| Theme | Prescription of Therapeutics and Monitoring for the Dialysis Patients | |
|---|---|---|
| Title | TDM of hematopoietic drugs | |
| Publish Date | 1999/11 | |
| Author | Takashi Mizuguchi | Internal Medicine, Kawashima Hospital |
| [ Summary ] | Various hematopoietic disorders, such as anemic diseases, are found in chronic renal failure patients undergoing dialysis. Renal anemia and iron deficiency anemia are representative. Recombinant human erythropoietin (rHuEPO) and iron spplementation are used for correcting these types of anemia. Determinations of serum ferritin, transferrin saturation and serum transferrin receptors are recommended as diagnostic and therapeutic strategies for treatment of iron deficiency. Serum ferritin levels of less than 100 ng/ml indicate iron deficiency, at these levels, it is recommended that iron supplementation be kept in the 100 to 300 ng/ml range. Transferrin saturation of less than 20% and/or high serum transferrin receptor levels indicate iron deficiency, even if serum ferritin levels are higher than 100 ng/ml. The target Ht level is 30% when rHuEPO is used to correct renal anemia in dialysis paitients. Therapeutic doses of rHuEPO are changed to keep pace with the rising rate of Ht at a rate of 0.8 to 1.0%/week. The determination of serum transferrin receptor levels are recommended as markers for therapeutic doses of rHuEPO for initiation and as indicators of changes in rHuEPO theraphy, because serum levels change before Ht levels. |
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