[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-566885-105":53,"doc-detail-566885-en":127},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":120,"head_meta":122,"extra_data":124,"updated_unix":126},105,"en","chronic-maintenance-in-center-standing-orders-mircera","Chronic Maintenance In-Center Standing Orders - Mircera","","Chronic Maintenance In-Center Standing Orders outline protocolized management of ESRD-related anemia in dialysis patients using methoxy polyethylene glycol-epoetin beta (Mircera). The document defines hemoglobin target 10.0–11.0 g/dL, dosing steps based on estimated dry weight, and administration routes for in-center hemodialysis (IV) versus home dialysis (SQ). It specifies dose escalation or reduction algorithms, holding rules for higher hemoglobin, blood pressure criteria for initiating Mircera in in-center treatment, post-hospitalization adjustments, and conversion guidance from Retacrit or Epogen.",{"@graph":63,"@context":119},[64,80,102],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":51,"@type":70,"position":76},"https://docshare.wps.com/template/general/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/chronic-maintenance-in-center-standing-orders-mircera/566885/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/chronic-maintenance-in-center-standing-orders-mircera/566885.png","ImageObject",442,249,{"name":88,"@type":89},"How to eat","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-30","2026-10-13",true,{"@type":98,"interactionType":99,"userInteractionCount":101},"InteractionCounter",{"@type":100},"ViewAction",7,{"@type":103,"mainEntity":104},"FAQPage",[105,111,115],{"name":106,"@type":107,"acceptedAnswer":108},"What hemoglobin target and goal are used for Mircera in this protocol?","Question",{"text":109,"@type":110},"The hemoglobin target goal is 10.0–11.0 g/dL for ESRD-related anemia management in dialysis patients.","Answer",{"name":112,"@type":107,"acceptedAnswer":113},"How is Mircera administered in-center hemodialysis versus home dialysis?",{"text":114,"@type":110},"Mircera is administered IV to in-center hemodialysis patients and SQ to home dialysis patients.",{"name":116,"@type":107,"acceptedAnswer":117},"When must Mircera be held or escalation restricted under the standing orders?",{"text":118,"@type":110},"Mircera is held when hemoglobin is greater than or equal to 12 g/dL, with weekly hemoglobin checks for in-center patients. Dose changes are not allowed more frequently than every 4 weeks except for specified hemoglobin falls and early follow-up after certain events.","https://schema.org",{"og:url":78,"og:type":121,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":123,"canonical":78},"index,follow",{"doc_id":125,"site_id":56},566885,1792103185,{"code":4,"msg":5,"data":128},{"doc_id":125,"user_id":129,"nickname":88,"user_avatar":130,"doc_module":9,"category_id":50,"category_name":51,"doc_title":59,"doc_description":61,"doc_content":131,"file_id":132,"file_url":133,"file_type":134,"file_size":135,"view_count":101,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":76,"language":136,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":137,"faqs":138,"seo_title":139,"seo_description":61,"update_tm":140,"read_time":9},962093541613,"https://ap-avatar.wpscdn.com/davatar_9964176cb1d06d4a9deccf72a44ae3dc","Northwest Kidney Centers  \nChronic Maintenance In-Center Standing Orders-Mircera  \nMethoxy polyethylene glycol-epoetin beta (Mircera®) Protocol  \nMethoxy polyethylene glycol (PEG)-epoetin beta (Mircera®)  \nICD-10 code D63.1 – Anemia in chronic kidney disease  \nPurpose: To provide optimal management of ESRD-related anemia in dialysis patients  \nHemoglobin Target Goal: 10.0-11.0 g/dL  \nMethoxy polyethylene glycol-epoetin beta Dosing:  \nDoses are based on estimated dry weight and rounded to the following steps:  \n\n| Step | Dose |\n| --- | --- |\n| 1 | 30 mcg everyfour weeks |\n| 2 | 50 mcg everyfour weeks |\n| 3 | 30 mcg every two weeks |\n| 4 | 50 mcg every two weeks |\n| 5 | 60 mcg every two weeks (30 mcg + 30 mcg) |\n| 6 | 75 mcg every two weeks |\n| 7 | 100 mcg every two weeks |\n| 8 | 150 mcg every two weeks |\n| 9 | 200 mcg every two weeks |\n\nTable 1  \n1. Methoxy polyethylene glycol-epoetin (Mircera®) will be increased and decreased in 1-step or 2-step increments, based on scale above.  \n2. Mircera® will be administered IV to in-center hemodialysis patients, and SQ to home dialysis patients.  \n3. Mircera® ceiling is 200 mcg every two weeks (or 3.0 mcg/kg every 2  \nweeks, whichever is lower) . Orders above 200mcg every two weeks require facility medical director or CMO approval.  \n4. For in-center hemodialysis patients, if pre-dialysis systolic blood pressure is >190 mm Hg, do not administer Mircera® at the beginning of treatment. If systolic blood pressure falls to \u003C190 mm Hg during hemodialysis, administer Mircera® during treatment. If Mircera® is held for the entire hemodialysis session due to persistent systolic blood pressure >190 mm Hg, notify nephrologist and reassess for administration of Mircera® dose at next hemodialysis session.  \nInitiating Mircera® for new patients or ESA naïve patients  \nFor new patients or established patients who have not received an ESA within the last 3 months, initiate as follows:  \n1. Iron repletion per iron standing orders  \n2. AND  \nNorthwest Kidney Centers  \nChronic Maintenance In-Center Standing Orders-Mircera  \na. If Hgb \u003C 10 g/dL, then start Mircera® at 0.6 mcg/kg every 2 weeks, and round down to closest step per Table 1 but no less than 30 mcg every 2 weeks (Step 3) .  \nb. If Hgb 10.0-10.4 g/dL, then start Mircera® at 30 mcg every 2 weeks (Step 3) .  \nc. If Hgb >= 10.5 g/dL, then do not start Mircera ® until Hgb falls to \u003C10.5 g/dL  \nMircera® Dosing Adjustment  \n1. Titrate Mircera® per the following table for patients who have a Mircera® order that has not been changed in the last 4 weeks:  \n\n| Mircera® Dosing Adjustment |  |\n| --- | --- |\n| Hgb decreased by greater than or equal to 0.5 g/dL since last Hgb level |  |\n| Current Hgb (g/dL) | Step Dose Change |\n| Less than 10 | 2 step dose increase |\n| 10.0-10.9 | 1 step dose increase |\n| 11-11.9 | No Change |\n| Hgb increased/decreased by less than 0.5 g/dL since last Hgb level |  |\n| Current Hgb (g/dL) | Step Dose Change |\n| Less than 9.5 | 2 step dose increase |\n| 9.5-9.9 | 1 step dose increase |\n| 10.0-10.4 | If Hgb decreased, do 1 step dose increase.\u003Cbr>If Hgb increased or stayed the same do NOT change |\n| 10.5-11.4 | No change |\n| 11.5-11.9 | 1 step dose decrease; if patient is on Step 1, do not HOLD |\n| Hgb increased greater than or equal to 0.5 g/dL since last Hgb level |  |\n| Current Hgb (g/dL) | Step Dose Change |\n| Less than 10 | 1 step dose increase |\n| 10-10.4 | No Change |\n| 10.5-11.9 | 1 step decrease; if patient is on Step 1, do not HOLD |\n| Current Hgb (g/dL) | Dose Change |\n| Greater than or equal to 12 g/dL | Hold Mircera; check Hgb at next redraw for home dialysis patients, and every week for in-center patients. |\n| If Hgb is increased or decreased at least 1.0 g/dl since the last Hgb level; recheck Hgb at next dialysis treatment for in-center HD and at next redraw for home patients . Follow the algorithm based on the results of the recheck, e.g., if the value remains the same as the first draw, then follow the algorithm for ","cbCaibFWRciPOzTV","https://ap.wps.com/l/cbCaibFWRciPOzTV","pdf",492001,"English","# Northwest Kidney Centers\n## Chronic Maintenance In-Center Standing Orders - Mircera\n### Purpose and hemoglobin target\n### Dosing based on estimated dry weight (Table 1)\n### Initiation for new/ESA-naïve patients\n### Dosing adjustment algorithm (Table 2)\n### Holding and monitoring rules\n### Post-hospitalization checks\n### Conversion from Retacrit or Epogen to Mircera (conversion chart)","[{\"question\":\"What hemoglobin target and goal are used for Mircera in this protocol?\",\"answer\":\"The hemoglobin target goal is 10.0–11.0 g/dL for ESRD-related anemia management in dialysis patients.\"},{\"question\":\"How is Mircera administered in-center hemodialysis versus home dialysis?\",\"answer\":\"Mircera is administered IV to in-center hemodialysis patients and SQ to home dialysis patients.\"},{\"question\":\"When must Mircera be held or escalation restricted under the standing orders?\",\"answer\":\"Mircera is held when hemoglobin is greater than or equal to 12 g/dL, with weekly hemoglobin checks for in-center patients. Dose changes are not allowed more frequently than every 4 weeks except for specified hemoglobin falls and early follow-up after certain events.\"}]","Chronic Maintenance In-Center Standing Orders - Mircera | PDF",1791864152]