Skip to 0 minutes and 14 secondsAnd EPO therapy after creating in the iron level, EPO as a most important and actually treat underlying diseases for patient with anemia in CRF. So there are several different kinds of EPO products and we know that erythropoietin is actually produced in renal and that's very important to help the patient give enough for EPO in their treatment. And EPO therapy usually we can use that by patient's level and remember to check the patient if they have some reason to resistant to EPO therapy including iron deficiency infection or aluminum toxicity and safer for EPO include hypertension, seizures, hyperkalemia and some flu-like symptoms.

Skip to 1 minute and 27 secondsSo for patient with EPO therapy, we need to actually monitor their hematocrit and hemoglobin level and also checking if their iron status is enough. And so there is a table provided for those monitoring schedules. So initial phase so we may want to check out more frequently and when a patient become more stable, we can check their level quarterly. And there are different kinds of formulary and now EPO comes with an EPO alpha, beta and darbepoetin and they have different link near carbohydrate chains. So actually their potency is different.

Skip to 2 minutes and 27 secondsAnd long-acting EPO analog is coming very more common and that's we called CERA, continuous erythropoietin receptor activator and CERA has more extended duration of action and with large polymer chain and that's has longer action and the patient can actually have those medication with less frequent dosing interval. And long-acting EPO there's another called Mircera and it's also a very new one with glycol-epoetin chain And this is also for chronic renal failure. And the half life is much longer even twenty times longer and epoetin and that's recommended dose even every two weeks.

Skip to 3 minutes and 38 secondsSo in our summary, we need to manage the underlying diseases and the well control for blood pressure, lipid, glucose, and closely follow a dietary plan for a CRF patients and also remember to treat those complications for those important complications. So that's the end of our renal, chronic renal failure patient treatment. Thank you

EPO therapy & Summary of this week

In this step, Prof. Chen explains the EPO therapy and gives the summary of this week.

First, the side effects for taking EPO therapy include influenza-like symptoms.

Secondly, we need to monitor their hematocrit and hemoglobin level, and check if their iron status is enough. The target Hct/Hb is between 33% (11g/dl) and 36% (12g/dl), and the target iron level, TSAT, need to be more than 20%, with ferritin ≥ 100 ng/ml.

Initially, we have to check out frequently. However, when the patient becomes stable, we can check it quarterly.

Besides, there are other options, including Epoetin α/β and Darbepoetin α. If you want to use long-acting EPO, Micera is a good choice. Recommended initial dose in ESA-naïve is 0.6 ug/kg once every 2 weeks.

Finally, we have learned the management of underline diseases, how to control BP, lipid and glucose, and the treatment of complications.

Which topic impressed you the most during this week? Please share it below.

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This video is from the free online course:

Pharmacokinetics: Drug Dosing in Renal Disease

Taipei Medical University