Anemia pada pasien CKD on

CAPD
Stase HOM
Diagnosis of anemia
• Diagnose anemia in adults and children >15 years with CKD when the
Hb concentration is <13.0 g/dl (<130 g/l) in males and <12.0 g/dl
(<120 g/l) in females.
Kidney International Supplements (2012) 2, 283–287

• Anemia is defined by the World Health Organization (WHO) criteria as

a hemoglobin (Hb) concentration <13 g/dL for adult males and
postmenopausal women and an Hb <12 g/dL for premenopausal
women
World Health Organization. Nutritional Anaemias: Report of a WHO Scientific Group. Geneva, Switzerland: World Health Organization, 1968
• HB : 5.2
• MCV : 76.4
• MCH :24.5 Anemia mikrositik hipokromik

Iron 16 (37-145)
TIBC 117 (228-428)
Saturasi 14 % (20-55)
UIBC 101 (112-346) Defisiensi besi
Systemic approach to anemia
• History : nutritional intake, review GI symptoms (abdominal
discomfort, hematochezia and bright red rectal bleeding), menstrual
history, systemic symptoms of an underlying chronic infectious or
inflammatory process, occupational or residential exposure to toxins,
such as lead, varying levels of fatigue or dyspnea.
• As the severity of anemia increases, physical findings may include a
systolic murmur and pallor of the mucous membranes, nail beds, and
palmar creases
(AAFP, 2010)
Investigation of anemia
• In patients with CKD and anemia (regardless of age and CKD stage), include
the following tests in initial evaluation of the anemia (Not Graded):
• Complete blood count (CBC), which should include Hb concentration, red
cell indices, white blood cell count and differential, and platelet count
• Absolute reticulocyte count
• Serum ferritin level
• Serum transferrin saturation (TSAT)
• Serum vitamin B12 and folate levels
Kidney International Supplements (2012) 2, 283–287
• Testing for occult blood in stool if iron deficiency is documented.
(UpToDate, 2018)

• Ferritin measurement is recommended as the first laboratory test for

evaluation of microcytosis.
(AAFP, 2010)
• Serum ferritin values <30 ng/ml (<30 mg/l) indicate severe iron
deficiency and are highly predictive of absent iron stores in bone
marrow.
• Ferritin values >30 ng/ml (>30 mg/l), however, do not necessarily
indicate the presence of normal or adequate bone marrow iron stores
Treatment of anemia in peritoneal dialysis
patients (UpToDate, 2019)
• The goal of treatment is to mitigate symptoms that may be related to
anemia and to reduce the likelihood of needing a blood transfusion.
• The selection of the individual therapy depends on the severity of
anemia and on the status of the iron parameters.
• Hb targets for peritoneal dialysis patients are the same as those for
hemodialysis patients. For most peritoneal dialysis patients who are
treated with ESAs, target Hb levels between 10 and 11.5 g/dL.
• The treatment of anemia includes iron, erythropoiesis-stimulating
agents (ESAs), and, among selected patients, blood transfusion
Initial treatment of hemoglobin ≤10 g/dL among peritoneal dialysis
patients

UpToDate, 2019
Use of ESAs and other agents to treat anemia
in CKD
• Address all correctable causes of anemia (including iron deficiency
and inflammatory states) prior to initiation of ESA therapy.
• For adult CKD 5D patients, we suggest that ESA therapy be used to
avoid having the Hb concentration fall below 9.0 g/dl (90 g/l) by
starting ESA therapy when the hemoglobin is between 9.0–10.0 g/dl
(90–100 g/l). (2B)
Kidney International Supplements (2012) 2, 283–287
Red cell transfusion to treat anemia in CKD

Kidney International Supplements (2012) 2, 283–287

Red cell transfusion to treat anemia in CKD
• When managing chronic anemia, we recommend avoiding, when
possible, red cell transfusions to minimize the general risks related to
their use. (1B)
• We suggest that the decision to transfuse a CKD patient with non-
acute anemia should not be based on any arbitrary Hb threshold, but
should be determined by the occurrence of symptoms caused by
anemia. (2C)

Kidney International Supplements (2012) 2, 283–287

URGENT TREATMENT OF ANEMIA
• In certain acute clinical situations, we suggest patients are transfused
when the benefits of red cell transfusions outweigh the risks; these
include (2C):
• When rapid correction of anemia is required to stabilize the patient’s
condition (e.g., acute hemorrhage, unstable coronary artery disease)
• When rapid pre-operative Hb correction is required

Kidney International Supplements (2012) 2, 283–287

Sintesa stase
• Wanita 46 thn dgn CKD stg V dgn CAPD mengeluh lemas.
• Hb 5,2, MCV 76 MCH 24 , K 2,37
• Profil besi : Saturasi 14, TIBC 117, iron 16, UIBC 101
• Diagnosis
• CKD stg V on CAPD dgn problem :
• anemia renal et chronic disease dd defisiensi besi
• Plan :
• CAPD sesuai TS nefro
• Tranfusi PRC untuk mengatasi anemia simtomatik
• Cek ferritin serum
• Suplemen besi dan Memperbanyak konsumsi makanan kaya zat besi