2) @ckd_ce is your ONLY source for π CE/#CME delivered wholly on Twitter! This program is supported by an educational grant from GSK. Statement of accreditation & faculty disclosures at https://t.co/PHlIpplEO4. Past programs still available for credit at https://t.co/KmHXCtvHyb!
— @CKD_ce (@ckd_ce) January 26, 2023
4) Anemia of chronic kidney disease (CKD) is primarily caused by deficiency of #erythropoietin (#EPO)
— @CKD_ce (@ckd_ce) January 26, 2023
π The kidneys are the major source of EPO, and as kidney function declines, production of EPO declines proportionately
5b) That was a trick question (sorry, not sorry)
— @CKD_ce (@ckd_ce) January 26, 2023
All of the above contribute to decrease RBC lifespan in #aCKD
Inflammation (via inflammatory cytokines) also plays an important mechanistic role
π π https://t.co/6Xm978fcBt pic.twitter.com/JCrZQEnVQV
7) Iron (Fe) availability is controlled by #hepcidin, which regulates dietary Fe absorption & macrophage Fe recycling from senescent RBCs
— @CKD_ce (@ckd_ce) January 26, 2023
π In those w/ CKD/ ESKD, hepcidin levels are β¬οΈ due to β¬οΈ renal clearance & induction by inflammation β‘οΈ Fe restricted erythropoiesis
9) #CKD also inhibits #EPO production by the kidney, and may also lead to
— @CKD_ce (@ckd_ce) January 26, 2023
π Circulating uremic-induced inhibitors of #erythropoiesis
π β¬οΈ RBC lifespan, and
π β¬οΈ Blood loss
11) Use of iron (Fe) to treat anemia of #CKD according to @goKDIGO guidelines ca. 2012
— @CKD_ce (@ckd_ce) January 26, 2023
π π https://t.co/But3KAx1wA pic.twitter.com/lQz2DBvsY8
13) Intravenous iron (Fe) agents used for treating #anemia in patients with kidney disease
— @CKD_ce (@ckd_ce) January 26, 2023
Table from @NephMadness @nupur_nephron @Nephronpower
π π https://t.co/47CWxy0sbZ pic.twitter.com/tS0Pq3rgMC
15) Subcutaneously administered #epoetin has slower absorption & longer half-life, and is more effective than a comparable dose administered through IV pic.twitter.com/fKEe0GJaJO
— @CKD_ce (@ckd_ce) January 26, 2023
17) In these #RCTs patients experienced β¬οΈrisks for death, major adverse #cardiovascular events, and #stroke when administered ESAs to target #Hb level >11 g/dL
— @CKD_ce (@ckd_ce) January 26, 2023
π No trial has identified a Hb target level, #ESA dose, or dosing strategy that does not increase these risks
19) Therefore, it is recommended that the lowest #ESA dose be used that is sufficient to reduce the need for RBC #transfusions
— @CKD_ce (@ckd_ce) January 26, 2023
21) RBC transfusion therapy for the anemia of CKD in the pre-ESA era was associated with which of following:
— @CKD_ce (@ckd_ce) January 26, 2023
A. Transmission of bloodborne infections
B. Fe overload
C. Sensitization for future kidney transplantation
D. All of the above
23) Nonetheless, RBC transfusions are occasionally required in patients with anemia and CKD, despite the use of ESA and iron therapy, especially in the setting of acute blood loss
— @CKD_ce (@ckd_ce) January 26, 2023
24b) π HIF-Ξ² is constitutively expressed, while HIF-Ξ± is modulated by oxygen tension via a family of HIF-prolyl hydroxylases (PHD) regulating its degradation
— @CKD_ce (@ckd_ce) January 26, 2023
26) HIF stabilizers (also called #PHIs, prolyl hydroxylase inhibitors) are small-molecule oral agents resulting in the activation of HIF-mediated gene expression
— @CKD_ce (@ckd_ce) January 26, 2023
π https://t.co/JvAcTeqFAJ pic.twitter.com/wqA296Fval
28) The HIF pathway also regulates Fe #homeostasis to meet the Fe demands of #erythropoiesis via direct & indirect mechanisms (β¬οΈ #transferrin, transferrin receptor, duodenal cytochrome B, divalent metal transporter-1, #ceruloplasmin)
— @CKD_ce (@ckd_ce) January 26, 2023
π π https://t.co/6Xm978fcBt pic.twitter.com/5xcbdQPujH
30) In summary
— @CKD_ce (@ckd_ce) January 26, 2023
π #Anemia of #CKD #aCKD is primarily caused by deficiency of #erythropoietin
πMany patients with CKD not receiving #hemodialysis and most patients receiving hemodialysis are Fe deficient and require Fe supplementation
32) Summary continued β
— @CKD_ce (@ckd_ce) January 26, 2023
π The #HIF pathway is the key oxygen sensing pathway in cells that plays an imp't role in the physiological response to hypoxia
π HIF stabilizers may have a role in patients unable to reach target hemoglobin levels on β¬οΈ doses of #ESA (#EPO resistant)
33) And that's it! You just earned 0.5hr π CE/#CME! π±οΈ to https://t.co/1w968lGkQc to claim your certificate. And FOLLOW US for more expert-authored #accredited #tweetorials! I am @edgarvlermamd and I thank you for joining us! pic.twitter.com/iCKhhDwG3i
— @CKD_ce (@ckd_ce) January 26, 2023