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PDAT3 > 25 - CKD Further consequences > Flashcards

25 - CKD Further consequences Flashcards

1
Q

Hypertension & CKD

A

2nd Cause of CKD

  • *Kidney fxn** :directly proportional: BP level
  • Keeping BP level @goal** –> *slows down LOSS of kidney fxn

if PROTEINURIA present:
keeping BP @ goal has GREATEST IMPACT in preserving renal fxn

Goals are STRICTER w/ albuminuria

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2
Q

HT & CKD

Non-Pharmacologic Treatment

A

Weight Loss - DASH Diet

  • *SODIUM RESTRICTION**
  • *<2 g/day** = 5g NaCl

FLUID RESTRICTION
Dialysis patients should GAIN 1-2kg between sessions

Dry Weight

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3
Q

Sodium & Fluid Balance

in ESRD

A

Na excretion & regulation is WELL maintained until
LATE STAGES OF CKD

Kidney will be UNABLE to change the rate of Na excretion
in relation to salt intake

Begin to Retain Na - Oliguria in ESRD
(<400mL of urine a day)
Edema / HTN / CHF

_STRICT SODIUM RESTRICTION
<2 g/day_

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4
Q

Fluid & Dry Weight

A

Dry Weight

  • *Weight where removing any more fluid –> Negative outcomes
  • HypoTension / Cramping / NV***

not meeting dry weight (OVER) –> results in continued HTN

if patient has LVH:
removing fluid is MORE EFFECTIVE in reducing LVH
than lowering BP with meds

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5
Q

Fluid Restriction

A
  • as kidney fxn declines:*
  • excess water** –> water RETENTION & *_hypoNatremia_

Quick reduction of water –> Volume depletion (dehydration)

2 L/day of Fluids
is appropriate

Hemodialysis Patients:
<4% of estimated dry weight

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6
Q

Pharmacologic Therapy

CKD

A

ACE-I** & **ARB
Cornerstone of therapy for ALL CKD stages & DIALYSIS

Control BP + Minimize Proteinuria
need a HIGHER dose generally

CCBs = good for RESISTANT HT

Beta-Blockers / Vasodilators / Alpha-Adrenergic Agonists

MAXIMIZE use of diuretics while still making urine

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7
Q

Look Diuretics

fo CKD

A

Mainstay of Therapy
Assist with:
Fluid Removal / ↓BP

May continue on DIALYSIS
if patient has decent urinary output > 500 mL/day

  • *DOSE IS MUCH HIGHER**
  • *Furosemide 120-160mg BID**
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8
Q

Thiazide Diuretics

for CKD

A

should not be used
once
GFR < 40

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9
Q

HyperKalemia in Renal Failure

Causes?

A

K excretion is IMPAIRED** & **secretion of K by the colon INCREASES
to maintain balance

↑K in stool is aldosterone dependent –> ↑colonic mucosal Na-K-Atpase

Caused by:

  • *SUDDEN DECREASE in Urine Output**
  • *Metabolic Acidosis**
  • *Salt Substitutes / Diet**
  • *Blood Transfusions**
  • *Medications**
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10
Q

Medications that can cause

HYPERKalemia
In ESRD

A

ACEi & ARBs –> directly increase K

K+ Sparing diuretics -> reduce urinary K+ excretions

SuccinylCholine / Muscle Relaxants –> release K+ from muscle

B-Adrenergic Antagonists –> prevent K+ entry into cells

Constipating Agents –> decrease k+ colonic excretion

Digoxin –> decrease K excretion

Penicillin = contains K

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11
Q

HyperKalemia

Outpatient Treatments

A

REDUCE K+ in DIET
necessary when ESRD & based on serum levels
2000-4000 mg/day = 51-103 mEq/day
Oranges / Bananas / Melons / Potatoes / Tomatoes / Dried beans

Sodium Polystyrene Sulfonate = Kayexalate

Patiromer = Valtessa

Sodium Zircon Cyclosilicate = Lokelma

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12
Q

Sodium Polystyrene Sulfonate
Kayexalate

Uses / Function

A

HYPERkalemia Treatment
15-20g in 20mL of SORBITOL po <4x/day

Cation Exchange:

