Chronic Kidney Disease Management

Question 1

What does management of CKD require?

Answer 1

Refer to nephrology
Treatment to slow renal disease progression
Treatment of renal complications of CKD
Treatment of other complication son CKD
Preparation for RRT

Question 2

What is target BP? What if DM?

Answer 2

Systolic< 140 diastolic <90

Systolic <130 if DM and diastolic < 80

Question 3

Who should you offer RAAS antagonist to?

Answer 3

DM and ACR>3
HTN and ACR >30
Any CKD with aCR>70

Question 4

What are risk of RAAS antagonists?

Answer 4

Hyperkalaaemia

Hypotension

Question 5

What advice would you give to CKD patient?

Answer 5

Control BP
Control DM
Exercise
Healthy weight
Smoking cessation
Limit smoke intake <2g sodium day

Question 6

What are complications of CKD?

Answer 6

Anaemia
Acidosis
Oedema
Bone mineral disorders
Restless legs/gramps

CVS disease due to hypertension, vascular stiffness, inflammation,

Question 7

How is acidosis treated in CKD?

Answer 7

Consider sodium bicarbonate supplements in patents with eGFR<30 and low serum bicarbonate <20mmol/L.
Caution in hypertension and fluid overload due to sodium component

Question 8

How is oedema treated in CKD?

Answer 8

Restrict fluid and sodium intake
Loop diuretics and thiazides
Monitor carefully

Question 9

How are bone mineral disorders treated in CKD?

Answer 9

CKD causes increase in serum phosphate and reduced hydroxylation o f vitamin D
Treat if phosphate > 1.5 with dietary restriction and phosphate binders

Give vitamin D supplements if deficient
If hyperparathyroidism - treat with an activated vitamin D analogue –> suppresses PTH with less effect on gut absorption of calcium and phosphate

Question 10

How is CVS risk treated in CKD?

Answer 10

Antiplatelets - low dose aspirin for CKD at risk of atherosclerotic events unless bleeding risk outweighs benefit

Statin