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EPO
If no other
cause for EPO deficiency is found, it can be treated with a
genetically engineered form of the hormone, which is usually
injected under the skin two or three times a week. Hemodialysis
patients who can't tolerate EPO shots may receive the hormone
intravenously during treatment, but this method requires a larger,
more expensive dose and may not be as effective. DOQI recommends
that patients treated with EPO therapy should achieve a target Hgb
of 11 to 12 g/dL.
Iron
Many people with kidney
disease need both EPO and iron supplements to raise their Hct to a
satisfactory level. If your iron levels are too low, then EPO won't
help and you'll continue to experience the effects of anemia. You
may be able to take an iron pill, but many studies show that iron
pills don't work as well in people with kidney failure as iron given
intravenously. Iron is injected directly into an arm or into the
tube that returns blood to your body during hemodialysis.
A
nurse or doctor will give you a test dose because a very small
number of people (less than 1 percent) have a bad reaction to iron
injections. If you begin to wheeze or have trouble breathing, your
health care provider can administer epinephrine or corticosteroids
to counter the reaction. Even though the risk is small, you'll be
asked to sign a form stating that you understand the possible
reaction and that you agree to have the treatment. Talk with your
health care provider if you have any questions.
In addition
to measuring your Hct and Hgb, your tests will also include two
measurements to show whether you have enough iron.
- Your ferritin level indicates the amount of iron stored in
your body. According to DOQI guidelines, your ferritin score
should be no less than 100 micrograms per liter (mcg/L) and no
more than 800 mcg/L.
- TSAT stands for transferrin saturation, a score that indicates
how much iron is available to make red blood cells. DOQI
guidelines call for a TSAT score between 20 percent and 50
percent.
In addition to EPO
and iron, a few people may also need vitamin B12 and folic acid supplements.
If
EPO, iron, vitamin B12, and folic
acid all fail, your doctor should look for other causes such as
sickle cell disease or an inflammatory problem. At one time,
aluminum poisoning contributed to anemia in people with kidney
failure because many phosphate binders used for treating bone
disease caused by kidney failure were antacids that contained
aluminum. But aluminum-free alternatives are now widely available.
Be sure your phosphate binder and your other drugs are free of
aluminum.
Anemia keeps many people with kidney disease from
feeling their best. But EPO treatments help most patients raise
their Hgb, feel better, live longer, and have more
energy.
Keeping on Top of Your Condition
Keeping in tune with your disease or condition not only makes treatment less intimidating but also increases its chance of success, and has been shown to lower a patients risk of complications. As well, as an informed patient, you are better able to discuss your condition and treatment options with your physician.
A new service available to patients provides a convenient means of staying informed, and ensures that the information is both reliable and accurate. If you wish to find out more about HealthNewsflash's innovative service, take the tour.
For more information,
contact the following organizations:
American Association
of Kidney Patients
100 South Ashley Drive
Suite
280
Tampa, FL 33602
Phone: 1-800-749-2257 or (813)
223-7099
Fax: (813) 223-0001
Email: AAKPnat@aol.com
Internet: http://www.aakp.org/
American
Kidney Fund
6110 Executive Boulevard
Suite
1010
Rockville, MD 20852
Phone: 1-800-638-8299
Fax: (301)
881-0898
Email: mailto:helpline@akfinc.org
Internet:
http://www.akfinc.org/
National
Kidney Foundation
30 East 33rd Street
New York, NY
10016
Phone: 1-800-622-9010
Fax: (212) 889-2210
Email: info@kidney.org
Internet: http://www.kidney.org/
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