CKD and Complications Flashcards
What is the definition of anemia of CKD?
hemoglobin <13g/dL (males) or <12 (females)
What are the four goals of therapy for anemia of CKD?
increase oxygen-carrying capacity, improve quality of life, prevent/alleviate symptoms and complications of anemia, and decrease the need for blood transfusions
At what GFR does anemia generally begin?
<45 mL/min
The redistribution of drug from tissue stores makes TDM unreliable during what phase?
post-dialysis equilibrium
What is the most common cause of erythropoietin resistance?
iron deficiency
How often should an iron panel be done in ESRD patients?
every 3 months
What are the two goals of iron deficiency therapy?
Tsat > 30%, serum ferritin >500 ng/mL
What are side effects of oral iron therapy?
GI upset, dark stools, many drug interactions
What are side effects of IV iron therapy?
INFECTIONS, dyspnea/wheezing, myalgias, hypotension, flushing edema, chest pain, injection site reactions
What forms of oral iron therapy have the most and least percent elemental iron?
most = polysacccharide iron and ferric citrate, least = ferrous sulfate
What is the dosing regimen for most oral iron therapies? Why?
once daily or every other day; decreases the rise in hepcidin
ferric gluconate brand name, iron content and dosing?
Ferrlecit, 12.5, 125mg TIW x 8 doses
iron sucrose brand name, iron content and dosing?
Venofer, 20, 100mg 1-3x weekly
Iron dextran brand name, iron content and dosing?
Dexferrum, 50, 50-100mg q week x10 weeks
LMW iron dextran brand name, iron content and dosing?
InFed, 50, 50-100mg q week x 10 weeks
Ferumoxytol brand name, iron content and dosing?
Feraheme, 30, 510mg x2 3-8 days apart
Ferric carboxymaltose brand name, iron content and dosing?
Injectafer, 50, 750mg x2 7 days apart
What are the four types of ESAs?
epoetin alfa, darbepoetin alfa, methoxy PEG epoetin beta, epoetin alfa-epbx
When should initiation of ESA happen as per KDIGO and FDA?
KDIGO = Hb 9-10 g/dL, FDA = <10 g/dL
What is the target Hb in ND-CKD as per KDIGO and FDA?
KDIGO = 11.5 MAX, FDA = 10
What is the target Hb in ESRD as per KDIGO and FDA?
KDIGO = 11.5 MAX, FDA = 10-11
What is the goal change in HGB per month?
1-2 g/dL
When should dose adjustments be performed when on erythropoiesis stimulating agents?
every 4 weeks, by increments of 25% of ESA dose
What are nine causes of ESA resistance?
iron deficiency, ACEi, hyperparathyroidism, aluminum toxicity, folate and/or B12 deficiency, infection, malignancy, trauma, inflammation
What are adverse effects of ESA therapy?
HTN, hypercoaguability, hypersensitivity reactions, pure red blood cell apasia (PRBCA)
What are the two goals of ESA therapy?
prevent blood transfusions, imrpove QoL
What is the conversion for epoetin to darbepoetin?
200 units of epoetin = 1mcg darbepoetin
What is the formula for corrected calcium?
corrected calcium = measured calcium + 0.8(4-albumin)
What are three consequences of CKD-MBD?
CV disease, bone disease, calciphylaxis/CUA
What are the first three steps, in order, for treating CKD-MBD?
phosphate binders, activated vitamin D, calcimimetics
For phosphate binders, if the serum calcium is normal-high, use ____, and if low use ____?
non-calcium based binders, calcium based binders
What is the first line non-calcium based binder?
sevelamer carbonate
What is a chewable non-calcium based binder?
lanthanum carbonate
What is a non-calcium based binder used in iron deficiency anemia?
ferric citrate
What is a non-calcium based binder used to reduce pill burden?
sucroferric oxyhydroxide
What are the two calcium based binders?
calcium acetate and calcium carbonate
For lowering PTH, if the serum calcium is normal-high, use ____, and if low use ____?
calcimimetics, activated vitamin D and analogs
Which calcimimetic is PO and which is IV?
PO = cinacalcet, IV = etelcalcitide
What vitamin D therapy mimics the endogenous chemical?
calcitriol
What vitamin D therapies cause less hypercalcemia?
paricalcitriol and doxercalciferol
