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Exam 1 Electrolytes: Renal: Diuretics: CKD & ESRD > CKD & ESRD > Flashcards

CKD & ESRD Flashcards

1
Q

what is CKD vs. AKI?

A
  • CKD
    –> over lifetime due to underlying conditions
  • AKI
    –> short period of time working then not
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2
Q

what value do we look at for a dec. GFR?

A
  • GFR < 60 ml/min
  • categories G3a-G5
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3
Q

what stage do we look at and care about for CKD and when are most people on dialysis?

A
  1. stage G3 is when we care
    - stage G5 for dialysis
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4
Q

what is the life expectancy for a 20 and 60 year old with and without ESKD?

A
  1. 20 WITHOUT add on 47-60yr
  2. 20 WITH add on 17-21 yr
  3. 60 WITHOUT add on 16-23 yr
  4. 60 WITH add on 4-5yr
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5
Q

what is the most commonly used equation for CrCl?

A
  • Cockroft and Gault formula
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6
Q

what equation is the most accurate for GFR?

A

MDRD ( mod of diet in renal disease)

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7
Q

what is the CrCl equation?

A

M= (140-age) IBW/ SCr x 72
W= above x 0.85

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8
Q

what waste do the kidneys excrete?

A

nitrogenous waste

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9
Q

what complication does nitrogneous waste cause and what value do we look at?

A
  • uremia and BUN
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10
Q

how can you fix electrolyte imbalances in CKD?

A

sodium bicarb

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11
Q

what hormone does the kidney secrete and what does this cause?

A
  1. erythropoietin
  2. kidney anemia
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12
Q

what are some effects of the body with people who have CKD?

A
  1. uremic fetor
  2. metallic taste
  3. uremic frost
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13
Q

do we need to fluid restrict in patients?

A

only if Na+ not controlled

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14
Q

what is a consideration when using diuretics on their CrCl?

A
  1. thiazides ineffective when CrCl <30ml/min
  2. loops will work when CrCl < 30 ml/min
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15
Q

what do we do about electrolyte imbalances specifically with Na and K?

A

Na- no salt added diet
K- 3gm/day
—> if pre-dialysis then 4.5-5.5

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16
Q

what are three pathways that increase PTH and inc. risk of fractures overall?

A
  1. inc. phos
  2. dec. ca
  3. dec. vit D
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17
Q

when is hyperphosphatemia a problem?

A

people who have ESRD (4&5 sstage)

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18
Q

when do we give phosphate binders?

A

with all meals

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19
Q

what are the calcium containing phosphate binders?

A
  1. tums
  2. Phoslo
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20
Q

what is the % of elemental calcium and SEs and a clinical pearl?

A
  • calcium carbonate has about 40% elemental calcium
  • don’t exceed 1500 EC/ day
  • can cause constipation
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21
Q

tell me a little bit about PhosLo and where it goes?

A
  1. has 25% elemental calcium
  2. 1500/day
    - goes through Gi tract and passes in feces
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22
Q

tell me about sevelamer; what does it do; and some SEs?

A
  1. it is a hydro gel
    - it decreases LDL by 15-30%
    - it dec. uric acid conc.
    - mild stomach upset
    - can take 14g/ day
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23
Q

tell me about lanthanum, SEs, and clinical pearls?

A
  • titrated to 1500-3000
  • better in acidic environment
  • eliminated in feces
  • gi: nausea, vomit, diarrhea
  • no LT accumulation
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24
Q

does sucroferric oxyhydroxide have an effect on iron?

A

no minimal effect

25
Q

what does auryxia do to TSAT and ferritin?

A

increases them

26
Q

when do we use aluminum hydroxide as a phosphate binder?

A

never; if do only for ST <4 wks or can be toxic

27
Q

what should we restrict our potassium to per day?

A

800-1000 if 3 or higher

28
Q

what d vitamins require activation?

