CKD Flashcards
List in order the leading causes of CKD
- DM
- HTN
- Glomerulonephritis
What is first line therapy for Diabetes + CKD? What does the urine albumin need to be to indicates use of these drugs?
ACE-1 or ARB
urine albumin >30 mg/24 hrs
When do you want to stop increasing the dose of an ACE-1 or ARB with DM + CKD?
- Urine albuminuria reduced by 30-50% OR
- Significant decrease in GFR OR
- Hyperkalemia
HTN + CKD treatment and its effects on CKD?
ACE-1 and ARBs
Limits disease progression
Pathogenesis of Anemia in CKD
Deficiency of erythropoietin production by kidneys
Anemia treatment in CKD
ESA (erythropoietin stimulating agent) + Iron supplementation
What does ESA increase your risk of?
CV events
When do you initiate ESA in Non-Dialysis CKD?
If HgB <10 g/dL
DO NOT initiate if Hb ≥10 g/dL
When do you initiate ESA in Dialysis CKD?
HgB between 9-10 g/dL to avoid drop in HgB to <9 g/dL
What HgB levels do you NOT want to use ESA for?
Increase HgB over 13 g/dL OR
to maintain HgB above 11.5
Iron initiation indications in CKD
If TSat is ≤30% (≤0.30) and ferritin is ≤500 ng/mL
What is the MOA of Erythropoietin Stimulating Agents (ESA)?
- Induces erythropoiesis by stimulating division/differentiation of progenitor cells
- Induces release of reticulocytes from bone marrow to blood stream
ESA Box warning
Increased CV and CKD events with Hg > 11g/dL
Other ADE’s of ESA
- Cancer
- Shortened survival/increased progression in certain CA’s when HgB >12 g/dL
- Increase risk of DVT
What is the net serum effect of PTH?
- Increased serum Ca+
2. Decreased serum Phosphorus
What is the net serum effect of Vitamin D
Both serum Ca/P increases
What is the net serum effect of Firbroblast growth factor 23 (FGF23)
Decrease in serum Phosphorus