25 - CKD Further consequences Flashcards
Hypertension & CKD
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
HT & CKD
Non-Pharmacologic Treatment
Weight Loss - DASH Diet
- *SODIUM RESTRICTION**
- *<2 g/day** = 5g NaCl
FLUID RESTRICTION
Dialysis patients should GAIN 1-2kg between sessions
Dry Weight
Sodium & Fluid Balance
in ESRD
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_
Fluid & Dry Weight
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
Fluid Restriction
- 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
Pharmacologic Therapy
CKD
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
Look Diuretics
fo CKD
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**
Thiazide Diuretics
for CKD
should not be used
once
GFR < 40
HyperKalemia in Renal Failure
Causes?
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**
Medications that can cause
HYPERKalemia
In ESRD
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
HyperKalemia
Outpatient Treatments
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
Sodium Polystyrene Sulfonate
Kayexalate
Uses / Function
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
Which HyperKalemia Treatment requires
2 HOUR SEPERATION
from other medications before & after?
- *Sodium Zircon Cyclosilicate** = Lokelma
- *2 hour separation**
Sodium Polystyrene Solfonate & Patiromer**
are **3 hour seperation
Patiromer = Veltassa
Uses / Function
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
Sodium Zircon Cyclosilicate
Lokelma
Uses
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
