key things to remember Flashcards by shayna rudd

what is 1mg/dl in µmol/L

88.4

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what is CrCl formula

CrCl(ml/min) = UCr x V / Scr x1440

U(Cr): Urinary creatinine concentration (mg/dL).
V: Urine volume in 24h

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how to calculate CrCl from Cockcroft-Gault equation

CrCl = (140-Age) x Weight x 0.85(if femal) / 72 x Scr

divide SCr by 88.4 if want to convert to microg/L

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what are late stage uremic symptoms

fatigue, muscle weakness, SOB, confusion, nausea, bleeding, itching, cold intolerance, neuropathy, uremic breath

imagine a person keep on running with a weak kidney –> tired until fain

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what are the signs of uremia (observed clinically)

Edema, urine output changes, abdominal distension. (due to fluid retention)
Pericardial rub (abnormal heart sounds : urgent emergency), asterixis (hand tremor = dialysis needed).

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what are the GFR categories?

G1: >90
G2: 60-89
G3a: 45-59
G3b: 30-44
G4: 15-29
G5: <15

from G2 onwards just - 15
units : ml/min/1.73m2

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what are the persistent albuminuria categories

A1: <30mg/g
A2: 30-300mg/g
A3: >300mg/g

to convert to mg/mmol just divide by 10 (i.e A1: <3mg/mmol)

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when is the only time we use fibrate?

Only if TG >11.3 mmol/L (risk of acute pancreatitis).
use fenofibrates

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what are examples of phosphate binders

Sevelamer, Lanthanum

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what is used for hyperurecemia

Xanthine Oxidase Inhibitors (Allopurinol, Febuxostat) for hyperuricemia.
colchicine or short course of oral steorid

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management of metabolic acidosis

Serum CO₂ <18-20 mmol/L → Use alkalinizing salts:
Sodium Bicarbonate (PO/IV, 500mg-1g BD-TDS).

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what is protein requirements?

pre-dialysis: 0.8g/kg/day
dialysis patients: 1.0-1.2g/kg/day

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what is caloric intake needed?

25-35 kcal/kg/day.

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what are renal specific supplements can provide

Renalmin, Renopro, Renavite

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what are the types of SGLT2i that can be given and what dose

Dapagliflozin 10mg once daily
Empagliflozin 10mg (can increase to 25mg daily if needed for glucose control)
Canagliflozin 100mg daily (higher dose of 300mg not recommended for CKD)

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when to initiate finerenone

Serum K ≤ 4.8 mEq/L, eGFR ≥ 25 mL/min/1.73m², type 2 DM and albuminuria >30 mg/g.
max dose: 20mg

what is dosing based on metformin XR (extended release)

initial: 500mg once daily
Increase 500mg/day every 7 days
max: 2g/day

what is example + dosing of GLP1-RA

Dulaglutide, trulicity SC, weekly
Dose: 0.75mg and 1.5mg once weekly
No dosing adjustment needed and use w eGFR >15ml/min per 1.73m2
Remember!: need to start low and titrate up slowly to avoid GI SE

what is TSAT equation

Equation!: TSAT = [(serum Fe)/ TIBC] x 100%

what are key paramters for anemia

Hgb: 10-11/5g/dl
TSAT: >20%
Serum Fe: >200 (HD) >100 (non-HD) ng/ml

oral iron dosing

≥200mg elemental Fe/day (divided into 2-3 doses) ==> provide iron polymaltose (100%)

IV iron dosing

Loading: Iron sucrose (Venofer): 100-200 mg IV per HD (but mostly once a week) session x 5-10 doses
* Iron isomaltoside (Monofer): 500 mg IV x 1-2 doses (1 week apart)

Maximum total loading dose = 1 g per month
maintenance: 100-200mg IV/month

how to manage iron overload

Desferrioxamine (chelating agent) or phlebotomy.
(usually for IV iron)

Epoetin Alfa (Eprex) features/dosing

-dosing: HD: 50-100 units/kg IV 3x/week
onset: 7-10 days
time to peak: 5-24 hours
(DO NOT USE SC)

Epoetin Beta (Recormon)

* Common starting dose: 4000 units SC 1x/week or IV 3x/week PD/Pre-dialysis: 20 units/kg 1-3x/week HD: 40 units/kg SC/IV 3x/week * onset: 7-10 days * time to peak: 5-24 hours

Darbepoetin (Aranesp)

HD: 1x/week IV PD/Pre-dialysis: Once every 2-4 weeks SC Recommended starting doseL 0.45mcg/kg SC or IV weekly or 0.75 mcg/kg q2 weeks * onset of action: 2-6 weeks * plasma conc to peak: 34 hour

Methoxy Polyethylene Glycol-Epoetin Beta (Mircera)

* Initial: 0.6 mcg/kg SC/IV every 2 weeks Can increase to monthly (1.2 mcg/kg) in stable patients * onset: 5-6 weeks * half life: 140 hours * plasma peak conc: 72 hours

what is corrected Ca?

measured Ca in mmol/l + [0.02 x (40- serum albumin in g/L]

how many times to monitor calcium and phosphate

For G3a/3b: monitor Ca,P : once, then q6-12 months For G4: monitor Ca,P : 3-6 months For G5/5D monitor Ca,P : 1-3 months

what is the categories for vitamin D

Monitor once then based on baseline level and treatments Adequate >20 (KDOQI >30) Insufficient 15-20 (KDOQI 16-30) Deficient <15 (KDOQI 5-15)

what is dietary phosphate restriction

(800-1000 mg/day)

Calcium carbonate (40% Ca) : (OsCal, Tums, Caltrate)

(1250 mg tab = 500 mg elemental Ca) Usual dose: 500 mg (elemental Ca) (so 1 tablet) TDS with meals Side effects: hypercalcemia, constipation, loss of appetite, nausea, vomiting, and urolithiasis Advantage is : low cost

Sevelamer carbonate (Renvela ®),

Dosage Form: 800 mg tablet Available in Singapore; MAF listing Usual dose used: 800-1600 mg TDS with meals (increase dose as needed based on serum P) Side effects Mainly GI (constipation, diarrhea, flatulence, indigestion, N/V) Metabolic acidosis (> common with Cl salt, less likely with CO 3 )

cholecalciferol type

Caltrate+D: 600 mg Ca, 400 units vit D 3 Lynae: 120 mg Ca, 1000 units vit D 3 Cholecalciferol oral solution (D-Cure): 25,000 units vit D 3 / 1-mL ampoule | patient can take anything from: Dosage strength: 200 – 25,000 IU

Calcitriol (PO: Rocaltrol, Meditrol, IV: calcijex)

Dosing: start 0.25mcg 3x a week (PO) ⇒ increase to daily dosing for predialysis CKD patients (IV may be given to HD but not available in SG)

Alfacalcidol

Available as PO (0.25, 0.5, 1 mcg oral capsules, 2 mcg/mL oral solution) and IV (2 mcg/mL injection (IV for patients w HD) Usual dose: 1-4 mcg three times weekly or daily

Cinacalcet (Regpara)

Strengths available: 25 mg tablet Usual doses used: 25 mg daily initially, titrated up by 25 mg every 3 weeks, not to exceed 100 mg daily Monitor: serum Ca once/week during initiation and dose titration, and every 2 weeks during maintenance PTH 2x/month during initiation and dose titration, and once/month during once PTH is stable