CKD & HTN Flashcards
4 most common causes of CKD
- diabetes
- HTN
- glomerulonephritis
- polycystic kidney disease
diabetes/A1C goal in CKD management
A1C < 7%
healthy weight
moderate intensity exercise
cardiovascular goals in CKD management
BP <120/80 mmHg
lipid management
renal goals in CKD management
slow eGFR decline, reduce albuminuria 30-50%
goal of ACE/ARB therapy in CKD and when to start
SBP <120 mmHg and 30-50% albuminuria reduction
start right away unless CI
contraindications of ACE/ARB
pregnancy, bilateral renal artery stenosis, history of ACE/ARB angioedema
side effects of ACE/ARB
hypotension/orthostasis/dizziness, cough, hyperkalemia
monitoring eGFR decline for ACE/ARB therapy
declines 30-50%, reduce dose
declines >50%, hold therapy
monitoring K rise for ACE/ARB therapy
K >5, dietary restrictions
K >6, start a loop +/- SPS or patiromer
goal of SGLT2 therapy in CKD and when to initiate
A1C <7% and reduce proteinuria
start right away regardless of DM
goal of finerenone and when to start in CKD
goal SBP <120 mmHg
used in those with T2DM with persistent albuminuria when other therapies are not enough.
what must eGFR and K be in order to start finerenone
eGFR > 25
K <5.5
when can a GLP1RA be used for CKD
in T2DM after SGLT2 has already been initiated
HGB levels in anemia
males <13 g/dL
females <12 g/dL
target HGB during anemia therapy
10-11 g/dL
(lower than normal)
target serum ferritin during anemia therapy
> 500 ng/mL (KDIGO)
(higher than normal)
target TSAT during anemia therapy
> 30% (KDIGO)
when to initiate ESAs in non-dialysis CKD, and what is the target
start when HGB < 10 g/dL, target <10g/dL
when to initiate ESAs in ESRD, and what is the target
start when HGB <10g/dL, target 10-11 g/dL.
when to reduced ESA dose by 25%
if HGB approaches 12g/dL after 4 weeks or if it increases >1g/dL in 2 weeks or less
when to increase ESA dose by 25%
if HGB is below target after 4 weeks
side effects of ESAs
hypertension, hypercoaguability (thrombosis risk), hypersensitivity, PRBCA, headache, fatigue, edema, progression of malignancy
target elemental iron for oral treatment
200 mg elemental iron/day in divided doses
side effects of oral iron
GI upset (nausea, cramping, constipation), dark stool, many DDIs
side effects of IV iron
dyspnea/wheezing, itching, myalgias, hypotension, flushing, edema, chest pain, cardiac arrest, injection site reaction, anaphylactic reactions, infection
corrected calcium =
measured calcium + 0.8 (4 - albumin)
consequences of MBD of CKD
CV disease, bone disease, calciphylaxis
target calcium in MBD treatment
8.5-10.2 mg/dL
avoid hypercalcemia
target phosphorous in MBD treatment
2.7-4.6 mg/dL
target iPTH in MBD treatment
<2-9x the upper limit of normal
~150-600 pg/mL
phosphate binders to use when calcium is normal-high
sevelamer carbonate
lanthanum carbonate ferric citrate
sucroferric oxyhydroxide
aluminum hydroxide
phosphate binders to use when calcium is low
calcium carbonate
calcium acetate
activated vitamin D products used to lower iPTH when calcium is normal-low
calcitriol
paricalcitol
doxercalciferol
calcimimetics to used to lower iPTH when calcium is normal-high
cincalcet
etecalcetide
side effects of sevelamer
GI upset, diarrhea
side effects of lanthanum carbonate
GI upset, possible lanthanum accumulation
ferric citrate for MBD side effects
GI, diarrhea, iron overload, stool discoloration
sucroferric oxyhydroxide for MBD side effects
GI, diarrhea
aluminum hydroxide side effects
Al toxicity- GI upset, CNS toxicity, microcytic anemia
side effects of calcium carbonate and acetate
abdominal discomfort, nephrolithiasis, calciphylaxis
stones, bones, abdominal groans
cinacalcet side effects
GI/NV, hypocalcemia, QTc prolongation, ventricular arrythmias
etecalcetide side effects
less GI but still NV, QTc prolongation, hypocalcemia
