11. Chronic Kidney Disease23 Flashcards
At what stage of Chronic Kidney Disease (CKD) is it recommended to consult a nephrologist?
Consultation with a nephrologist is recommended when stage 4 CKD develops (eGFR <30 mL/min/1.73 m2).
What are the potential benefits of consulting a nephrologist when stage 4 CKD develops?
Consulting a nephrologist when stage 4 CKD develops has been found to reduce cost, improve quality of care, and delay dialysis.
When should health care professionals consider referral to a nephrologist?
Health care professionals should consider referral to a nephrologist if the patient has continuously rising UACR levels and/or continuously declining eGFR, if there is uncertainty about the etiology of kidney disease, for difficult management issues (anemia, secondary hyperparathyroidism, significant increases in albuminuria in spite of good blood pressure management, metabolic bone disease, resistant hypertension, or electrolyte disturbances), or when there is advanced kidney disease (eGFR <30).
What are some reasons to refer a patient to a nephrologist?
Some reasons to refer a patient to a nephrologist include continuously rising UACR levels, continuously declining eGFR, uncertainty about the etiology of kidney disease, difficult management issues (anemia, secondary hyperparathyroidism, significant increases in albuminuria despite good blood pressure management, metabolic bone disease, resistant hypertension, or electrolyte disturbances), or advanced kidney disease (eGFR <30).
When should a patient be referred to a nephrologist for difficult management issues?
A patient should be referred to a nephrologist for difficult management issues such as anemia, secondary hyperparathyroidism, significant increases in albuminuria despite good blood pressure management, metabolic bone disease, resistant hypertension, or electrolyte disturbances.
What percentage of study group participants discontinued due to hyperkalemia? IN (FIDELIO-DKD) trial FOR FINERENONE?
2.3%
NO HYPERKALEMIA DEATHS
Were there any deaths related to hyperkalemia in the completed study?
No, there were no deaths related to hyperkalemia in the completed study.
For what purpose can GLP-1 RAs be used at low eGFR?
GLP-1 RAs can be used at low eGFR for cardiovascular protection.
What factors may influence the selection of specific agents for individuals with type 2 diabetes and CKD?
The selection of specific agents for individuals with type 2 diabetes and CKD may depend on comorbidity and CKD stage….
in individuals with eGFR ≥20 mL/min/1.73 m2 and UACR ≥200 mg/g
Which trials provide evidence of the reduced cardiovascular and renal events with SGLT2 inhibitor use?
The CREDENCE and DAPA-CKD trials, as well as secondary analyses of cardiovascular outcomes trials with SGLT2 inhibitors, provide evidence of reduced cardiovascular and renal events.
IN PT WITH EGFR < 20
What is the risk reduction of new or worsening nephropathy with semaglutide?
Semaglutide reduced the risk of new or worsening nephropathy by 36%.
What does the composite of persistent UACR >300 mg/g creatinine, doubling of serum creatinine, or ESRD represent in the study?
The composite represents new or worsening nephropathy.
By what percentage did liraglutide reduce the risk of new or worsening nephropathy?
Liraglutide reduced the risk of new or worsening nephropathy by 22%.
By what percentage did canagliflozin reduce the risk of progression of albuminuria?
27%
By what percentage did canagliflozin reduce the risk of reduction in eGFR, ESRD, or death from ESRD?
40%
By what percentage did empagliflozin reduce the risk of incident or worsening nephropathy?
Empagliflozin reduced the risk of incident or worsening nephropathy by 39%.
By what percentage did empagliflozin reduce the risk of doubling of serum creatinine accompanied by eGFR ≤45 mL/min/1.73 m2?
Empagliflozin reduced the risk of doubling of serum creatinine accompanied by eGFR ≤45 mL/min/1.73 m2 by 44%.
WHEN are GLP-1 RAs suggested for CKD T2DM PT ?
GLP-1 RAs are suggested for cardiovascular risk reduction if such risk is a predominant problem.
Who are SGLT2 inhibitors recommended for?
SGLT2 inhibitors are recommended for people with stage 3 CKD or higher and type 2 diabetes.
What are the benefits of SGLT2 inhibitors for people with type 2 diabetes and CKD?
SGLT2 inhibitors slow CKD progression and reduce heart failure risk independent of glucose management.
When should metformin be temporarily discontinued?
Metformin should be temporarily discontinued at the time of or before iodinated contrast imaging procedures in patients with eGFR 30–60 mL/min/1.73 m2.
