Kidney disease, chronic peritoneal dialysis

FIGURE 76-5. Guidelines for iron therapy in the management of the anemia of chronic kidney disease (CKD). (CHr, content of hemoglobin in the reticulocytes ESA, erythropoietic-stimulating agent Hb, hemoglobin HD, hemodialysis PD, peritoneal dialysis TSat transferrin saturation.)... 

Dialysis should be initiated electively rather than urgently in patients with chronic kidney disease (see Chap. 44). Because of the progressive nature of the disease, the planning for dialysis should begin once the patient s creatinine clearance (Clcr) drops below 30 mL/min per 1.73m .Beginning the preparation process at this point allows adequate time for proper education of the patient and family and for the creation of suitable vascular or peritoneal access. 

Patients with anemia secondary to chronic kidney disease are ideal candidates for epoetin alfa therapy. The response in predialysis, peritoneal dialysis, and hemodialysis patients is dependent on the severity of renal failure, erythropoietin dose and route of administration, and iron availability. The subcutaneous route of administration is preferred to the intravenous route because absorption is slower and the amount of drug required is reduced by 20 to 40%. 

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