2) Follow this 🧵for your credit!
— @CKD_ce (@ckd_ce) June 8, 2023
Statement of accreditation and faculty disclosures are at https://t.co/PHlIppl6Yw. This program is intended for #healthcare #providers and is supported by an unrestricted educational grant from GSK.#FOAMed #nephtwitter @MedTweetorials
4) So let's talk about #anemia in the context of chronic #kidneydisease #CKD.
— @CKD_ce (@ckd_ce) June 8, 2023
Worldwide, anemia of CKD is very common, but how common…? Check the numbers: pic.twitter.com/gnkIRMozZw
6a) Let’s review #hematopoiesis:
— @CKD_ce (@ckd_ce) June 8, 2023
A- Hematopoietic stem cells (#HSCs) give rise to myeloid and lymphoid lineages of cells.
B- With the increased expression of GATA1 & decreased expression of PU.1, HSCs differentiate into megakaryocyte-erythroid progenitors
6c)
— @CKD_ce (@ckd_ce) June 8, 2023
D- Delivery of 02 to the kidney depends on #hemoglobin #Hgb concentration. If Hgb concentration ⤵️, pericytes or peritubular fibroblasts sense hypoxia & produce EPO
🔓 https://t.co/CegwTKmWQZ pic.twitter.com/GYnrSR2Pz0
7b) But under hypoxia, the #HIF hydroxylation is inhibited and these stabilized alpha subunits bind to beta subunits and translocate to the nucleus, binding Hypoxia-Response Elements #HREs, promoting transcription of genes involved in #erythropoiesis. pic.twitter.com/OUhhYtpa6V
— @CKD_ce (@ckd_ce) June 8, 2023
9) #Hepcidin was discovered in 2000. It’s a key regulator of Fe metabolism, use, recycling & transport. It’s produced by the liver & levels are affected by Fe stores, inflammatory states, & #EPO. Elevated levels lead to iron sequestration and functional iron deficiency. pic.twitter.com/oXAS6pL0ip
— @CKD_ce (@ckd_ce) June 8, 2023
11) How do we screen for #anemia in #CKD? .@goKDIGO recommends screening for all patients with CKD III at least annually and more frequently in those with advanced CKD
— @CKD_ce (@ckd_ce) June 8, 2023
🔓 https://t.co/0c3pN0Yymi pic.twitter.com/s9v8e2yUWy
13) How do we diagnose iron deficiency #anemia in #CKD? Check #hemoglobin, serum #ferritin saturation (#TSAT), & serum ferritin.
— @CKD_ce (@ckd_ce) June 8, 2023
Fatigue, ⬇️cognitive function, loss of libido, & ⬇️sense of well being are the most common clinical manifestations of anemia in CKD. pic.twitter.com/CRa4Sae3ve
15) Traditional ferrous salts such as ferrous sulfate, are oral #iron preparations are used by most physicians due to their low cost. Newer oral formulations (i.e. ferric citrate and ferric maltol) are more expensive but their use is limited due to their cost. pic.twitter.com/Sg4yFw95K1
— @CKD_ce (@ckd_ce) June 8, 2023
17) As much as possible, avoid #transfusions of #PRBCs! This can result in clinically significant increases in antibody production impacting subsequent #kidney transplant outcomes. pic.twitter.com/Leqa1LZ0Y1
— @CKD_ce (@ckd_ce) June 8, 2023
19a) So what have you learned?
— @CKD_ce (@ckd_ce) June 8, 2023
âť“ What is the role of the #VHL tumor suppressor protein in the #HIF pathway?
a. It mediates hydroxylation of HIF-α
b. It facilitates ubiquitination of hydroxylated HIFs, ➡️ proteasomal degradation
c. It binds to #HRE
d. None of the above
20a) Which of the following about #hepcidin is true?
— @CKD_ce (@ckd_ce) June 8, 2023
a. Synthesized by liver due to inflammation
b. Based on Fe demand, hepcidin regulates Fe import into plasma
c. Overexpression of hepcidin ➡️ internalization & degradation of ferroportin in duodenal enterocytes
d. all the above
21) You just earned 0.5hr CE/#CME, #physicians #physicianassociates #nurses #NPs #pharmacists! Go to https://t.co/6zBJDecilQ & grab your certificate. .@HecmagsMD thanks you for JOINING us, invites you to FOLLOW us, and reminds you to watch the 📽️ at https://t.co/61lXmmrk5f.
— @CKD_ce (@ckd_ce) June 8, 2023