University Of Michigan Nephrology Clinic Anemia Management Orders printable pdf download

University Of Michigan Nephrology Clinic Anemia Management Orders

University of Michigan Nephrology Clinic

Anemia Management Orders and Erythropoietin Dosing Algorithm

1. This patient has anemia due to CKD

Yes

2. Financial review: obtain insurance prior authorization; refer all self pay or uncovered patients to

medication assistance program (Amgen program for Aranesp 1-800-272-9376; OrthoBiotech

program for Procrit 1-800-553-3851)

3. Hgb goal:

11-12.5 gm/dl

other

4. Monitor with monthly labs: CBC

5. Monitor quarterly: iron, TIBC, transferring saturation (iron/TIBC), ferritin (See below for iron

management)

6. Is patient receiving oral iron supplement?

Yes

7. Before changing dose, consider factors that may temporarily change Hgb (infection, transfusion,

hospitalization, missed doses, acute blood loss, fluid balance ie dehydration vs. volume overload); if

unclear consult with M.D.

8. Epoetin dose changes should be made monthly (when necessary), unless otherwise ordered.

9. Starting dose:

Epotein alfa (Procrit)

4,000 units SQ every week

10,000 units SQ every week (150 units/Kg for 70 Kg pt)

other dose____________ units SQ every ______________

Darbopoetin alfa (Aranesp)

25 mcg sc __________week

40 mcg sc __________week

60 mcg sc __________week

100 mcg sc __________week

other dose___________week

10. Erythropoietin will be titrated to maintain Hgb in target range. Evaluate CBC and BP after 4 weeks

No change in Hgb

Increase current dose by 1 step (~ 25%)

Hgb increase ≤ 1 g/dL

Cont current dose

Hgb increase > 1 g/dL (rapid rise)

Decrease current dose by 1 step (~ 25%)

BP Check: increase > 10 mm Hg (systolic or dialstolic) OR SBP >180, DBP >100, notify M.D.

University Of Michigan Nephrology Clinic Anemia Management Orders