to seek help immediately. 

5. List one or two adverse reactions for the selected agent that would cause you to change therapy.

            High blood pressure and fever are to adverse reactions that would cause me to change the therapy. 

 

6. What over the counter and/or alternative medications would be appropriate for M.W.?

            Iron supplements as well as vitamin supplements would be appropriate for the patient. 

7. What dietary and lifestyle changes would you recommended for M.W.?

            The patient should increase iron in diet, which can come from green and leafy vegetables, as well as beans, lentils, and cashew nuts (Martin-Masot et al., 2019). 

References

Gafter-Gvili, A., Schechter, A., & Rozen-Zvi, B. (2019). Iron deficiency anemia in 

chronic kidney disease. Acta haematologica142(1), 44-50.

Karaboyas, A., Morgenstern, H., Fleischer, N. L., Vanholder, R. C., Dhalwani, N. N., 

Schaeffner, E., … & Robinson, B. M. (2020). Inflammation and erythropoiesis-stimulating agent response in hemodialysis patients: a self-matched longitudinal study of anemia management in the dialysis outcomes and practice patterns study (DOPPS). Kidney medicine2(3), 286-296.

Martín-Masot, R., Nestares, M. T., Diaz-Castro, J., López-Aliaga, I., Alférez, M. J. M., 

Moreno-Fernandez, J., & Maldonado, J. (2019). Multifactorial etiology of anemia in celiac disease and effect of gluten-free diet: A comprehensive review. Nutrients11(11), 2557.

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Adelisa Bencomo

3/14/22, 6:48 PM 

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Anemia of Chronic Kidney Disease

When a patient arrives in any clinical setup while sick, it is the duty of a health officer, nurse, or doctor to diagnose the patient to understand the health problem. On arrival to the hospital, M.W. was referred for clinical evaluation of increasing shortness of breath. After evaluation, M.W. had a medical past of long-lasting renal insufficiency, hypertension, congestive heart failure, diabetes mellitus type 2, poor control, deep vein thrombosis, alcohol abuse, a chronic obstructive pulmonary disease with respiratory failure, and a family medical history. M.W. is 69 inches and weighs 205 lb. His blood pressure was found to be a pulse of 86 beats per minute. His lungs were clear, supple neck negative for jugular venous distention. The laboratory findings were as follows: serum creatinine was 2.8 K+ which is 5.1, blood urea nitrogen (BUN) was 56, sodium ions were 147, white blood cells level was 5.0, hemoglobin was 8.2, hematocrit level was 24.6, serum ferritin was 189mg/Dl M.W. takes 52 packs of tobacco and alcohol distant past.

The main goal of treating M.W. is controlling the anemia to prevent complete kidney failure, which can be achieved by making M. W’s body makes more red blood cells (Rath, n.d.). Also, lowering the serum creatinine, which was too high. Lowering the blood urea nitrogen, which is high, indicates poor kidney working. M.W hemoglobin and hematocrit levels should be raised to 13 and 40 respectively and above.

Medication prescribed to M.W includes Erythropoietin, a stimulating agent for raising red blood cells in the blood, hence raising hematocrit levels above 40% (Cleveland clinic, 2018). To lower the serum creatinine, M.W. should take trimethoprim-sulfamethoxazole antibiotics, which reduces creatinine secretion. Streptomycin lowers blood urea nitrogen. Also, M.W. should reduce or stop smoking tobacco that raises the blood urea nitrogen. Iron supplements orally will help increase hemoglobin levels.

To monitor the efficacy of the prescribed drugs, M.W was asked to come back for diagnosis. Diagnosis of glomerular filtrate rate and albumin to creatinine ratio is keenly checked (Monitor Chronic Kidney Disease Progression | NIDDK, n.d.). Basic education such as taking food with low salt content, taking food rich in iron to raise the iron level in the blood, and finally make him understand the importance of following the drugs transcription as stated.

If M.W. develops a heart problem and difficulty breathing, the prescribed therapy is not working. Hence I should change (Anemia in Chronic Kidney Disease | NIDDK, n.d.). The two main treatments that M.W. can buy over the counter are Erythropoietin and iron.

In conclusion, M.W. should change his lifestyle by reducing tobacco smoking. Also, he should take fresh food rich in minerals such as iron and potassium. M.W can also take time and do some exercise by jogging, swimming, or walking.