  • *binds 1 mEq of K** per gram of drug –> in exchange for SODIUM
  • may result in* Na OVERLOAD

caution with obstructive bowel disorders

Needs to be seperated by
3 HOURS from other MEDS

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13
Q

Which HyperKalemia Treatment requires

2 HOUR SEPERATION
from other medications before & after?

A
  • *Sodium Zircon Cyclosilicate** = Lokelma
  • *2 hour separation**

Sodium Polystyrene Solfonate & Patiromer**
are **3 hour seperation

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14
Q

Patiromer = Veltassa

Uses / Function

A

HYPERkalemia Treatment
8.4g daily –> titrate qweek until GOAL K level
packets to be taken with FOOD

Cation exchange polymer –> binds K in GI tract

Caution with
obstructive bowel disorders

3 HOUR SEPARATION
from other meds –> due ti reduction in peak conc.
amlodipine / cinacalcet / clopidogrel / furosemide / metoprolol

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15
Q

Sodium Zircon Cyclosilicate
Lokelma

Uses

A

HYPERKalemia Treatment
10g TID up to 48 hours, suspension

Preferentially –> exchanges K for SODIUM & HYDROGEN

Avoid with bowel disorders
may cause edema

  • *2 HOUR SEPARATION**
  • *b4 & after** medications
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16
Q

HYPERlipidemia in ESRD

A

As patients become UREMIC
INCREASE in –> VLDL / LDL / TG –> Atherosclerosis

  • decrease in* Enzymes that REMOVE TGs
  • *Insulin Resistance**

STATINS
important in CKD G3a-5
reduces CV risk & rate of CKD progression

17
Q

Metabolic Acidosis

in ESRD

A

Metabolic Acidosis occers when there is:
> 50% reduction in GFR

Arterial pH can be affected by:
diarrhea / dehydration / catabolism / fever / sepsis

as kidney fxn DECLINES –> less H+ excretion –> ↓pH & ↓HCO3

↓NH4 excretion / ↓PO4 excretion
retention of SO4 & other organic ions

BUFFERING of H+ from CALCIUM CARBONATE
is RELEASED from BONE, compensates for metabolic acidosis

18
Q

Metabolic Acidosis

Indirect Treatment

A

Acidosis –> BONE will release CALCIUM to BUFFER with H+

Need to treat with:

Sodium Bicarbonate
600mg TID

Sodium Citrate** + **Citric Acid Solution
15-30mL in water 4x a day

Titrate doses to maintain serum bicarb > 22mmol/L

19
Q

Maltnutrition in CKD & ESRD

Risk Factors

A

decreases in: serum albumin + total protein

  • Unable to synthesize proteins*
  • less ESSENTIAL AA &* HIGHER non-essential AA’s

Increase in Muscle protein BREAKDOWN

Protein intake is also REDUCED in CKD patients

Risk Factors:
Uremia / Depression / Gastroparesis
Dietary restriction / HEMODIALYSIS

20
Q

Protein Requirements for those

GFR < 30 mL/min

A

0.8 mg/kg/day

to decrease production of NITROGENOUS wastes
also:
Decrease SODIUM intake –> reduce PROTEINURIA
<2 g/day

21
Q

Protein Requirements for those

ONCE ON HEMODIALYSIS

A
  • *1.2-1.3 g/kg/day**
  • *can give more protein once on Hemodialysis**

to decrease production of NITROGENOUS wastes
also:
Decrease SODIUM intake –> reduce PROTEINURIA
<2 g/day

22
Q

Protein Requirements for those

RISK of CKD progression

A

< 1.3 g/kg/day

to decrease production of NITROGENOUS wastes
also:
Decrease SODIUM intake –> reduce PROTEINURIA
<2 g/day

23
Q

Energy & Vitamin Requirements in CKD / ESRD

Calorie requirements?

A
  • *30-35 kcal/kg**
  • vs 25 kcal /kg*
  • *need appropriate amount of energy to utilize the protein ingested**

Losing WATER soluble vitamins & trace Elements
VVV
appitite loss & N/V
deficiencies in: B Vitamins / Vitamin C / Iron / Zinc

Most patients are on:
specific renal vitamin

PDAT3 (23 decks)

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