Low HEMOGLOBIN

[Bungarian]

On the 10th it was 10.0 and they took labs Thursday and it was 8.5

I accessed my lab results on the Davita website and have not talked to anyone at my clinic about it. What would cause it to fall? Is it too low?

I feel fine and would not know without the labs.

[Michael Murphy]

From what I understand hemoglobin levels are maintained by drugs given during dialysis.  The doctor will up the dosages and it will go back up.

[Hootie]

Our nephrologist uses epo to manage the hemoglobin. She changes dosage based on hemoglobin levels. We administer at home at start of dialysis once a week. Dosage varies over time based on hemoglobin labs. The EPO stimulates the bone marrow to make blood. Normal kidney function does that except in CKD patients.

[Vt Big Rig]

We administer at home at start of dialysis once a week.

Interesting ... We were told to administer at then end of dialysis at the end of the week.

Also at home

[Bungarian]

I take epo and iron at my clinic. I guess they need to up the dosage.

[PrimeTimer]

We administer at home at start of dialysis once a week.

Interesting ... We were told to administer at then end of dialysis at the end of the week.

Also at home

We too were told to do the EPO after treatment. My husband will be starting on Micera tho before the end of the month. Has to go to the clinic for that. Darn.

[PrimeTimer]

I take epo and iron at my clinic. I guess they need to up the dosage.

They will need to give you more EPO first tho before they can do the iron. The EPO will produce blood cells that are needed for iron to latch on to. 
You can read up on it here: "Kidney Disease And Anemia: Why Is It So, And How Is It Treated?" by Dr. John Agar dated 10-29-15.

[Vt Big Rig]

We too were told to do the EPO after treatment. My husband will be starting on Micera tho before the end of the month. Has to go to the clinic for that. Darn.

If they follow the same procedure they will iron load your hubby before the micera. I was given the first micera shot last clinic. NEVER AGAIN. The same night I developed spasmodic headaches  that would come every 15 to 30 seconds. Hurt like HE double toothpicks. They were bad enough to make me cringe every time. Lasted two or three days. I am back on EPO.

[PrimeTimer]

We too were told to do the EPO after treatment. My husband will be starting on Micera tho before the end of the month. Has to go to the clinic for that. Darn.

If they follow the same procedure they will iron load your hubby before the micera. I was given the first micera shot last clinic. NEVER AGAIN. The same night I developed spasmodic headaches  that would come every 15 to 30 seconds. Hurt like HE double toothpicks. They were bad enough to make me cringe every time. Lasted two or three days. I am back on EPO.

That's what I fear. My husband is the quiet type, not one to ever complain so I told him to please, PLEASE speak up if he experiences any side effects.

Question: When you went back on EPO, were you able to get it from your clinic or do they write you a prescription for it? The clinic gives my husband EPO to inject at home but say they won't be carrying it anymore now that they are switching to Micera so, I was wondering if he has to go back on EPO if that means they will have to write him a prescription for it to be filled at a pharmacy.

[Vt Big Rig]

So far the clinic has gone back to ordering my EPO. I have clinic this week so we shall see if it changes.

[Bungarian]

I saw the nutritionist today. She said they would increase my epo. She also said to eat more red meat and put me o something called Renavit.

[PrimeTimer]

I saw the nutritionist today. She said they would increase my epo. She also said to eat more red meat and put me o something called Renavit.

When my husband's Hemoglobin was down to a 6 (long story) they increased his EPO injections from 1x a week to 2-3x a week for a month. That did the trick.

Sorry, should have added the fact that he got a blood transfusion AND THEN they increased his EPO.

[Riki]

Mine dropped once, back in 2005.  It was at 7.7, if I remember right.  I was on PD at the time, and getting Aranesp every 2 weeks.  They did all kinds of tests, looking for the reason for the drop, but never found anything.  What they did for me was, first, a blood transfusion, then had to have Venofer once a week for 6 weeks, and that seemed to do the trick.

Now, my hemoglobin is high enough, I think the last one I saw was 12.5, that I don't need Arenesp anymore, and I had such nasty blood pressure issues while on Feralicit, that I was taken off that too.  I take Feramax now to keep my iron stores up, but that's it.

