Download - Salford Royal NHS Foundation Trust

University Teaching Trust
Treatment of renal anaemia with
Erythropoeitin Stimulating Agent (ESA)
Hope Building
Renal Unit
0161 206 1882
© G16100301W. Design Services, Salford Royal NHS Foundation Trust, All Rights Reserved 2017.
Document for issue as handout. Unique Identifier: NOE 47 (16). Review date: February 2019.
Introduction
What is renal anaemia?
Your renal team have recommended
that you have treatment for your
renal anaemia. Renal anaemia
is treated with a drug called
Erythropoeitin Stimulating Agent
(ESA).
You may also hear it called EPO,
Darbepoetin or Aranesp.
Patients with kidney disease often
develop renal anaemia.
Renal anaemia is caused by a
reduction in the number of red
blood cells in the body. Red blood
cells are important as they contain
Haemoglobin (Hb) which carries
oxygen around your body. Your
body makes red blood cells in
response to a hormone called
Erythropoeitin. This hormone,
Erythropoeitin, is made in the
kidneys.
Consequently, when you have
kidney disease/ kidney impairment,
you may not be producing enough
Erythropoeitin.
If anaemia remains untreated,
symptoms can occur which can affect
quality of life, these include:
lTiredness / lack of energy
lShortness of breath on
minimal exertion
lFeeling cold
lLack of concentration.
This booklet has been written to:
lExplain to you and your family
why treatment is needed
lExplain the ordering and
prescribing process
lProvide information about the
monitoring involved
lRecord the details of your
treatment.
The chronic kidney disease (CKD)
team will explain the information
in this booklet before you start your
treatment.
1
If anaemia is not treated, your heart
may also become bigger because it
has to work harder to deliver oxygen
around the body.
What is the treatment for
renal anaemia?
There are two medications you
may be given to treat your renal
anaemia:
How will ESA be given?
Unless you are on haemodialysis,
ESA is given as a subcutaneous
injection. This means the medication
is injected into the subcutaneous
layer (the fatty tissue) in your skin.
The injection is usually given into
the abdomen flanks, the areas either
side of your belly button, as this is
easy to access and provides adequate
surface area to rotate sites.
1.Iron
2.ESA
You may require both of these
treatments.
1.Iron
If your iron levels are low, you may
be given iron tablets or an iron
infusion. More information will be
given by the medical team if you are
prescribed iron.
2.ESA
ESA is a medication used to replace
the Erythropoeitin that your kidneys
would usually make. By giving you
ESA, we aim to increase the number
of red cells and Haemoglobin in your
blood.
You can give this to your self at
home or you can choose a carer,
practice nurse or district nurse to
give the injection for you.
ESA injections are usually given
once a week unless other wise
directed by your renal team. You
will need a sharps bin to dispose of
the injections after use.
© G16100301W. Design Services, Salford Royal NHS Foundation Trust,
All Rights Reserved 2017. Document for issue as handout.
Unique Identifier: NOE 47 (16). Review date: February 2019.
2
What are the side effects
of ESA?
How will I get my ESA
injections?
What monitoring will I
need?
How do I order my ESA
injections?
You may experience some side
effects with ESA treatment. A full
list of the side effects can be found
on the information leaflet inside the
injection box. Common side effects
include:
Unlike other medications, Your
GP is not licensed to prescribe
ESA injections. The injections are
prescribed and monitored by the
hospital.
We will be delivered your ESA
injections to you at home using a
company called Fresenius.
Fresenius will usually contact you to
arrange a delivery time and date.
One box holds 4 injections.
You will need to re-order your
injections, please see page 4.
It will take some time for your body
to make the new red blood cells that
you need.
ESA injections need to be ordered
from the hospital by you.
l Increase in blood pressure
l Flu like symptoms
l Skin rash
l Stinging at injections site.
The CKD team will be monitoring
your ESA treatment closely and are
happy to discuss any concerns you
have about side effects.
How do I store my ESA
injections?
ESA injections should be kept in the
fridge soon as possible after being
delivered.
Your injection should remain in the
fridge until needed.
Should you find the ESA injections
have not been stored correct please
contact the CKD team for advice.
3
We will use a blood test called a
Full Blood Count (FBC) to measure
your Haemoglobin level. From this
we can see how you are responding
to the ESA injections and adjust the
dose if needed. The blood test can
be taken at your GPs and will need
to be done every 2 weeks for 6
months from starting the treatment.
After 6 months has passed the FBC
blood test can be reduced to once a
month.
You will also need to take your
blood pressure before you give the
ESA injection.
We will also check your iron levels
(ferritin and iron saturations) every 3
months.
It can take up to two weeks for
the renal team to check your blood
results and issue a new prescription.
Therefore, We recommend you
order your ESA injections when
there are two left in the fridge.
When the new prescription is issued,
it is check by the hospital pharmacy
before being sent to a company call
Fresenius. Fresenius will deliver your
new ESA injections to you at home.
Please note: The renal team
is unable to issue your next
prescription if your have not had
your blood test taken within 4
weeks of you ordering the ESA
injections. We may send you a letter
in the post to remind you.
