CKD

Question 1

most significant reason patients with CKD develop anaemia

Answer 1

reduced erythropoietin levels
- normochromic normocytic anaemia

Question 2

management of anaemia from CKD

Answer 2

target Hb 100-120
oral iron offered first
- if target Hb not reached in 3 months switch to IV iron
ESAs (erythropoietin or darbeopetin) used in those who are likely to benefit- optimising iron status?
- require IV iron also

Question 3

pathophysiology of bone disease in CKD

Answer 3

CKD leads to low vit D
kidneys also responsible for excreting phosphate- CKD causes high phosphate

Question 4

impact of high phosphate and low vit D in CKD

Answer 4

high phosphate- causes osteomalacia
low calcium because of low vit D and high phosphate
secondary hyperparathyroid

Question 5

management of mineral bone disease in CKD

Answer 5

reduce dietary intake of phosphate- first line
phosphate binders
vit D: alfacalcidol, calcitriol
parathyroidectomy