Chronic Kidney Disease and Dialysis Flashcards
Two criteria to meet for a chronic kidney disease diagnosis
Abnormalities in structure and function of the kidney (progressive decline in number of working nephrons)
Must be present for more than 3 months
Three drug types to avoid in patients with chronic kidney disease
NSAIDs
Aminoglycosides
IV contrast
True or false. SGLT2 inhibitors can only be used in chronic kidney disease patients who also have diabetes.
False
Substance used to remove impurities in peritoneal dialysis
Dialysate
Potassium levels are maintained in chronic kidney disease until GFR falls below this level
GFR <10
Most and second most common causes of chronic kidney disease
MCC = Diabetes
Second = Hypertension
Hypertension goals and treatment in patients with chronic kidney disease
Goal is <130/80
Use ACE inhibitors/ARBs
As GFR declines in chronic kidney disease, how will levels of phosphate and calcium also change?
Calcium and phosphorus have an inverse relationship
Kidneys can’t activate vit D
Low vit D means less calcium absorption from food
Serum phosphate increases as calcium goes down and kidneys can’t keep up with excretion
Why might ecchymosis, purpura, petechia, gingival bleeding, and oozing from canula sites occur in chronic kidney disease patients?
Decreased platelet aggregation/adhesiveness
Diet for patients with renal failure
Low NaPhosK
Also reduce protein and increase calcium
Treatment for hyperphosphatemia in chronic kidney disease
Calcitriol + phosphate binder (RenaGel)
May need to supplement vitamin D
Can ACE inhibitors and ARBs be used in acute kidney injury, chronic kidney disease, or both?
Good in CKD
Bad in AKI
Hyperlipidemia goals in patients with chronic kidney disease
LDL <100
HDL >50
Triglycerides <150
Methods to reduce potassium levels in patients with late chronic kidney disease
Loop diuretic to increase potassium excretion
If acidotic, use sodium bicarbonate to increase potassium excretion
If still hyperkalemic use a potassium binding resin (sodium polystyrene/Kayexalate)
Avoid magnesium
Which type of dialysis, hemodialysis or peritoneal dialysis is preferred in patients with residual renal function?
Peritoneal dialysis
Early symptoms (2) and one late symptom of chronic kidney disease
Early = urinary frequency + nocturia
Late = Itching when near ESRD
As well as decreased kidney size, renal ultrasound of a patient with chronic kidney disease might show these three things
Cortical thinning
Scarring
Obstruction
Earliest sign of chronic kidney disease in diabetes patients
Microalbuminuria
Symptoms for chronic kidney disease often don’t show up until stage 3, at which point GFR is …
GFR <60%
Long term vascular access is obtained through this in hemodialysis
Arteriovenous fistulas
SCr levels in chronic kidney disease at which to refer a patient to a nephrologist
Women: >1.5mg/dL
Men: > 2.0mg/dL
True or false. Chronic kidney disease is irreversible and treatments are aimed at slowing progression
True
Best marker for structural damage in the kidney
Proteinuria
GFR level at which to start dialysis
GFR 5-9 mL/min
Chronic kidney disease causes normocytic normochromic anemia due to decreased erythropoietin. What is the first step in treatments of CKD anemia?
Treat iron deficiency first if present
If Hgb <10 and iron normal, give EPO and aim to maintain Hgb >10
