CKD Flashcards
What is the BP goal for CKD with HTN?
< 120/80 mmHg
What is the default HbA1c goal for CKD with DM? (without those factors like life expectancy)
< 6.5%
Which agents help with proteinuria?
- ACEi/ARB
- SGLT2i
- finerenone
What is the target Hb for those with CKD with anaemia?
10-11.5
What is considered CKD with anaemia? (Hb levels for male and female)
M: <13
F: <12
What is the target TSAT and ferritin goal for CKD with anaemia?
TSAT: 30
Ferritin: 500
What is considered AKI?
- increase in SCr by 0.3 mg/dL (26.5 mol/L) within 48h
- increase in SCR by 1.5x baseline in past 7D
- urine vol < 0.5mL/kg/h in past 6h
What can cause ATN?
- vancomycin
- aminoglycosides
- amp B
- contrast-induced
Percentage of iron in iron products:
- ferrous fumarate
- ferrous gluconate
- ferrous sulfate
- iron polymaltose
- ferrous fumarate: 33%
- ferrous gluconate: 12%
- ferrous sulfate: 20%
- iron polymaltose: 100%
What are short and long acting ESAs?
- short: epoetin alpha & beta
- long: darbepoetin alpha, methoxy polyethylene glycol-epoetin beta
Is epoetin alpha given as IV or SC? Why?
IV (SC causes pure red cell aplasia)
When to start ESA? When to stop ESA?
start: Hb <10
stop: Hb >11.5 (increase risk of CV events & stroke)
When to start IV and PO iron?
- IV: dialysis
- PO: not on dialysis
How long for ESA to work?
10 days to reach SS (time taken for erythrocyte progenitor cells to mature & release into circulation)
Maximum increase in Hb allowed while on ESA?
1g/dL Q2-4w
Adverse effects of ESA?
- HTN
- pure red cell aplasia
- seizures
- flu-like sx
- vascular access thrombosis
Percentage of calcium in calcium products?
- calcium carbonate: 40%
- calcium acetate: 25%
- calcium citrate: 21%
Pharm options for CKD-MBD?
- phosphate binders
- vitamin D analogues
- calcimimetics
Examples of phosphate binders (calcium and non-calcium based)?
- calcium: calcium acetate, carbonate
- non-calcium: sevelamer, lanthanum, aluminium, sucroferric oxyhydroxide
Examples of vitamin D & analogues for CKD-MBD?
- alfacalcidol
- calcitriol
- paricalcitol
Examples of calcimimetics for CKD-MBD?
cinacalcet, etelcalcitide
To take phosphate binders with or without food? Which ones can be chewed and which ones must be swallowed?
Take with food
Chew: lanthanum, calcium carbonate / acetate, sucroferric oxyhydroxide
Swallow: sevelamar
Maximum duration to use aluminium?
4 weeks
Frequency of all phosphate binders?
TDS
What is the active form of vitamin D?
calcitriol
Activation of vitamin D?
ergocalciferol / cholecalciferol -> add OH grp to 25th position in liver -> calcifediol -> add OH grp to 1st position in kidney -> calcitriol
How do calcimimetics work?
Binds and modifies calcium sensing receptor on parathyroid gland, causing increased sensitivity to extracellular calcium, reducing PTH levels
How to switch between cinacalcet and etelcalcitide?
- cinacalcet to etelcalcitide: stop cinacalcet for ≥7D before starting etelcalcitide
- etelcalcitide to cinacalcet: stop etelcalcitide for ≥4w before starting cinacalcet
How to change alfacalcidol to active form?
Activation by 25-hydroxylase in liver
Bicarbonate level target for metabolic acidosis?
≥ 22 mEq/L
Treatment for metabolic acidosis? With dose
Sodium bicarbonate 500-1000mg TDS (one 500mg capsule is 5.95 mEq of Na & bicarbonate)
When to stop bicarbonate supplementation?
Once regular dialysis is initiated
When is dialysis indicated?
Acidosis
Electrolyte abnormalities
Intoxication
Overload (fluid)
Uraemia
What factors affect drug dialysability?
- molecular weight
- water solubility (more water soluble, more dialysable)
- Vd (higher Vd, less plasma drug conc, less dialysable)
- protein binding (more protein binding, less plasma free drug, less dialysable)
- type of dialysate
What does PD dialysate NOT contain?
potassium
