CKD part 2 Flashcards
What to do with lab changes?
Elevations in SCr or decrease in eGF
Elevations in K+
Sometimes these are transient changes so you start the pt on a medication and your getting changes in the body and we might see an increase jump in their serum creatinine or an increase jump in their potassium levels we don’t need to discontinue the medication we just need to ride it out
We start pt on ACE or ARB lets check renal function panel in how many weeks?
4 weeks
Pts that there potassium levels will increase on ACE or ARB so we add loop diuretic or potassium resin binder like lokelma
Hyperkalemia associated with use of RASi can often be
managed by measures to reduce the serum potassium levels
rather than decreasing the dose or stopping RASi
§ Veltassa ® (Patiromer)
§ Lokelma ® (Sodium Zirconium Cyclosilicate)
Patients with CKD should be considered increased risk for CVD
SGLT2i and ____________ have exhibited cardiorenal protection and
reduction in CV events in clinical trials
finerenone
Finerenone can reduce albuminuria levels and can be used in pts with CKD and diabetes
Side effects of SGLT inhibitors
urinary tract infections, increase glucose in the urine, blood pressure reduction orthostatic hypotension, dehydration, hypovolemia
Finerenone causes less risk of hyperkalemia, lower risk of gynecomastia, may be used with ACE and ARBS, can be used to decrease cardiovascular disease mortality
ACEi/ARBs play a large role in helping decrease albuminuria
as well as control BP in patients with CKD
* ACEi/ARBs together are not recommended
* BP goal of <120/80 or <130/80 is what is targeted for most
patients
* Newer agents available to assist with CKD progression, more to
potentially come down the pipeline
§ ACR >30mg/d is an independent risk factor for the
development of CKD and GFR loss and for cardiovascular
morbidity and mortality
§ ACEIs or ARBs are preferred in normotensive patients with
diabetes and albuminuria who are at high risk of DKD or its
progression
§ New role for non steroidal mineralocorticoid receptor antagonists
If pt has albuminuria and diabetes what would be something ti think about
fineronine
If pt has hypertension, add an ACE or a what?
ARB
Management of Albuminuria
ACEi and ARB
Treating other progression risk factors (HTN, DM, etc.)
Non-dihydropyridine calcium channel blockers:Verapamil (Calan®), Diltiazem (Cardizem®)
Dihydropyridine calcium channel blockers
Amlodipine,Nifedipine
Routine monitoring is recommended
Doctors use the following in hypertension like Dihydropyridine calcium channel blockers like amlodipine and nifedipine and sometimes there’s increase in protein levels in the urine vs if pt is on verapamil and dilitazem we can see reductions in albuminuria