According to the article, should metformin be initiated for patients with an eGFR below what value?
Metformin should not be initiated for patients with an eGFR <45.
At what eGFR level is metformin contraindicated?
Metformin is contraindicated in patients with an eGFR <30 mL/min/1.73 m2.
What should be monitored while taking metformin?
eGFR should be monitored while taking metformin.
ESPECIALLY IF EGFR < 45
What is the reported effect of GLP-1 RAs on the kidney?
GLP-1 RAs have been reported to improve renal outcomes.
By how much do SGLT2 inhibitors reduce oxidative stress in the kidney?
SGLT2 inhibitors reduce oxidative stress in the kidney by >50%.
What are some effects of SGLT2 inhibitors on renal function?
SGLT2 inhibitors reduce renal tubular glucose reabsorption, weight, systemic blood pressure, intraglomerular pressure, and albuminuria and slow GFR loss.
What are the mechanisms by which SGLT2 inhibitors slow GFR loss?
The mechanisms by which SGLT2 inhibitors slow GFR loss appear to be independent of glycemia.
IF THERE IS NO CKD,…Are ACE inhibitors or ARBs superior to other classes of antihypertensive therapy?
No, ACE inhibitors or ARBs have not proven to be superior to alternative classes of antihypertensive therapy like thiazide-like diuretics and dihydropyridine calcium channel blockers.
According to the ACEI AND ARBS are considered to have similar benefits AND RISKS?
ACE inhibitors and ARBs are considered to have similar benefits AND RISKS.
In which cases may lower blood pressure targets be suitable?
Lower blood pressure targets may be suitable in some cases, especially in individuals with severely elevated albuminuria (≥300 mg/g creatinine).
What blood pressure level is recommended to reduce CVD mortality and slow CKD progression among all people with diabetes?
A blood pressure level <130/80 mmHg is recommended.
What is the recommended therapy for people with type 1 or 2 diabetes with established Chronic Kidney Disease (CKD) and high urine albumin levels?
ACE inhibitor or ARB therapy is recommended for people with type 1 or 2 diabetes with established CKD (eGFR <60 mL/min/1.73 m2 and UACR ≥300 mg/g creatinine) to reduce the risk of progression to ESRD.
How can restricting dietary sodium help in controlling blood pressure and reducing cardiovascular risk?
Restricting dietary sodium to less than 2,300 mg/day can help control blood pressure and reduce cardiovascular risk.
Why might the individualization of dietary potassium be necessary?
The individualization of dietary potassium may be necessary to control serum potassium concentrations.
What is the recommended daily allowance of dietary protein for individuals with chronic kidney disease?
The recommended daily allowance of dietary protein for individuals with chronic kidney disease is 0.8 g/kg/day.
Does reducing dietary protein below .8 G/KG/DAY the recommended daily allowance affect blood glucose levels, cardiovascular risk measures, or the course of GFR decline?
No, reducing dietary protein below the recommended daily allowance does not alter blood glucose levels, cardiovascular risk measures, or the course of GFR decline.
What are the potential negative effects associated with higher levels of dietary protein intake?
Higher levels of dietary protein intake have been associated with increased albuminuria, more rapid kidney function loss, and CVD mortality.
What are the risks associated with consuming more than 20% of daily calories from protein or more than 1.3 g/kg/day?
Consuming higher levels of dietary protein intake (>20% of daily calories from protein or >1.3 g/kg/day) has been associated with increased albuminuria, more rapid kidney function loss, and CVD mortality.
What are the only proven primary prevention interventions for CKD?
Blood glucose and blood pressure control.
When is screening for complications of CKD indicated?
Screening for complications of CKD is indicated when eGFR is <60 mL/min/1.73 m2.
BP, OVERLOAD, ANEMIA , BONE METABOLISM AND ELECTROLYTE.
In which type of diabetes may remission of albuminuria occur spontaneously?
Type 1 diabetes.
What is considered a valid surrogate for renal benefit IN CKD MANAGMENT?
An initial reduction of CREATININE >30% from baseline OR UACR <300 mg/g , subsequently maintained over at least 2 years, is considered a valid surrogate for renal AND CARDIAC benefit.
What may be detected by Early changes in kidney function ?
Increases in albuminuria before changes in eGFR.
What are the key components measured in the assessment of metabolic bone disease in CKD PT?
The key components measured in the assessment of metabolic bone disease are serum calcium, phosphate, PTH, and vitamin 25(OH)D.
What test is recommended to determine anemia?
Hemoglobin; iron testing if indicated.
