Starting Aranesp

[danielleblock]

Hi everyone! Stage 4 warrior here ( GFR 22). Yesterday my labs showed HCT at 28, so nephrologist wants to start Aranesp. I know that it will most likely give me more energy, but the black box warning is worrisome. Anyone had issues with blood clots from it?

[Hidden]

Hi and welcome. I've not heard of a "black box warning" prior to your post. I'm sure someone on here will respond with helpful information. In the meantime, you might use drugs.com and look up Aranesp on that site and get a thorough explanation of Side Effects as well as other information on the medication. Best of luck.

[Kbressler NKF Peer Mentor NKF Ambassador]

Talk to your Nephrologist and the PharmD at your pharmacy. Reading a black box warning is informational but you need reason and clarification.

[Bassetmommer NKF Ambassador]

HI, I looked up the medication here aranesp.com/. I understand your concern and I would suggest you talk to your doctor about something that may not have as many side effects. My HCT was 29 a year ago and started taking just OTC iron pills and now it is 39 and has remained there. Just a suggestion.

[WYOAnne NKF Ambassador]

Everyone is different. When I was in ckd I used epogen. From what I know it is similar to aranesp, and in fact has the same side effects. I had no issues with any of the side effects. However, before starting this medication you need to ask this question to your nephrologist. It may be that it is a very small percentage of people had issues with blood clots. They are required to state all warnings for this drug no matter how small.

Best of luck to you and hope it will make you feel better

I am now 18 years post transplant!

[steve680]

The short answer is to discuss with your doctor. However, if your doctor doesn't know about the FDA black box warning, then you should find another doctor. It's that serious. It's not usually prescribed until you have severe anemia (HGB below 10/HCT below 30). Per below, the doctor should not target your HGB to be above 11 as it raises your risk for heart attacks and strokes. Also, ask your doctor about checking your iron levels before giving you Aranesp:

accessdata.fda.gov/drugsatf...

"Evaluate the iron status in all patients before and during treatment and maintain iron repletion. Correct or exclude other causes of anemia (e.g., vitamin deficiency, metabolic or chronic inflammatory conditions, bleeding, etc.) before initiating Aranesp"

Here's the FDA warning:

WARNING: ESAs INCREASE THE RISK OF DEATH, MYOCARDIAL INFARCTION, STROKE, VENOUS THROMBOEMBOLISM, THROMBOSIS OF VASCULAR ACCESS and TUMOR PROGRESSION OR RECURRENCE

See full prescribing information for complete boxed warning.

Chronic Kidney Disease:

• In controlled trials, patients experienced greater risks for death, serious adverse cardiovascular reactions, and stroke when administered erythropoiesis-stimulating agents (ESAs) to target a hemoglobin level of greater than 11 g/dL (5.1).

• No trial has identified a hemoglobin target level, Aranesp dose, or dosing strategy that does not increase these risks.

• Use the lowest Aranesp dose sufficient to reduce the need for red blood cell (RBC) transfusions (5.1).

[danielleblock]

Thank you all for the feedback. HCT is 28.7% and HGB is 10.1. It seems I am on the borderline. I am going to call his office to talk to him more about it. Iron levels are in normal range, so maybe this is something I can avoid for the immediate future. I guess the main question is when I would need an emergency RBC transfusion. With GFR 22 I am anticipating a transplant in the next 12-18 months ( fingers crossed we can find a living donor before dialysis) and need to avoid transfusions to decrease antibody exposure before transplant.