CKD & ESRD Flashcards
what is CKD vs. AKI?
- CKD
–> over lifetime due to underlying conditions - AKI
–> short period of time working then not
what value do we look at for a dec. GFR?
- GFR < 60 ml/min
- categories G3a-G5
what stage do we look at and care about for CKD and when are most people on dialysis?
- stage G3 is when we care
- stage G5 for dialysis
what is the life expectancy for a 20 and 60 year old with and without ESKD?
- 20 WITHOUT add on 47-60yr
- 20 WITH add on 17-21 yr
- 60 WITHOUT add on 16-23 yr
- 60 WITH add on 4-5yr
what is the most commonly used equation for CrCl?
- Cockroft and Gault formula
what equation is the most accurate for GFR?
MDRD ( mod of diet in renal disease)
what is the CrCl equation?
M= (140-age) IBW/ SCr x 72
W= above x 0.85
what waste do the kidneys excrete?
nitrogenous waste
what complication does nitrogneous waste cause and what value do we look at?
- uremia and BUN
how can you fix electrolyte imbalances in CKD?
sodium bicarb
what hormone does the kidney secrete and what does this cause?
- erythropoietin
- kidney anemia
what are some effects of the body with people who have CKD?
- uremic fetor
- metallic taste
- uremic frost
do we need to fluid restrict in patients?
only if Na+ not controlled
what is a consideration when using diuretics on their CrCl?
- thiazides ineffective when CrCl <30ml/min
- loops will work when CrCl < 30 ml/min
what do we do about electrolyte imbalances specifically with Na and K?
Na- no salt added diet
K- 3gm/day
—> if pre-dialysis then 4.5-5.5
what are three pathways that increase PTH and inc. risk of fractures overall?
- inc. phos
- dec. ca
- dec. vit D
when is hyperphosphatemia a problem?
people who have ESRD (4&5 sstage)
when do we give phosphate binders?
with all meals
what are the calcium containing phosphate binders?
- tums
- Phoslo
what is the % of elemental calcium and SEs and a clinical pearl?
- calcium carbonate has about 40% elemental calcium
- don’t exceed 1500 EC/ day
- can cause constipation
tell me a little bit about PhosLo and where it goes?
- has 25% elemental calcium
- 1500/day
- goes through Gi tract and passes in feces
tell me about sevelamer; what does it do; and some SEs?
- it is a hydro gel
- it decreases LDL by 15-30%
- it dec. uric acid conc.
- mild stomach upset
- can take 14g/ day
tell me about lanthanum, SEs, and clinical pearls?
- titrated to 1500-3000
- better in acidic environment
- eliminated in feces
- gi: nausea, vomit, diarrhea
- no LT accumulation
does sucroferric oxyhydroxide have an effect on iron?
no minimal effect
what does auryxia do to TSAT and ferritin?
increases them
when do we use aluminum hydroxide as a phosphate binder?
never; if do only for ST <4 wks or can be toxic
what should we restrict our potassium to per day?
800-1000 if 3 or higher
what d vitamins require activation?
- ergocalciferol - D2
- cholecalciferol - D3
– CKD of 3 or 4
what are some activated vit d compounds for CKD stage 5 pts?
calcitriol, paricalcitol, doxcercalciferol
what are some clinical pearls for calcitriol?
- greaatest risk for hypercalcemia
- cheao
what are some clincial pearls for paricalcitol?
- dec. in PTH by 30%
- most favorable AEs profile
- dec. calcemic activity
what is doxercalciferol? what are some clinical pearls for it?
- prodrug that is activated in the liver
- dec. in pth by 30%
- ince. hyperphosphatemia
- dec. hypocalcemia
- produces more even serum conc.
when is cinacalcet contraindiacated?
- contraindicated in hypocalcemia. DON”T USE if Ca < 7.5 mg/dL and withhold until =8 or above
what percent of ESRD patients will develop anemia?
nearly all
what agent is cinacalcet?
type 2 calcimimetic
what is the main reason they develop anemia?
dec. production in erythropoietin
what labs do we look at for iron and what Ses?
LABS
- Hb
- TSAT
- Ferritin
- MCV
-RDW
SEs
- dizziness
-fatique
- dec. cognition
- HA
what is the normal range for MCV?
between 80-96
what is the RDW and what is the normal lab value?
- 11.5-14.5%
- either normal or abnormal distribution
what is a normal Hb for M and F?
< 12 for F
< 13 for M
what are the KDIGO guidelines for suggesting iron therapy?
TSAT <30%% and ferritin <500ng/mL
what is the monitoring parameters for oral iron and when do you stop therapy?
- every 3 months and when levels are above 30% and 500
who is oral iron not recommended for and what are side effects for regular iron?
- for correcting and maintaining iron stores for HD patients
- SEs
–> stomach upset - better in acidic environment
- separate from Ca by 2 hours
what is the dose recommended for iron?
200mg Elemental/day
what is heme iron and some clinical pearls?
- proferrin es and forte
- better absorption
- works somewhere else in stomach
what IV iron needs a test dose?
iron dextran
what IV iron needs to be taken after an MR due to interfering with it for up to 3 months after the 2nd injection?
ferumoxytol (feraheme)
what is triferic?
an iron cmpd added to dialysate
when is it suggested to begin ESA?
CKD 3-5ND Hb <10
CKD 5D Hb bwtn 9-10
what are the warnings for ESAs and what is the max limit to not go over?
- do not push above 11.5
- incidence of cerebrovascular events increases.
what id our Hb goal per FDA?
10-11
what are the types of ESAs?
erythropoietin and darbepoetin alfa and methoxy PEG AKA epoetin beta
what are the AEs for ESAs?
- pure red blood cell aplasia
- 23% will have inc. in BP
what are the causes of EPA failure?
lack of vitamins and iron
what is the new therapy for CKD and the indication for dialysis?
- daprodustat which is once daily
- have to be on dialysis for at least 4 months
what is the average nutrion for CKD/ESRD pts?
60-65 kcal/kg/day
what is the protein amount for GFR < 30 and if have stage 4 ESKD?
- 0.8 for GFR <30
- 1.2 for ESKD
what vitamins do patients need to take on dialysis since they are removed?
water soluble vitamin B and C