 

References

Anemia in Chronic Kidney Disease | NIDDK. (n.d.). National Institute of Diabetes and Digestive and Kidney Diseases. Retrieved March 1, 2022, from https://www.niddk.nih.gov/health-information/kidney-disease/anemia#:~:text=In%20people%20with%20CKD%2C%20severe

Cleveland clinic. (2018). Erythropoietin-Stimulating Agents | Cleveland Clinic. Cleveland Clinic.
https://my.clevelandclinic.org/health/drugs/14573-erythropoietin-stimulating-agents

Monitor Chronic Kidney Disease Progression | NIDDK. (n.d.). National Institute of Diabetes and Digestive and Kidney Diseases.
https://www.niddk.nih.gov/health-information/professionals/clinical-tools-patient-management/kidney-disease/identify-manage-patients/manage-ckd/monitor-progression

Rath, L. (n.d.). Anemia With CKD: Treatment Options. WebMD. Retrieved March 1, 2022, from
https://www.webmd.com/a-to-z-guides/anemia-ckd-treatment

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Luanda Gan Bedoya

Anemia of Chronic Kidney Disease

The goals of treatment of M.W., which has been diagnosed with anemia in chronic kidney disease (CKD), as well as comorbidities, are the treatment of renal failure, deep vein thrombosis, heart failure, blood pressure control, and diabetes 2. In this case, I would prescribe recombinant human erythropoietin therapy. Erythropoietin replacement therapy is the most effective and belongs to the standards of treatment of patients with CHF who have anemia (Gafter-Gvili et al., 2019). Since erythropoietin does not cause side effects, so often and strongly expressed with the introduction of androgens. In addition, parenteral administration of a well-purified and free of side effects drug not only stimulates the proliferation of normoblasts but also reduces ineffective erythroid production (Woo & Robinson, 2015). At the same time, the patient should monitor hemoglobin, blood sugar, and blood pressure to avoid adverse reactions to the prescribed drug. Therefore, drug treatment is important for this patient due to age and comorbidities.

M.W. should adhere to the prescribed regimen of pharmacological treatment, monitor the state of health, and key indicators such as sugar, hemoglobin, and blood pressure. Furthermore, since the patient is an elderly man with comorbidities, drug interactions are an important element in preventing complications. Erythropoiesis-stimulating agents have such side effects as hypertension, increased thrombosis, bone pain, allergic reactions, euphoria, and psycho-emotional arousal (Portolés et al., 2021). In such cases, the man should see a doctor and stop taking the medication. An alternative treatment for anemia of CKD is to use iron supplements or foods that contains iron. For example, M.W. may eat nuts, legumes, buckwheat, prunes and dried apricots, and lots of greens. In addition, the diet should be supplemented with vitamins C, B12, and folic acid. Finally, lifestyle changes also reduce the symptoms of anemia and correct the symptoms of comorbidities. Therefore, a man should give up smoking and drinking alcohol, exercise, follow a treatment regimen and diet.

References

Gafter-Gvili, A., Schechter, A., & Rozen-Zvi, B. (2019). Iron deficiency anemia in chronic kidney disease. Acta Haematologica, 142, 44–50. https://doi.org/10.1159/000496492

Portolés, J., Martín, L., Broseta, J. J., & Cases, A. (2021). Anemia in chronic kidney disease: From pathophysiology and current treatments, to future agents. Frontiers in Medicine, 8, 642296. https://doi.org/10.3389/fmed.2021.642296

Woo, T. M., & Robinson, M. V. (2015). Pharmacotherapeutics for advanced practice nurse prescribers (4th ed.). F.A. Davis Company.

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Discussion 11: Diagnosis: Anemia of Chronic Kidney Disease

Henly Rojas

Specific Goals of Treatment for M.W.

I can comment that within the specific goals for the treatment of said patient, that his condition is anemia in chronic kidney disease, is to strengthen renal function as quickly as possible, without affecting the other functions of the organism, as well as increasing the elaboration of red blood cells. Another aspect to mention is that the treatment given to this type of patient will be based on the etiology of said anemia and its signs and symptoms.

 

Drug Therapy for M.W.

Within the preliminary therapy that should be used for anemia of chronic kidney disease, erythropoiesis-stimulating agents (ESAs) should be used. Among these agents available in North America are epoetin alfa and darbepoetin alfa (Aranesp). Health providers should start treatment with these drugs for patients who present this pathology when the Hemoglobin is below 10 g/dL, this value being the indicated threshold to start treatment with erythropoiesis-stimulating agents in an individual patient.

For patients such as the one referred to in that discussion, with anemia associated with chronic kidney disease, epoetin alfa is started at 50 to 100 units/kg in adults calculated as 3 doses per week. The dose of epoetin alfa is adequate to maintain the value of Hgb at levels between 10 and 12 g/dL. The dose is increased by about 25% if the Hgb is less than 10 g/dL and has not increased by 1 g/dL after 4 weeks of treatment or if it falls below 10 g/dL. The dose of epoetin alfa is lowered by 25% if the hemoglobin is close to or equal to 12 g/dL or if it rises by more than 1 g/dL at any given time in 2 weeks.

