CKD Pharmacotherapy

Question 1

Chronic CKD =

Answer 1

> 3 months

Question 2

RASS inhibition is

Answer 2

Renoprotective

BP decrease Albuminuria decreases

Question 3

Prevent progression via

Answer 3

BP management/RAAS interruption
Protein intake
Glycemic control
Salt intake

Question 4

Treat to

Answer 4

Urine albumin excretion less than 39 or BP is >140 or >90

Question 5

Non-DM treat to

Answer 5

Urine albumin excretion of 30-300mg/24h OR >300mg/24h
BP consistently >130 or >80
-ACEi or ARB recommended

Question 6

DM treat to

Answer 6

Urine albumin >30mg/24h
BP consistently >130 or >80
-ACEi or ARB recommended

Question 7

ACEi/ARB dosing

Answer 7

Low dose, then titrate at 4 weeks

Increase until proteinuria decrease 30-50% or side effects

Question 8

ACEi/ARB dosing

Answer 8

Low dose, then titrate at 4 weeks

Increase until proteinuria decrease 30-50% or side effects

Question 9

Non-DHP CCB

Answer 9

May been beneficial for proteinuria

Diltiazem and verapamil

Question 10

MDRD

Answer 10

Modification of Diet in Renal Disease
Restriction of protein and phosphorus
Systemic BP reduction
Most for Non-DM pts

Question 11

Protein Restriction

Answer 11

0.8g/kg/d for GFR less than 30

Avoid >1.3g/kg/d in adults at high risk for CKD progression

Question 12

DM CKD

Answer 12

A1c: ~7.0

>7.0 if co-morbidities, limited life expectancy, hypoglycemia

Question 13

Diabetes Control and Complication Trial (DCCT)

Answer 13

Decreased incidence of microalbuminuria and albuminuria

Question 14

Salt intake

Answer 14

Less than 2 grams per day

Question 15

High sodium intake:

Answer 15

Increases BP, proteinuria
Induces glomerular hyperfiltration
Blunts RAAS blockade

Question 16

Complications of ESRD

Answer 16

Anemia
CVD
Renal bone disease
K homestasis
Acidosis
Volume overload/edema

Question 17

Complications of ESRD

Answer 17

Anemia
CVD
Renal bone disease
K homestasis
Acidosis
Volume overload/edema