CKD; management of complications

Question 1

Why do most people witj CKD develop anaemia?

Answer 1

Reduced erythropoietin levels

Question 2

What type of anaemia do people with CKD develop?

Answer 2

Normochromic normocytic anaemia

Question 3

When does anaemia in people with CKD become apparent?

Answer 3

Stage 4
(eGFR 15-30)

Question 4

What does anaemia in CKD predispose the patient to?

Answer 4

Left ventricular hypertrophy

Question 5

What is a target haemoglobin for people with anaemia in CKD?

Answer 5

Target haemoglobin of 10 - 12 g/dl

Question 6

What is the management of anaemia in CKD?

Answer 6

Erythropoiesis-stimulating agents (ESA).

Question 7

What should be optimised before the administration of erythropoiesis-stimulating agents (ESA) in someone with anaemia in CKD?

Answer 7

Determination and optimisation of iron status

Question 8

Who should oral iron be offered to?

Answer 8

Oral iron should be offered for patients who are not on ESAs or haemodialysis

Question 9

If target Hb levels are not reached within 3 months of being on oral iron, what are patients switched to?

Answer 9

IV iron

Question 10

What should patients on ESAs or haemodialysis be offered initially to get iron levels up to standard?

Answer 10

IV iron

Question 11

What are exampls of ESA’s that can be given for anaemia in CKD?

Answer 11

Erythropoietin
Darbepoetin

Question 12

How is proteinuria diagnosed in someone with CKD?

Answer 12

albumin:creatinine ratio (ACR)

Question 13

How is the albumin:creatinine ratio (ACR) measured?

Answer 13

First-pass morning urine specimen

Question 14

What is classed as clinically important poteinuria?

Answer 14

ACR of more than 3 mg/mmol

Question 15

If the initial ACR is between 3mg/mmol and 70 mg/mmol, what needs to be done?

Answer 15

Subsequent early morning sample

Question 16

If the ACR is more than 70mg/mmol, does a subsequent sample need to be taken?

Answer 16

No

Question 17

What is the management of proteinuria?

Answer 17

ACE inhibitors (or angiotensin II receptor blockers)

Question 18

What problems can CKD cause that result in bone issues?

Answer 18

low vitamin D
high phosphate
low calcium: due to lack of vitamin D high phosphate
secondary hyperparathyroidism

Question 19

What bone manifestations can occur due to the metabolic disturbances in CKD?

Answer 19

Osteomalacia- low vitamin D
Osteosclerosis
Osteoporosis

Question 20

What can be used in the management of CKD complications?

Answer 20

Active forms of vitamin D (alfacalcidol and calcitriol)
Low phosphate diet
Bisphosphonates can be used to treat osteoporosis

Question 21

Why is there high phosphate is someone with CKD?

Answer 21

Due to reduced phosphate excretion

Question 22

Why is there low active vitamin D in someone with CKD?

Answer 22

Kidney is essential in metabolising vitamin D to its active form

Question 23

Why is there low calcium in someone with CKD?

Answer 23

Low active vitmain D
Active vitamin D is essential in calcium absorption from the intestines and kidneys

Question 24

Why can Secondary hyperparathyroidism occur in someone with CKD?

Answer 24

Parathyroid glands react to the low serum calcium and high serum phosphate by excreting more parathyroid hormone

Question 25

How can osteomalacia (softening of bones) occur in soemone with CKD?

Answer 25

Increased turnover of bones without adequate calcium supply.

Question 26

What can be used to treat hyperphosphataemia?

Answer 26

Calcium acetate
Sevelamer

Question 27

What can be used to treat osteoporosis and bone disorders in patients with CKD?

Answer 27

Alendronic acid (bisphosphonate)

Question 28

What is a possible side effect of calcium acetate?

Answer 28

Hypercalcaemia

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