If your blood pressure is 180/100 or
higher, do not give your injection
and contact the CKD team for
advice.
© G16100301W. Design Services, Salford Royal NHS Foundation Trust,
All Rights Reserved 2017. Document for issue as handout.
Unique Identifier: NOE 47 (16). Review date: February 2019.
4
ESA dose change:
The renal team may advise changing
the dose or the frequency of ESA
injections after reviewing your blood
results.
A letter would be sent in the post to
confirm any changes. The letter may
instruct you to use up your existing
supply of injections before going
onto the new dose.
How do I dispose of my
sharps bin?
Once your sharps bin is full you can
lock it by closing it fully, you will be
unable to open it again after it is
locked.
The sharps bin can be brought back
to the renal outpatients department
and you can collect a new one.
What happens if I miss a
dose of ESA?
If there is an occasion where you
miss a dose of ESA , do not worry,
you are not in any immediate
danger.
If you have missed a dose, you
should take your ESA injection as
soon as possible. Your next dose
after this should be approximately 7
days later.
Please contact the ESA order line
number
0161 206 0807
when you have 2 injections at home.
What do I do if I am
admitted to another
hospital?
If you are admitted to another
hospital your ESA treatment should
continue. Please inform the ward
staff you are being treated with ESA
for renal anaemia. If the ward staff
have any questions they can contact
the CKD team on
0161
206 1882
We hope you will start to feel
better within 6-8 weeks of starting
ESA treatment. The symptoms of
anaemia such as tiredness and
feeling cold should improve.
By treating your renal anaemia your
heart will not have to work so hard
to deliver oxygen around your body.
This will have long term benefits to
your health.
Is there an alternative to
ESA treatment?
Where can I get more
information?
The only alternative to ESA
treatment is regular blood
transfusions. Blood transfusions
carry their own risks as it is possible
to have a reaction to the donated
blood.
If you have any questions or would
like to discuss anything in this
booklet, please contact the CKD
team:
If you receive a lot of blood
transfusions this may affect your
changes of receiving a kidney
transplant in the future. This is
because your body may develop
more antibodies through the
donated blood.
5
What are the benefits of
ESA treatment?
0161 206 1882
0161 206 7043
© G16100301W. Design Services, Salford Royal NHS Foundation Trust,
All Rights Reserved 2017. Document for issue as handout.
Unique Identifier: NOE 47 (16). Review date: February 2019.
6
Initiation and Monitoring Diary
In order to treat your anaemia you have been prescribed:
Monitoring Diary
Date
Result BP
ESA dose
given
Comments (ESA Brand)
(ESA dose)
(ESA frequency)
Date of first injection:
Date and day of next injection:
Given by: Self CKD team Practice nurseOther
District nurse Date of blood test (FBC/ BP):
Bloods to be taken by: Practice Nurse
District Nurse
Renal ClinicOther
Date blood test should be reduced to once a month
Reminder:
lYou should take your blood pressure before having your ESA injection.
If your blood pressure is 180/100 or high do not give the injections and
contact the CKD team
lYou will need to have a blood test (FBC) every 2 weeks from the date of
first injection for 6 months
lAfter the 6 months is over, the blood tests can be reduced to once a month
lYou will also need a blood test to check your iron levels (ferritin and iron
saturations) every 3 months.
7
© G16100301W. Design Services, Salford Royal NHS Foundation Trust,
All Rights Reserved 2017. Document for issue as handout.
Unique Identifier: NOE 47 (16). Review date: February 2019.
8
Monitoring Diary
Date
Result 9
Monitoring Diary
BP
ESA dose
given
Comments Date
Result BP
ESA dose
given
Comments © G16100301W. Design Services, Salford Royal NHS Foundation Trust,
All Rights Reserved 2017. Document for issue as handout.
Unique Identifier: NOE 47 (16). Review date: February 2019.
10
Useful contact details
Notes
ESA order line number
0161 206 0807
Or email
[email protected]
If you have any questions or concern
please do not hesitate to contact the
CKD team.
CKD team
0161 206 1882
or email
[email protected]
11
© G16100301W. Design Services, Salford Royal NHS Foundation Trust,
All Rights Reserved 2017. Document for issue as handout.
Unique Identifier: NOE 47 (16). Review date: February 2019.
12
© G16100301W. Design Services
Salford Royal NHS Foundation Trust
All Rights Reserved 2017
This document MUST NOT be photocopied
University Teaching Trust
Information Leaflet Control Policy:
Unique Identifier: NOE 47 (16)
Review Date: February 2019
For further information on this leaflet, it’s references and sources
used, please contact 0161 206 1882.
If you need this interpreting please telephone
Copies of this information are
available in other languages
and formats upon request.
In accordance with the
Equality Act we will make
‘reasonable adjustments’
to enable individuals with
disabilities, to access this
treatment / service.
Email: [email protected]
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from living patients from whom tissue has been taken for
diagnosis or testing to use any left over tissue for the following
purposes: clinical audit, education or training relating to human
health, performance assessment, public health monitoring and
quality assurance.
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purposes, please inform a member of staff immediately.
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on 0161 206 1779
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