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PHM601 AKI/CKD > CKD - MBD > Flashcards

CKD - MBD Flashcards

1
Q

What does stimulation of the PTH gland do?

A

Increases serum calcium and phosphorus

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2
Q

What causes MBD in CKD

A

secondary hyperparathyroidism

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3
Q

Hyperparathyroidism directly leads to what

A

phosphate retention
decreased vitamin D activation

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4
Q

Phosphate retention and decreased Vit D activation lead to what?

A

Hypocalcemia

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5
Q

True or False

As GFR declines, CKD-MBD worsens

A

True

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6
Q

Clinical Presentation pf CKD-MBD

A

Usually asymptomatic so monitor labs
Consequences are significant when severe/uncontrolled

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7
Q

When should you monitor Calcium and Phosphorus

A

CKD Stage 3 - Every 6 - 12 months
CKD Stage 4 - Every 3 - 6 months
CKD Stage 5 - every 1 - 3 months

***Calcium with ALbumin

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8
Q

When should you monitor iPTH

A

CKD Stage 3 - every 12 months
CKD Stage 4 - every 3 - 12 months
CKD Stage 5 - every 3 - 6 months

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9
Q

When should you monitor 25-OH Vitamin D

A

at baseline

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10
Q

What is alkaline phosphatase/Bone -specific
(ALP/BALP)?

A

Bone specific ALP; reflects biosynthetic activity of osteoblasts

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11
Q

Equation for Corrected Calcium

A

= Measured Ca + 0.8(4- albumin)

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12
Q

Calcium normal range

A

8.5 - 10.2

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13
Q

Consequences of CKD-MBD

A
  • Bone disease
  • CV disease (#1 cause of ESRD death)
  • Calciphylaxis (CUA)
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14
Q

Consequences of secondary hyperparathyroidism

A
  • ESA resistance
  • Left ventricular hypertrophy
  • Parathyroid Hyperplasia
  • Myocardial fibrosis
  • Immune dysfunction
  • Lipid metabolism (HyperTG)
  • Renal Osteodystrophy
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15
Q

What happens if you undertreat HyperPTH

A

Ostetitis fibrosa

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16
Q

What happens if you overtreat HyperPTH

A

Adynamic bone disease
Osteomalacia

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17
Q

Goals of CKD-MBD Treatment

A
  • Prevent cardio/extravascular calcification
  • Prevent development of HyperPTH and Renal Osteodystrophy
  • Maintain critical biochemical parameters in range (Calcium, Phosphorus, iPTH)
  • Prevent mortality
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18
Q

General Approach to CKD-MBD Treatment

A

1st step: Phosphate Binders (w/dietary control)
2nd step: Activated Vitamin D
3rd step: Calcimimetics

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19
Q

How to give phosphate binders

A

Check serum Calcium

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20
Q

Low serum Ca, give what phosphate binder?

A

Calcium based phosphate binder

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21
Q

Normal serum Ca, give what phosphate binder

A

Non-Ca based phosphate binder

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22
Q

High serum Ca, give what phosphate binder?

A

Non- Ca based phosphate binder

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23
Q

What are your calcium based phosphate binders?

A

Calcium carbonate
Calcium acetate

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24
Q

Calcium acetate specifications

A

Expensive
Only available Rx
Less Ca

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25
Calcium carbonate specifications
OTC (Tums) More Ca Less expensive Requires acidic pH
26
What are your non-Ca based phosphate binders?
Sevelamer carbonate Lanthanum carbonate Ferric citrate Sucroferric oxyhydroxide
27
1st line non-Ca based Phos Biinder?
Sevelamer carbonate ***may improve metabolic acidosis
28
When should you use Lanthanum carbonate
when you cannot use Renvela OR when you need a chewable formulation ***worsens metabolic acidosis
29
After Phosphate binders, what should you do to lower PTH
Activated Vitamin D/analogs OR Calcimimetic
30
When should you use Activated Vitamin D/analogs
Serum Calcium is normal - low
31
When should you use Calcimetic
Serum calcium normal - high
32
Goals of treatment for secondary hyperparathyroidism
Avoid hypercalcemia (asymptomatic hypoCa is okay) Phosphate towards normal range: 2.7 - 4.6, 3.5-5.5 iPTH 2- 9 x ULN (150 - 600)
33
What are your Activated Vitamin D & analogs
- Calcitriol (Rectorol) - Paracalcitol (Zemplor) - Doxercalciferol (Hectorol)
34
Activated Vitamin D vs Analaogs
Analogs have less risk of hypercalcemia
35
What are your calcimimetics
Cinacalcet (Sensipar) - PO Etelcalcitide (Parsabiv) - IV
36
How should you take Phosphate binders?
WITH FOOD
37
Adverse effects of Ca based phosphate binders
Abdominal Discomfort Nephrolithiasis Calciphylaxis
38
Ca based Phos binders dosinh
Carbonate 1250 mg TID w/ food Acetate 1334 mg TID W/ food ***Note TID w/ food
39
Ca based phosphate binders DDI
Fluroquinolones Levothyroxine Iron ***other meds, separate by 2 hrs
40
Sevelamer dosing
Based on serum phosphate levels 5.5 - 7.5 800 mg TID 7.5 - 9 1200 - 1600 mg TID >9 1600 mg TID
41
Sevelamer Adverse effects
GI and Diarrhea
42
Iron based phosphate binders
Ferric citrate (PO TID) - iron deficiency anemia Sucroferric oxyhydroxide (chewable) - lower pill burden
43
Ferric citrate adverse effetcs
iron overload stool discoloration Gi diarrhea
44
Sucroferric oxyhydroxide adverse effects
Gi diarrhea
45
Al based phosphate binder
Last line Risk of Al toxicity ADEs: Gi, CNS toxicity Use short term
46
Phosphorus and Mortality
Every 1 mg/dl increase in Phos above normal is 18% increase in mortality risk
47
True or False You cannot combine Calcium and non-Calcium based Phosphate binders
False
48
What is activated Vitamin D
Calcitriol
49
When should Calcitriol or its analogs be used
When iPTH is still elevated w/ Calcium and Phosphate at goal OR Persistent HypoCa and HyperPhos
50
When should Calcitriol and its analogs not be used
HyperCa AND HyperPhos
51
What is vitamin D2 and its dosing
Ergocalciferol 50,000IU weekly/monthly
52
What is Vitamin D3?
Cholecalciferol >1000IU daily
53
What are your Vitamin D analogs?
Ergocalciferol and Cholecalciferol ***Recommended in CKD and ESRD for Vit D deficiency
54
What is Calcifediol?
Prohormone of calcitriol (calcidiol)
55
Calcifediol dosing
30 mcg PO QHS
56
Calcifediol specifications
Only use in CKD Stage 3 and 4 ***NOT ESRD Serum Ca must be <9.8 and Serum Phos <5.5
57
Side effects of Calcifediol
HyperCalcemia HyperPhosphatemia
58
Cinacalcet
Oral Calcimimetic that increases sensitivity of PTH gland to increase Calcium affinity and reduce PTH secretion
59
Cinacalcet dosing
30 mg/day w/ food (titrate up) - Requires acidic pH
60
Cinacalcet Adverse effects
- GI (N/V) - QTc Prolongation - Ventricular Arrythmia - Hypocalcemia (paresthesias, cramping) ***All are dose limiting
61
What is Etelcalcitide
IV Calcimimetic dosed at hemodialysis
62
Etelcalcetide Adverse effetcs
- QTc Prolongation - Hypocalcemia - Less GI effects vs PO form

PHM601 AKI/CKD (5 decks)

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