A
  • ergocalciferol - D2
  • cholecalciferol - D3
    – CKD of 3 or 4
29
Q

what are some activated vit d compounds for CKD stage 5 pts?

A

calcitriol, paricalcitol, doxcercalciferol

30
Q

what are some clinical pearls for calcitriol?

A
  • greaatest risk for hypercalcemia
  • cheao
30
Q

what are some clincial pearls for paricalcitol?

A
  • dec. in PTH by 30%
  • most favorable AEs profile
  • dec. calcemic activity
31
Q

what is doxercalciferol? what are some clinical pearls for it?

A
  1. prodrug that is activated in the liver
    - dec. in pth by 30%
    - ince. hyperphosphatemia
    - dec. hypocalcemia
    - produces more even serum conc.
31
Q

when is cinacalcet contraindiacated?

A
  • contraindicated in hypocalcemia. DON”T USE if Ca < 7.5 mg/dL and withhold until =8 or above
31
Q

what percent of ESRD patients will develop anemia?

A

nearly all

32
Q

what agent is cinacalcet?

A

type 2 calcimimetic

33
Q

what is the main reason they develop anemia?

A

dec. production in erythropoietin

34
Q

what labs do we look at for iron and what Ses?

A

LABS
- Hb
- TSAT
- Ferritin
- MCV
-RDW
SEs
- dizziness
-fatique
- dec. cognition
- HA

35
Q

what is the normal range for MCV?

A

between 80-96

36
Q

what is the RDW and what is the normal lab value?

A
  • 11.5-14.5%
  • either normal or abnormal distribution
37
Q

what is a normal Hb for M and F?

A

< 12 for F
< 13 for M

38
Q

what are the KDIGO guidelines for suggesting iron therapy?

A

TSAT <30%% and ferritin <500ng/mL

39
Q

what is the monitoring parameters for oral iron and when do you stop therapy?

A
  • every 3 months and when levels are above 30% and 500
40
Q

who is oral iron not recommended for and what are side effects for regular iron?

A
  • for correcting and maintaining iron stores for HD patients
  • SEs
    –> stomach upset
  • better in acidic environment
  • separate from Ca by 2 hours
41
Q

what is the dose recommended for iron?

A

200mg Elemental/day

42
Q

what is heme iron and some clinical pearls?

A
  1. proferrin es and forte
    - better absorption
    - works somewhere else in stomach
43
Q

what IV iron needs a test dose?

A

iron dextran

44
Q

what IV iron needs to be taken after an MR due to interfering with it for up to 3 months after the 2nd injection?

A

ferumoxytol (feraheme)

45
Q

what is triferic?

A

an iron cmpd added to dialysate

46
Q

when is it suggested to begin ESA?

A

CKD 3-5ND Hb <10
CKD 5D Hb bwtn 9-10

47
Q

what are the warnings for ESAs and what is the max limit to not go over?

A
  1. do not push above 11.5
    - incidence of cerebrovascular events increases.
48
Q

what id our Hb goal per FDA?

A

10-11

49
Q

what are the types of ESAs?

A

erythropoietin and darbepoetin alfa and methoxy PEG AKA epoetin beta

50
Q

what are the AEs for ESAs?

A
  1. pure red blood cell aplasia
  2. 23% will have inc. in BP
51
Q

what are the causes of EPA failure?

A

lack of vitamins and iron

52
Q

what is the new therapy for CKD and the indication for dialysis?

A
  • daprodustat which is once daily
  • have to be on dialysis for at least 4 months
53
Q

what is the average nutrion for CKD/ESRD pts?

A

60-65 kcal/kg/day

54
Q

what is the protein amount for GFR < 30 and if have stage 4 ESKD?

A
  1. 0.8 for GFR <30
  2. 1.2 for ESKD
55
Q

what vitamins do patients need to take on dialysis since they are removed?

A

water soluble vitamin B and C

Exam 1 Electrolytes: Renal: Diuretics: CKD & ESRD (5 decks)

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