CRF with anemia best treatment -

Ans. is 'b' i.e., Erythropoietin o Chronic kidney disease leads to normocyih normochronic anemiaThe kidney is the primary' site of erythropoietin production in the adult. Erythropoietin enhances the growth and differentiation of erythropoietin progenitors.With increasing renal dysfunction decreased level of erythropoietin are produced resulting in progressive anemia,o The primary therapeutic options for anemia of chronic kidney disease areo Red blood cell transfusionso Erythropoietin stimulating agentso Androgen (to a much lesser degree)o Erythropoietin administration is considered the mainstay of the treatment of anemia of chronic disease in renal failureThe administration of erythropoietin stimulating agent is particularly attractive because they have substantially reduced the need for red cell transfusion with an attendant decrease in and for risk for transfusion related complications.# The erythropoietin deficiency can be corrected by the exogenous administration of erythropoietin stimulating agentsTwo such agents available in the united statesEpoetin afla (recombinant human erythropoietin)Darbepoetin alfaEpoetin alfa (recombinant human erythropoietin E.P.O.)o Provides effective treatment for anemia in patients, when administered, once weekly Has become standard care.o However, one problem with epoeitin alfa is that the need for the weekly dose can place a considerable burden on both patients and healthcare staff.Darbepoetin alfao Another erythropoiesis stimulator i.e.darbepoeitin alfa can provide an alternative as it has three fold longer half life.o The dose of darbepoeitin can be scheduled once weekly or twice weekly or may be monthly.Peginasatideo It is a synthetic peptide that activates EPO receptor. Peginesatide stimulates erythroid colony growth, reticulocyte count and hematocriiRed blood cell transfusionso RBC transfusion are universally sussessful in raising hemoglobin levels.o Transfusions often can ameliorate the patient s symptoms and improve health related quality of life .o However they may be associated with significant complications that include transfusion transmitted infection, immunological sensif cation, iron overload syndromes volume overload! transfusion reactionsAndrogenso Prior to the availability of erythropoietin stimulating agents, androgens were used regularly in the treatment of anemia in dialyses patients. Androgens may increae endogenous erythorpoietin production sensitivity of erythroid progenitors and red blood cell sunivat. However the role of androgen was limited because of side effects which was virilisation, priapism, peliosis hepatic, liver function and risk of hepatocellular Ca