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Competency > CKD > Flashcards

CKD Flashcards

1
Q

What is the BP goal for CKD with HTN?

A

< 120/80 mmHg

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2
Q

What is the default HbA1c goal for CKD with DM? (without those factors like life expectancy)

A

< 6.5%

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3
Q

Which agents help with proteinuria?

A
  • ACEi/ARB
  • SGLT2i
  • finerenone
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4
Q

What is the target Hb for those with CKD with anaemia?

A

10-11.5

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5
Q

What is considered CKD with anaemia? (Hb levels for male and female)

A

M: <13
F: <12

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6
Q

What is the target TSAT and ferritin goal for CKD with anaemia?

A

TSAT: 30
Ferritin: 500

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7
Q

What is considered AKI?

A
  • 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
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8
Q

What can cause ATN?

A
  • vancomycin
  • aminoglycosides
  • amp B
  • contrast-induced
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9
Q

Percentage of iron in iron products:
- ferrous fumarate
- ferrous gluconate
- ferrous sulfate
- iron polymaltose

A
  • ferrous fumarate: 33%
  • ferrous gluconate: 12%
  • ferrous sulfate: 20%
  • iron polymaltose: 100%
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10
Q

What are short and long acting ESAs?

A
  • short: epoetin alpha & beta
  • long: darbepoetin alpha, methoxy polyethylene glycol-epoetin beta
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11
Q

Is epoetin alpha given as IV or SC? Why?

A

IV (SC causes pure red cell aplasia)

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12
Q

When to start ESA? When to stop ESA?

A

start: Hb <10
stop: Hb >11.5 (increase risk of CV events & stroke)

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13
Q

When to start IV and PO iron?

A
  • IV: dialysis
  • PO: not on dialysis
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14
Q

How long for ESA to work?

A

10 days to reach SS (time taken for erythrocyte progenitor cells to mature & release into circulation)

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15
Q

Maximum increase in Hb allowed while on ESA?

A

1g/dL Q2-4w

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16
Q

Adverse effects of ESA?

A
  • HTN
  • pure red cell aplasia
  • seizures
  • flu-like sx
  • vascular access thrombosis
17
Q

Percentage of calcium in calcium products?

A
  • calcium carbonate: 40%
  • calcium acetate: 25%
  • calcium citrate: 21%
18
Q

Pharm options for CKD-MBD?

A
  • phosphate binders
  • vitamin D analogues
  • calcimimetics
19
Q

Examples of phosphate binders (calcium and non-calcium based)?

A
  • calcium: calcium acetate, carbonate
  • non-calcium: sevelamer, lanthanum, aluminium, sucroferric oxyhydroxide
20
Q

Examples of vitamin D & analogues for CKD-MBD?

A
  • alfacalcidol
  • calcitriol
  • paricalcitol
21
Q

Examples of calcimimetics for CKD-MBD?

A

cinacalcet, etelcalcitide

22
Q

To take phosphate binders with or without food? Which ones can be chewed and which ones must be swallowed?

A

Take with food

Chew: lanthanum, calcium carbonate / acetate, sucroferric oxyhydroxide
Swallow: sevelamar

23
Q

Maximum duration to use aluminium?

A

4 weeks

24
Q

Frequency of all phosphate binders?

A

TDS

25
Q

What is the active form of vitamin D?

A

calcitriol

26
Q

Activation of vitamin D?

A

ergocalciferol / cholecalciferol -> add OH grp to 25th position in liver -> calcifediol -> add OH grp to 1st position in kidney -> calcitriol

27
Q

How do calcimimetics work?

A

Binds and modifies calcium sensing receptor on parathyroid gland, causing increased sensitivity to extracellular calcium, reducing PTH levels

28
Q

How to switch between cinacalcet and etelcalcitide?

A
  • cinacalcet to etelcalcitide: stop cinacalcet for ≥7D before starting etelcalcitide
  • etelcalcitide to cinacalcet: stop etelcalcitide for ≥4w before starting cinacalcet
29
Q

How to change alfacalcidol to active form?

A

Activation by 25-hydroxylase in liver

30
Q

Bicarbonate level target for metabolic acidosis?

A

≥ 22 mEq/L

31
Q

Treatment for metabolic acidosis? With dose

A

Sodium bicarbonate 500-1000mg TDS (one 500mg capsule is 5.95 mEq of Na & bicarbonate)

32
Q

When to stop bicarbonate supplementation?

A

Once regular dialysis is initiated

33
Q

When is dialysis indicated?

A

Acidosis
Electrolyte abnormalities
Intoxication
Overload (fluid)
Uraemia

34
Q

What factors affect drug dialysability?

A
  • 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
35
Q

What does PD dialysate NOT contain?

A

potassium

Competency (30 decks)

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