Anemia Management Protocol: Hemodialysis - BC Renal Agency

BCPRA HEMODIALYSIS ANEMIA MANAGEMENT PROTOCOLUPDATED APRIL 2012FOR HEALTH AUTHORITIES REPEATING BLOOD WORK EVERY 4 WEEKSPAGE 2: ASSESS IRON STATUS (Standard Iron Parameters – TSAT & Ferritin)If at anytime the serum ferritin is above 1000 mcg/L, or the patient is on IV antibiotics or has signs and symptoms ofsepsis (e.g. temperature > 38°, chills, rigors, unexplained hypotension), do not give IV iron.TSAT > 50%Ferritin >1000 mcg/Lsee aboveIRON OVERLOADTSAT 22% to 50%MAINTAIN IRON STORESTSAT < 22%REPLETE IRON STORESHOLD IRONMeasure TSAT andferritin in 5 weeks andreassess iron dosageregimenNB. Notify MD if ironindices remain highfor 3 consecutivemeasurementsIf receivingmaintenance iron:Continue currentmaintenance doseRefer to currentmaintenance doseIf iron loadingdose justcompleted:Start ironmaintenancedoseFerrlecit ®125 mg IV 2 times/monthDexIron ®100 mg IV 2 times/monthIf iron is currentlyon hold:Restart ironmaintenancedoseFerrlecit ®125 mg IV monthlyDexIron ®100 mg IV monthlyIf not on IV iron:Start IV ironmaintenancedose (obtainMD order tostart anemiaprotocol)START IRON LOADING DOSE• If TSAT < 20% and Ferritin is > 1000 mcg/L,refer to MD for an assessment and ironmanagement prescription• Do not start/continue IV iron loading doseif Hgb is > 120 g/L => give iron monthlymaintenance dose• NB. No more than 3 courses of ironreplacement may be administered in a row.Notify MD if iron indices remain low.Venofer ®100 mg IV 2 times/monthVenofer ®100 mg IV monthlyMeasure TSAT and ferritin in 5 weeks andreassess iron dosage regimen.< less than≤ less than or equal to> greater than≥ greater than or equal toMeasure TSAT and ferritin in 3 months and reassess iron dosage regimenIV iron loading dose:Ferrlecit ® 125 mg IV 3 times/week for 3 weeksDexIron ® 100 mg IV 3 times/week for 3 weeksVenofer ® 100 mg IV 3 times/week for 3 weeks

BCPRA HEMODIALYSIS ANEMIA MANAGEMENT PROTOCOLESA DOSAGE ADJUSTMENT TABLESUPDATED APRIL 2012The following tables provide guidance for most dosage adjustments. If a patient’s Hgb cannot bemaintained within the desired range with 3 consecutive dose modifications using the dosage schedulebelow, contact a nephrologist or renal pharmacist for advice. If a patient’s erythropoiesis stimulatingagent (ESA) dosage is not available in the tables below, please contact a nephrologist for ESA dosagemodification. The lowest ESA dosage to maintain Hgb within acceptable range should be used.Darbepoetin (Aranesp®) Dosage Adjustment TablePre-filled syringes available for CKD patients include: 10 mcg, 20 mcg, 30 mcg, 40 mcg, 50 mcg,60 mcg, 80 mcg, 100 mcg, 130mcg and 150 mcg.Current Dose Increase Dose Decrease Dose10 mcg every 2 weeks10 mcg every 1 week20 mcg every 1 week30 mcg every 1 week40 mcg every 1 week50 mcg every 1 week60 mcg every 1 week80 mcg every 1 week100 mcg every 1 week130 mcg every 1 week150 mcg every 1 week10 mcg every 1 week20 mcg every 1 week30 mcg every 1 week40 mcg every 1 week50 mcg every 1 week60 mcg every 1 week80 mcg every 1 week100 mcg every 1 week130 mcg every 1 week150 mcg every 1 weekCheck for nephrologistD/C, check Hgb in 2 weeks10 mcg every 2 weeks10 mcg every 1 week20 mcg every 1 week30 mcg every 1 week40 mcg every 1 week50 mcg every 1 week60 mcg every 1 week80 mcg every 1 week100 mcg every 1 week130 mcg every 1 weekEpoetin alpha (Eprex®) Dosage Adjustment TablePrefilled syringes available for CKD patients include: 1000 units, 2000 units, 3000 units, 4000units, 5000 units, 6000 units, 8000 units and 10,000 units.Current Dose Increase Dose Decrease Dose1000 units every 1 week2000 units every 1 week3000 units every 1 week2000 units 2 times per week3000 units 2 times per week4000 units 2 times per week5000 units 2 times per week6000 units 2 times per week8000 units 2 times per week10,000 units 2 times per week8000 units 3 times per week10,000 units 3 times per week2000 units every 1 week3000 units every 1 week2000 units 2 times per week3000 units 2 times per week4000 units 2 times per week5000 units 2 times per week6000 units 2 times per week8000 units 2 times per week10,000 units 2 times per week8000 units 3 times per week10,000 units 3 times per weekCheck with nephrologistD/C, check Hgb in 2 weeks1000 units every 1 week2000 units every 1 week3000 units every 1 week2000 units 2 times per week3000 units 2 times per week4000 units 2 times per week5000 units 2 times per week6000 units 2 times per week8000 units 2 times per week10,000 units 2 times per week8000 units 3 times per weekt