I. Pathogenesis (see above)
2. Chronic kidney disease staging (see above)
Three: complication treatment:
(1) Prevention and control of water and sodium retention (see above)
(ii) Prevention and control of potassium retention (see above)
(3) Treatment of H+ retention (see above)
(iv) Prevention and control of phosphorus retention (see above)
(5) Correction of renal anemia:
1: Assess the degree of anemia and the status of iron in the body.
(1) Such as anemia assessment: hemoglobin < 100g/l and start erythropoietin EPO therapy after excluding anemia caused by the digestive tract, with a target of >115g/l. (Criteria for anaemia: 130 g/L for male <, 120 g/L for nonpregnant females <, 110 g/L for pregnant females <)
(2) Iron status assessment:
a: Iron reserve assessment: serum ferritin. b: Assessment of iron adequacy of erythrocyte production: serum transferrin saturation TSAT (serum iron/transferrin i.e., total iron binding force) is recommended. Mean red blood cell volume (MCV) and mean red blood cell hemoglobin concentration (MCH) are lower than normal only for long periods of time when iron deficiency is low.
c: Iron supplementation should be made to the target target, regardless of dialysis. Dialysis 200ug/l< ferritin < 500ug/l and 20% < TSAT<50%, non-dialysis or peritoneal dialysis: 100ug/l< ferritin <500ug/l and 20% < TSAT<50%.
2: Supplementation with EPO (erythropoietin):
The initial subcutaneous total amount was 100-120 IU/Kg/week (given in 1-2 times), the growth rate of Hb was 10-20g/l per month, the increase < the dose of 10g/l was increased by 25%, and the > 20g/l was reduced by 25%. The change in Hb concentration in the stable phase > the increase or decrease of 10 g/l dose by 25%. (Up to 300u/kg/week, four months still not up to the standard should pay attention to EPO resistance).
3: Iron supplementation:
(1) Non-dialysis or peritoneal dialysis patients can take iron by mouth. Oral: 200 mg of elemental iron daily, monthly assessment during the induction phase of EPO and onset of anaemia, and every 1 to 3 months after stabilization. (Ferrous gluconate contains 12% iron, ferrous sulfate 20%, ferrous lactate 19%, dextran 27-30%, ferrous fumarate 32.9%, ferrous succinate 35%, polysaccharide iron complex 46%)
(2) Dialysis requires a larger amount of iron than non-dialysis, and veins are the best route. Iron sucrose is the safest intravenous iron agent. Intravenous iron supplementation requires allergy testing, especially dextran iron. Patients are closely observed for 1 h after the first infusion and prepared for resuscitation. In the presence of systemic active infections and severe liver disease, intravenous iron should be contraindicated.
Intravenous iron supplementation: (1) Initial phase: a course of iron sucrose or iron dextran is usually 1000 mg (e.g., 100 mg/dose 3 times a week). After the completion of one course of treatment, the iron status has not yet reached the standard, and a course of treatment can be repeated. (2) Maintenance treatment stage: when the iron status reaches the standard, the dose and time interval given should be adjusted according to the patient's iron status, the average weekly amount of iron sucrose or dextran iron is about 50 mg, and excessive intravenous iron supplementation can cause hemosiderin deposition in internal organs. (3) Monthly assessment during the induction phase of EPO and when anemia worsens, and every 1 to 3 months after stabilization.
4: Blood transfusion if necessary: avoid blood transfusion as much as possible, Hb level alone is not used as the standard for blood transfusion, and red blood cell transfusion therapy may be considered in the following cases: anemia with EPO resistance; severe anemia with cardiovascular and neurological symptoms.
(Note: (1) Levocarnidine: Hemodialysis may be beneficial, not recommended as conventional treatment, should be treated according to clinical practice as appropriate.) (2) Vitamin C and androgen preparations: routine supplementation is not recommended.
Emergency Department of Tieying Hospital (Li Xuefeng)
October 23, 2021
(Disclaimer: Personal summary, for reference, welcome to correct)