CKD part 2 Flashcards
What foods contain sodium?
Pts should get low sodium soups, don’t have heavily processed foods or things with alot of preservatives in them, limit frozen foods, limit fast food, don’t add salts to food, recommend Ms.Dash for seasoning because they are salt free :)
Dietary Considerations for CKD
Sodium less than ______/day in all pts with CKD
less than 2 grams/day
Potassium less than _______/day in CKD patients with abnormal levels
Normal range of potassium is 3.5 to 5.1/2
If you have a pt on an exam whose potassium is 5.5 a great nonpharm recommendation would be a low potassium diet because their potassium would be elevated or abnormal
THERE’S AN EXAM QUESTION ON THIS PROFESSOR STATED!!
Phosphorous 800-1000mg/day in CKD pts with mineral bone disease
phosphorus 800-1000mg/day
Protein restriction in patients with CKD Stages G3-5 (no more
than 0.8 g/kg/day)
no more 0.8g/kg/day
High phosphorous containing foods you think about your dark cocoa colas than ginger ale or orange soda
Low potassium containing foods
apples,blackberries, blueberries, eggplant, kale, grapes, grapefruit, cranberries, cucumber, cauliflower,corn, lettuce
Any low potassium containing food can become a high potassium food if portion size is not met
Low phosphorous foods are seafood, fresh or frozen meats w/o breading or sauce
White bread
Egg noodles
Soy milk
Key Interventions to Preventing Progression of CKD
Control _____________ (titrate medications
Reduce Proteinuria
Lose weight if BMI >30
Control _____________ if diabetic
Minimize hyperuricemia
Avoid nephrotoxic agents
Blood pressure
blood sugars
Is this pt at risk for CKD? Yes pt has hypertension and diabetes
Hypercholsterolemia can contribute to an inflammatory state in the body
Lisinopril is what kind of drug? Its an ACE inhibitor and for this pt its good this pt
Is blood pressure of 142/84 controlled for this pt? its not controlled and we want the blood pressure to be less than 130/80
We need to increase the dose of lisinopril to 10mg lisinopril
Metoprolol Tartrate- thats a beta blocker medication so not sure if we should keep it or not since we don’t know pt’s heart rate
For A1C goal look at comorobidites of pt they don’t have a ton and look at their age which is 67 yrs old in this case A1C could be less 7% or less than 6.5% how long have they had diabetes we don’t have that info…so we should have A1C less than 7%
Should we keep pt on metformin…maybe consider a SGLT2 inhibitor or GLP1-agonist
Metformin is dosed according to GFR and what is the cutoff for metformin use for pts with CKD?
less than 30 metformin is contraindicated in pts with CKD
If someone’s GFR is 25 you must discontinue metformin for the pt and instead, you can add an SGLT inhibitor and we have to see how much A1C reduction we get with their diabetes
SGLT inhibitor can lower A1C level by 0.8 to 1.2% maybe 4%
Does atorvastatin need renal dose adjustment?
no!!!
Rosuvastatin needs renal dose adjustment
A pt would come off aspirin if pt has GI bleed
Asprin is considered an NSAID…aspirin 81mg is cardioprotective and its not seen as nephrotoxic at that dose…if pt was on like 325mg, 500, or 1000 then discontinue the dose
If pt has high blood pressure decrease sodium to less than 2grams/day
Pt should exercise 150 minutes per week
Assess pt if they smoke or drink alcohol
So for male pt no more than 2 drinks
If pt is a smoker then smoking cessation
Recommend a Mediterranean diet for diabetes pt, minimize CARB INTAKE
Refer pt to nephrologist as well
