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
