Diabetic Kidney Disease Flashcards
What is he most common cause of death in persons with CKD?
CVD
Per pt’s with DM and CKD, which type of medication should be considered for treatment of hyperglycemia and/or CVD events?
SGLT2 cotransporters
What should initial antihypertensive treatment for pt’s with DM and CKD consist of?
An ACEi or ARB
How is CKD defined?
Structural or functional abnormalities of the kidney for > 3 months using following criteria:
- GFR < 60 mL/min
- Persistent albuminuria, UACR >30 mg/g creatinine or > 3 mg/mmol creatinine
- Albumin excretion rate > 30 mg/24 hours
OR
Other manifestations of kidney disease (urine sediment abnormalities, lyte and other abnormalities d/t tubular disorders, or h/o kidney transplant)
True or false: All kidney disease found in patient’s with DM is Diabetic Kidney Disease (presence of albuminuria and/or reduced GFR <60)
False; presentation of DKD usually occurs w/ DM of long standing duration w/ progressive decline of GFR
What is the cut off for moderately increased and severely increased albuminuria?
Moderate: 30-300 mg/g (3-30 mg/mmol
Severe > 300 mg/g (>30 mg/mmol)
What is the most common risk factor for DKD?
Advanced age (given renal function naturally declines w/ increaing age)
What ethnic groups are at high risk for DKD?
AA, hispanics, native americans, and asians
Evidence also supports genetic predisposition to DKD
How often should pt’s with type 1 and type 2 DM be screened for DKD?
Type 1: 5 years after dx, annually thereafter
Type 2: At dx, annually thereafter, and during pregnancy
What is the recommended screening method for screening for albuminuria
Measurement of the urinary albumin to creatinine ration (UACR) in a random spot urine collection
A normal UACR is defined as <30 mg/g creatinine
2 of 3 spot UACRS (preferably from first void urine) collected w/in 3-6 month period, must be abnormal to dx albuminuria
What is the best overall index of kidney function?
GFR
The CKE Epidemiology Collaboration Equation is the preferred method to determine this
In older adults w/ end stage illness such as ESRD, an A1c goal of < ____% may be appropriate to minimize risk of hypoglycemia
8.5%
Which stages of CKD is Metformin approved for use for?
1-3
Per pt’s with DM2 and DKD with GFR > 30 with severely increased albuminuria which oral DM med is rec’d to decrease risk of CKD progression, CV events (or both) independent of baseline A1c of A1c goals
SGLT-2 inhibitor
While evidence less robust with GLP-1 receptor agonists, they may also be considred in pt’s with CKD to reduce risk of CV events and/or progression of albuminuria
Which DPP4 inhibitors should be used in caution with CKD patients due to increased risk for HF?
Saxagliptin, alogliptin
Which oral SU agents may be considered if pt’s are expected to have endogenous insulin production remaining?
Glipizie or glimepiide–> preferred to other agents in the pharmacologic class d/t short duration of action and limited ability to accumulate in renal impairment. Glyburide should NOT be used with GFR <60 and should be avoided in older pt’s with DM2
What class of oral medication is typically not recommended in CKD due to potential for fluid retention?
TZD
Specifically, use of rosiglitazone has demonstrated increased risk for acute MI
Why does recurrent or severe hypoglycemia happen in CKD?
As kidney function declines, exogenous insulin acts longer and in an unpredictable manner. Additionally, anorexia that may present in advanced stages of CKD prior to starting dialysis will result in dietary changes
To slow the progression of CKD, a BP < ____ is recommended for adults with HTN by the CKD and ACC/ADA
130/80 mmHg
True or False: An ACEi is recommended as concomitant therapy with an ARB
False; this is not recommended as there has found to be no benefit and increases risk of adverse events such as hyperkalemia and AKI
What is the recommended restriction of dietary sodium to reduce BP and associated CV risk?
<1500-2300 mg/dL and implementation of DASH diet
What are current recommendations to initiating statin therapy for primary prevention of CVD in adults age 40-75 with DM and LDL > 70?
Moderate intensity statin therapy should be started for primary prevention of CVD regardless of pt’s estimated 10 year risk of ASCVD
Further intensification should be considered in adults with DM & multiple risk factors for CVD or age 50-75 years, as well as those w/ established CVDq
Why is initiation of stain therapy in pt’s with advanced CKD not recommended?
Lower rate of deaths due to atherosclerotic causes in dialysis pt’s and lack of benefit from statin initiation in RCTs.
True or false: low CHO or very low CHO diet plans are recommended for patient with renal impairment
False; they are not recommended
