Chronic Kidney Disease - Hypertension Flashcards
Dr. Covert
What is the goal BP in CKD patients with HTN?
< 120 mmHg if tolerated
What are the drug classes recommended for patients with CKD?
RAAS inhibitor:
ACEi and ARBs
for patients with diabetes m. and ACR (albumin-to-creatinine ratio) of >30 mm/g
Albumin should not leak into the urine!
Dual RAAS inhibitors are recommended in CDK patients
True or False
False
Why??? -> no evidence of benefit -> worsens hyperkalemia
Why might patients with CKD not tolerate ACEi and ARBs?
The kidney is responsible for excreting (Na exchange with K) potassium -> in CKD potassium builds up
-ACEi and ARBs are causing K build up so it would worsen hyperkalemia
Recommended drug for early (within 1 year) transplant patients
-Dihydropine Calcium channel blocker
-Amlodipine, Nifedipine
Why can’t we use ACEi and ARBs for transplant patients?
Because ACEi and ARBs cause VASODILATION of the EFFERENT arteriole -> causing less perfusion of the kidney
Which drug is recommended in patients with CrCl lower than < 30
Loop diuretics bc they work on the loop of Henle, where more Na is available to be reabsorbed
-Are loop diuretics 2nd line drugs for CKD and HTN patients???
Beta Blockers (BB) are often indicated for solely HTN
False
used for: HFrEF (heart failure with reduced ejection fraction), post-MI, atrial fibrillation)
When to use Aldosterone blockers like Spironolactone)
-for compelling indications (HFrEF, post-MI)
-resistant hypertension
-may not be tolerated well due to causing hyperkalemia
When are Calcium Channel blockers used?
-1st-year kidney transplant recipients
-can be used as add-on therapy
When to use K-sparing diuretics?
-f.e.: Amiloride
-AVOID
-no morbidity or mortality benefits
-cause hyperkalemia in CKD patients
Other drugs for CKD and HTN
-5th or 6th line drugs
-Minoxidil, doxazosin, clonidine, hydralazine