[Bungarian]

Latest test show it is up to 10.0

[PrimeTimer]

Latest test show it is up to 10.0

That's great! How many people can say they REALLY ARE a "10"! lol  And just in time for the holidays and the start of a (hopefully good) new year! Yay Hemoglobin!

[Simon Dog]

I was down to 6.2 after my transplant (hip, not kidney).    I was told this was the result of the surgery, and my refusal to accept transfusions (which my MDs supported).    I was exiled back to the clinic until it hit 8.5.

[Charlie B53]

Nurse tells me my numbers but my brain is a lot like a seive, it fails to hold much.

I am on a daily iron supplement in attempt to keep my iron within range.  Many times it has dropped as low as 10%.  Nurse gets exciited and bothers Dr until he order Iron IV. Sometimes up to 4 rounds, once a week, and I feel a lot better.

Red count is linked to iron, starts falling off once I get under about 15%.  No Epo yet.

Nurse was telling me something about the NEW medicare drug changes, that Epo may no longer be covered without exception, that most all will be switched to (?) Aracept.  Not sure of the name as I haven't had any, yet.

Ask about your iron levels, does it need attention?  A addition to your diet of iron rich food/source?

[Simon Dog]

Nurse was telling me something about the NEW medicare drug changes, that Epo may no longer be covered without exception, that most all will be switched to (?) Aracept.  Not sure of the name as I haven't had any, yet.

Fresenius has been switching patients to Micera (PEGged EPO)

[Riki]

Nurse was telling me something about the NEW medicare drug changes, that Epo may no longer be covered without exception, that most all will be switched to (?) Aracept.  Not sure of the name as I haven't had any, yet.

Aranesp is similar to Epo, but it works slower over a longer period of time.. so you generally only need it once or twice a month, where with Epo it was once a week at least... it was also given to us on the machine, so no extra sticks, which I liked.. when I was on it anyway.. I don't need it anymore.. Arenesp also needs iron to work, so if you get IV iron, you'll probably get it the same day

[PatDowns]

They will need to give you more EPO first tho before they can do the iron. The EPO will produce blood cells that are needed for iron to latch on to. 
You can read up on it here: "Kidney Disease And Anemia: Why Is It So, And How Is It Treated?" by Dr. John Agar dated 10-29-15.

This is wrong information.  You might have misread Dr. Agar's article.   If ones iron levels are too low, then EPO or any other ESA (erythropoiesis-stimulating agents)  alone won't help with esrd related anemia.  EPO needs iron to replenish red blood cells.   I don't like to reinvent the wheel.  So, while I couldn't find the article you referred to by using google search, I did find this info from the Kidney School on Anemia and Kidney Disease - http://www.kidneyschool.org/pdfs/KSModule6.pdf

On page 6-5: Anemia and Iron - "There is another key player in the anemia story besides EPO: iron.  Iron is the key building block for making red blood cells. Without enough iron, EPO will still signal the bone marrow, but few blood cells will be made. "

and this on anemia management from Davita's web site: "If a patient’s hemoglobin does not go up after beginning treatment with an erythropoiesis-stimulating agent, the doctor will recheck iron. Even though there is now a higher level of erythropoietin in the body, there needs to be enough iron for red blood cell production to occur. Vitamin B-12 and folic acid levels must also be in a normal range for healthy red blood cell production to occur." -  http://www.davita.com/kidney-disease/overview/treatment-overview/anemia-management-and-chronic-kidney-disease/e/4840

Hope this helps. -  PatDownsII

[PatDowns]

I saw the nutritionist today. She said they would increase my epo. She also said to eat more red meat and put me o something called Renavit.

Sorry to be a bit late in responding to your post.  Not getting enough iron either through your diet and/or with supplementation (including IV) and not getting enough EPO are the two most common reasons why hemoglobin stays low in esrd patients.  However, please look into the following:

* Have you been experiencing abnormal blood loss during dialysis?

* Has food become a turnoff to you?  Have you been drinking more fluids or eating more high fluid content veggies/fruits in your diet?  Losing real weight and replacing with fluid build up can keep Hgb low even with taking an ESA (erythropoiesis stimulating agent like EPO).  Fluid overload dilutes Hgb.

