Consequences of CKD

Question 1

Why is dialysis the absolute last resort

Answer 1

There is an increase of cardiovascular disease once on dialysis

Question 2

What are non-CKD related risk factors for cardiovascular disease

Answer 2

Diabetes, Hypertension, Hyperlipidemia

Question 3

What are CKD related risk factors for cardiovascular disease

Answer 3

CKD, volume overload, Anemia, Mineral bone disease

Question 4

T/F: Keeping blood pressure at goal is the best way to preserve renal function, especially of proteinuria is present

Answer 4

True

Question 5

What should blood pressure be at home for dialysis patients, during dialysis

Answer 5

135/85, 140/90

Question 6

What are non pharmacological treatments to keep blood pressure ideal during dialysis

Answer 6

weight loss, salt restriction to less than 2 grams per day, DASH diet, fluid restriction

Question 7

What diseases and features will be present in Na-oliguria

Answer 7

Edema, hypertension, congestive heart failure

Question 8

What foods are high in sodium

Answer 8

meats, frozen dinners, Asian sauces, Soup, restaurants

Question 9

What is dry weight

Answer 9

Estimated weight that a patient would be at if their kidneys were fully functional

Question 10

T/F: If a patient has left ventricular hypertrophy, fluid is more effective in reducing left ventricular hypertrophy than lowering blood pressure with medications

Answer 10

True

Question 11

What is the water restriction for patients who have CKD, CKD on dialysis

Answer 11

2 liter per day, less than 4% of their estimated dry weight

Question 12

What is the cornerstone of therapy for all CKD stages

Answer 12

ACE inhibitors and ARBs

Question 13

Once ACEs and ARBs are at max doses what other classes of medications can be used to control blood pressure

Answer 13

Beta-blockers, calcium channel blockers, vasodilators, alpha adrenergic agonists

Question 14

T/F: If a patient is on dialysis they are no longer able to make urine

Answer 14

False: Patients can still make urine due to residual renal function

Question 15

What class of diuretics will not be used once the GFR is less than 40ml/min/1.73m2

Answer 15

Thiazides

Question 16

What is the diuretic class that is best for patients on dialysis, when would a patient no longer use diuretics in dialysis

Answer 16

Loop diuretics, less than 500ml per day

Question 17

How can hyperkalemia occur in CKD patients

Answer 17

sudden decrease in urine output, metabolic acidosis, diet, blood transfusion, medications

Question 18

What is the best way to reduce risk of hyperkalemia in dialysis patients

Answer 18

Diet

Question 19

What are foods that are high in potassium

Answer 19

oranges, bananas, melons, potatoes, tomatoes, dried beans

Question 20

What medications can cause hyperkalemia in dialysis and should be discontinued

Answer 20

ACEs and ARBs, potassium sparing diuretics, succinyl choline, beta antagonists, digoxin, penicillin

Question 21

What are medications used to treat hyperkalemia

Answer 21

Sodium polystyrene sulfonate, Patiromer, sodium zicron cyclosilicate

Question 22

What are the two drugs that may decrease risk of hyperkalemia but uses sodium for cation exchange in dialysis

Answer 22

sodium zicron cyclosilicate and sodium polystyrene sulfonate

Question 23

How long should sodium polystyrene sulfonate be seperated from other medications, patiromer, sodium zicron cyclosilicate

Answer 23

3 hours, 3 hours, 2 hours

Question 24

T/F: The hyperkalemic agents should be avoided in patients who have bowel obstruction

Answer 24

True

Question 25

What is a medication that should be used in patients with CKD G3a-5 but not used in patients with dialysis

Answer 25

Statins

Question 26

T/F: Patients are more prone to metabolic alkalosis in kidney failure

Answer 26

False: Patients are more prone to metabolic acidosis in kidney failure

Question 27

T/F: Patients who have proteinuria they are directed to eat less protein unless they are put on hemodialysis

Answer 27

True