CKD; management of complications Flashcards
Why do most people witj CKD develop anaemia?
Reduced erythropoietin levels
What type of anaemia do people with CKD develop?
Normochromic normocytic anaemia
When does anaemia in people with CKD become apparent?
Stage 4
(eGFR 15-30)
What does anaemia in CKD predispose the patient to?
Left ventricular hypertrophy
What is a target haemoglobin for people with anaemia in CKD?
Target haemoglobin of 10 - 12 g/dl
What is the management of anaemia in CKD?
Erythropoiesis-stimulating agents (ESA).
What should be optimised before the administration of erythropoiesis-stimulating agents (ESA) in someone with anaemia in CKD?
Determination and optimisation of iron status
Who should oral iron be offered to?
Oral iron should be offered for patients who are not on ESAs or haemodialysis
If target Hb levels are not reached within 3 months of being on oral iron, what are patients switched to?
IV iron
What should patients on ESAs or haemodialysis be offered initially to get iron levels up to standard?
IV iron
What are exampls of ESA’s that can be given for anaemia in CKD?
Erythropoietin
Darbepoetin
How is proteinuria diagnosed in someone with CKD?
albumin:creatinine ratio (ACR)
How is the albumin:creatinine ratio (ACR) measured?
First-pass morning urine specimen
What is classed as clinically important poteinuria?
ACR of more than 3 mg/mmol
If the initial ACR is between 3mg/mmol and 70 mg/mmol, what needs to be done?
Subsequent early morning sample
If the ACR is more than 70mg/mmol, does a subsequent sample need to be taken?
No
What is the management of proteinuria?
ACE inhibitors (or angiotensin II receptor blockers)
What problems can CKD cause that result in bone issues?
low vitamin D
high phosphate
low calcium: due to lack of vitamin D high phosphate
secondary hyperparathyroidism
What bone manifestations can occur due to the metabolic disturbances in CKD?
Osteomalacia- low vitamin D
Osteosclerosis
Osteoporosis
What can be used in the management of CKD complications?
Active forms of vitamin D (alfacalcidol and calcitriol)
Low phosphate diet
Bisphosphonates can be used to treat osteoporosis
Why is there high phosphate is someone with CKD?
Due to reduced phosphate excretion
Why is there low active vitamin D in someone with CKD?
Kidney is essential in metabolising vitamin D to its active form
Why is there low calcium in someone with CKD?
Low active vitmain D
Active vitamin D is essential in calcium absorption from the intestines and kidneys
Why can Secondary hyperparathyroidism occur in someone with CKD?
Parathyroid glands react to the low serum calcium and high serum phosphate by excreting more parathyroid hormone
How can osteomalacia (softening of bones) occur in soemone with CKD?
Increased turnover of bones without adequate calcium supply.
What can be used to treat hyperphosphataemia?
Calcium acetate
Sevelamer
What can be used to treat osteoporosis and bone disorders in patients with CKD?
Alendronic acid (bisphosphonate)
What is a possible side effect of calcium acetate?
Hypercalcaemia
Abdo pain, back pain, muscle weakness, anxious