* Malnutrition - what is your serum albumin level?  Best to keep it 4.0-4.3 range

* Do you have inflammatory problems - arthritis, lupus, or inflammatory bowel disease? 

* Internal bleeding - not uncommon if you have polycystic disease.

Some things to discuss with your nephrologist and dietitian if you feel there is any validity with your situation. 

BTW, Renavit is a vitamin B-12 and Folic acid supplement.  Both help in the production of red blood cells.  However, since they are water soluble, we loose them during dialysis treatment.  Not uncommon at all for patients to be taking this or some other renal vitamin.  I take Dialyvite with Zinc and Folic acid with DHA.

Hope this helps and that your well-being improves. - PatDownsII

 

[PrimeTimer]

They will need to give you more EPO first tho before they can do the iron. The EPO will produce blood cells that are needed for iron to latch on to. 
You can read up on it here: "Kidney Disease And Anemia: Why Is It So, And How Is It Treated?" by Dr. John Agar dated 10-29-15.

This is wrong information.  You might have misread Dr. Agar's article.   If ones iron levels are too low, then EPO or any other ESA (erythropoiesis-stimulating agents)  alone won't help with esrd related anemia.  EPO needs iron to replenish red blood cells.   I don't like to reinvent the wheel.  So, while I couldn't find the article you referred to by using google search, I did find this info from the Kidney School on Anemia and Kidney Disease - http://www.kidneyschool.org/pdfs/KSModule6.pdf

On page 6-5: Anemia and Iron - "There is another key player in the anemia story besides EPO: iron.  Iron is the key building block for making red blood cells. Without enough iron, EPO will still signal the bone marrow, but few blood cells will be made. "

and this on anemia management from Davita's web site: "If a patient’s hemoglobin does not go up after beginning treatment with an erythropoiesis-stimulating agent, the doctor will recheck iron. Even though there is now a higher level of erythropoietin in the body, there needs to be enough iron for red blood cell production to occur. Vitamin B-12 and folic acid levels must also be in a normal range for healthy red blood cell production to occur." -  http://www.davita.com/kidney-disease/overview/treatment-overview/anemia-management-and-chronic-kidney-disease/e/4840

Hope this helps. -  PatDownsII

Thanks so much for correcting me, PatDownsII and for the info! Gee, just when I thought I had learned something...
My husband's clinic would not give him iron until his Hemoglobin was back up to at least 9.5. Meanwhile, they had increased his EPO. Sorry if I misunderstood Dr. Agar's blog post.

I hope I can correctly link Dr. Agar's article (see below). If not, it can be read at "Home Dialysis Central" under the News/Research section and from there, the KidneyViews Blog. His article is titled "Kidney Disease And Anemia: Why Is It So And How Is It Treated?" dated Oct. 29, 2015.

http://www.homedialysis.org/news-and-research/blog/124-kidney-disease-and-anemia-why-is-it-so-and-how-is-it-treated

[Fabkiwi06]

When I first went to the ER and was diagnosed with kidney failure, my hemoglobin was at a 2.9. Needless to say, one of the biggest concerns was getting my iron back up. My nephrologist got me a advance sample of auxia - which is a binder with iron added. Didn't work great for my phosphorus personally, but it did get my iron up in conjunction with everything else. I'm at a 12.1 now 

[PrimeTimer]

When I first went to the ER and was diagnosed with kidney failure, my hemoglobin was at a 2.9. Needless to say, one of the biggest concerns was getting my iron back up. My nephrologist got me a advance sample of auxia - which is a binder with iron added. Didn't work great for my phosphorus personally, but it did get my iron up in conjunction with everything else. I'm at a 12.1 now 

Glad your Hemoglobin level is back up. My husband doesn't feel "good" until his is at least at 11 or higher. He's still under 10...darn Micera seems to be very slow compared to EPO. Maybe we'll have to look into the "auxia" you wrote about. Thanks. 

[Vt Big Rig]

I recently switched binders to auryxia because the calcium acetate  I was taking was causing my calcium to creep up each month.

My iron stats have increased a bunch. Because of a bad reaction to micera I am still taking EPO ...... but right now my HGb is high enough they told me to put it on hold.