 

Parameters For Monitoring Success of Therapy

 

The parameters to propose a successful treatment in relation to this type of pathology are to establish Hgb levels of 11 to 12 g/dL and Hct levels of 33% to 46%. To estimate a correct response to treatment with the type of drugs used, the KDIGO guidelines advocate quantifying Hemoglobin no less than once a month when in the initial phase. When in the maintenance phase, it is advisable to measure hemoglobin no less than every three months in non-dialysis-dependent patients and at least once a month in patients with dialysis-dependent chronic kidney disease. It is vitally important to monitor these parameters regularly in our patient since he is hypertensive and has congestive heart failure.

 

Specific Patient Education Based on The Prescribed Therapy

With reference to the education of our patient in relation to the drug used, patients with said pathology and who are not receiving dialysis should be advised that blood pressure and hematocrit should be regulated with the same periodicity as if they were receiving dialysis. dialysis. Another point to note is that the hematocrit should be kept under control with a regularity of twice a week until the appropriate value is reached, and the maintenance dose has been established and subsequently for at least 2 to 6 weeks after each adjustment of the dose. dose. The patient should be informed that the instructions related to the drug, its use and proper technique, storage, safe administration, among other details, can be found in the brochure. Another issue to mention is that our patients should be educated regarding the signs and symptoms of possible allergic reactions to said drug.

A very vital issue to mention is that we need to ensure that our patient takes into consideration all the instructions mentioned in the prescription. The same must be educated with reference to the form of administration, the correct use of the drug, if you have doubts you should contact the health care provider. Likewise, he should be educated that he should prepare the injection only when it is going to be administered, as well as if the color change solution should not be given. You should contact your doctor if you have any signs of weakness or tiredness or dizziness, if you are going to perform any surgical procedure you should inform the surgeon that you are receiving said drug and said drug must be refrigerated and out of reach of light and children.

 

Adverse Reactions of Epoetin Alfa

Among the most frequent adverse reactions we can mention high blood pressure and allergic reactions to the drug. You must have a thorough control of your blood pressure autonomously and you must know the different signs and symptoms of an allergic reaction. The patient should also be aware that there may be episodes of seizures, as well as heart attacks or strokes. Also, the use of epoetin alfa can accelerate the growth of tumors and decrease the time of remission or survival of certain patients. Its use should be prohibited in people who do not have controlled high blood pressure or in patients who at some points have presented pure red blood cell aplasia.

 

Appropriate Over the Counter And/or Alternative Medications for M.W.

 

When using alternative drugs, the use of agents that stimulate the production of endogenous erythropoietin in the kidney and non-renal tissues should be considered. Such agents work to stabilize the hypoxia-inducible component by inhibiting prolyl hydroxylase enzymes. These enzymes promote the release of iron into the bone marrow. This drug has the advantage that it can be administered orally. Within these drugs we can mention: roxadustat, vadadustat, daprodustat and molidustat. Patients taking Epoetin Alfa are recommended to take iron and multivitamin supplements such as Vitamin B12 and folate (B9).

Diet And Lifestyle Changes for M.W.

 

With regard to diet, it should be noted that a balanced diet helps control anemia, although it presents complications when choosing the diet plan when referring to patients with chronic kidney disease, since some foods with a high presence of iron such as red meats have a lot of protein and phosphorus at the same time, which are not good for people with chronic kidney disease. That is why it is recommended to go to professional dietitians who can help us in the development of an adequate eating plan. The first thing to do is select medications low in salt and sodium, which help us control blood pressure. Another point to consider is knowing the correct amount of food that we should eat, as well as the appropriate proteins for said pathology. Another element to consider is to choose healthy foods for our cardiovascular system, such as those low in fat, and limit alcohol intake and maintain an exercise routine, as well as eradicate the consumption of tobacco and its derivatives, such as cigarettes.

 

References

 

 

Moser, T., & Robinson, M.V. (2016). Pharmacotherapeutics for Advance Practice Nurse Prescribers. (4th ed.). Philadelphia: F. A. Davis Company.

 

Pietrangelo, A. (2021). Anemia in Chronic Kidney Disease: Treatment and More. Retrieved on March 12, 2022, from
https://www.healthline.com/health/kidney-disease/anemia-in-chronic-kidney-disease

 

Saumil P.; & Jayesh B. (2022). Epoetin Alfa. Retrieved on March 12, 2022, from
https://www.ncbi.nlm.nih.gov/books/NBK554547/

 

Desoto L.(2022). Nutrition and Chronic Kidney Disease. . Retrieved on March 12, 2022, from
https://www.verywellhealth.com/renal-diet-foods-for-healthy-kidneys-5214737
.

 

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