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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
what does auryxia do to TSAT and ferritin?
increases them
26
when do we use aluminum hydroxide as a phosphate binder?
never; if do only for ST <4 wks or can be toxic
27
what should we restrict our potassium to per day?
800-1000 if 3 or higher
28
what d vitamins require activation?
- ergocalciferol - D2 - cholecalciferol - D3 -- CKD of 3 or 4
29
what are some activated vit d compounds for CKD stage 5 pts?
calcitriol, paricalcitol, doxcercalciferol
30
what are some clinical pearls for calcitriol?
- greaatest risk for hypercalcemia - cheao
30
what are some clincial pearls for paricalcitol?
- dec. in PTH by 30% - most favorable AEs profile - dec. calcemic activity
31
what is doxercalciferol? what are some clinical pearls for it?
1. prodrug that is activated in the liver - dec. in pth by 30% - ince. hyperphosphatemia - dec. hypocalcemia - produces more even serum conc.
31
when is cinacalcet contraindiacated?
- contraindicated in hypocalcemia. DON"T USE if Ca < 7.5 mg/dL and withhold until =8 or above
31
what percent of ESRD patients will develop anemia?
nearly all
32
what agent is cinacalcet?
type 2 calcimimetic
33
what is the main reason they develop anemia?
dec. production in erythropoietin
34
what labs do we look at for iron and what Ses?
LABS - Hb - TSAT - Ferritin - MCV -RDW SEs - dizziness -fatique - dec. cognition - HA
35
what is the normal range for MCV?
between 80-96
36
what is the RDW and what is the normal lab value?
- 11.5-14.5% - either normal or abnormal distribution
37
what is a normal Hb for M and F?
< 12 for F < 13 for M
38
what are the KDIGO guidelines for suggesting iron therapy?
TSAT <30%% and ferritin <500ng/mL
39
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
40
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
41
what is the dose recommended for iron?
200mg Elemental/day
42
what is heme iron and some clinical pearls?
1. proferrin es and forte - better absorption - works somewhere else in stomach
43
what IV iron needs a test dose?
iron dextran
44
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)
45
what is triferic?
an iron cmpd added to dialysate
46
when is it suggested to begin ESA?
CKD 3-5ND Hb <10 CKD 5D Hb bwtn 9-10
47
what are the warnings for ESAs and what is the max limit to not go over?
1. do not push above 11.5 - incidence of cerebrovascular events increases.
48
what id our Hb goal per FDA?
10-11
49
what are the types of ESAs?
erythropoietin and darbepoetin alfa and methoxy PEG AKA epoetin beta
50
what are the AEs for ESAs?
1. pure red blood cell aplasia 2. 23% will have inc. in BP
51
what are the causes of EPA failure?
lack of vitamins and iron
52
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
53
what is the average nutrion for CKD/ESRD pts?
60-65 kcal/kg/day
54
what is the protein amount for GFR < 30 and if have stage 4 ESKD?
1. 0.8 for GFR <30 2. 1.2 for ESKD
55
what vitamins do patients need to take on dialysis since they are removed?
water soluble vitamin B and C

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

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