Co morbid CKD Mgt Flashcards
What is GFR categories for KDIGO?
1: >90%
2: 60-89%
3a: 45-59%
3b: 30-44%
4: 15-29%
5: <15%
What are the top three etiologies of CKD and ESRD?
DM
HTN
Glomerularnephritis
What is first line tx for urine albumin excretion >30mg/24 hours?
ACE/ARB
- increase until 30-50% drop in urine albumin excretion
- drop in eGFR
- hyperkalemia
How do you tx HTN induced CKD?
ACE/ARB
decreases BP and effects renal hemodynamics
When should you use caution for using ACE/ARB for tx of HTN? (2)
BP <110/70 or eGFR <30
What do you do if BP is >130/80 after adding ACE/ARB for tx of HTN?
increase dose or ACE or ARB or add thiazide diuretic
if BP continues to be elevated add clonidine, minoxidil, or hydralazine
Drug tx for DM and HTN?
ACE or ARB
Why does anemia develop in CKD?
- reduced erythropoeitin production
- toxin build up in blood cuts RBC lifespan from 120 to 60 days
- folate and B12 deficiency
- iron deficiency
How do you tx anemia?
1.give erythropoeitin stimulating agents
epoeitin alfa, darbepoetin alfa
2. regular iron supplementation (IV)
What are the administration limits to ESA?
- increased risk of cardiovascular events
- when Hg target is greater than 11g/dL
What is MOA of ESA?
- stimulates erythroid progenitor cells in bone marrow to make RBC’s
- kicks out reticulocytes
What are ADE of ESA’s? (3)
-DVT, cancer, and cardiac events with Hg>11 g/dL
T/F It is very painful to give ESA sub Q
True
When do you initiate ESA’s in ND-CKD?
- when Hg <10g/dL
- need for blood transfusion
- rate of drop if Hgb
- risk of ESA tx
- DO NOT initiate if Hgb >10
When do you initiate ESA’s in CKD 5HD and 5PD?
when Hgb is between 9-10g/dL
When do you start iron IV infusion for ND-CKD and 5HD and 5PD CKD?
when TSat <30% and ferritin < 500
T/F Do not use ESA to get Hb above 13.5 or to maintain Hb above 11.5g/dL
TRUE
What is ESA dosing guidelines?
1-2g/dL increase of Hb in 4 weeks
What should you do if the Hb increases more than 1 g/dL in 2 weeks
reduce ESA dose by 25%
What should you do if the Hb does not increases by more than 1 g/dL in 4 weeks?
increase ESA by 25%
How long should you wait before checking labs after iron IV infusion?
1 week
Whats is one reason for hypo responsiveness of ESA’s?
low iron! check iron
How does PTH regulate Ca and Phosphorus?
increases Ca and decreases Phosphorus
How does vitamin D regulate Ca and Phosphorus?
both increased in serum
