Midterm Flashcards
Initiation of ACEI or ARB monitoring:
Obtain SCr, K, and BP
Initiation of ACEI or ARB monitoring:
Obtain SCr, K, and BP
When to d/c ACEI or ARB:
SCr increases suddenly by > 30%, hyperkalemia, or hypotensive
When to titrate ACEI or ARB:
Every 1 to 3 months until goal is reached
Protein intake in dialysis:
1.2 g/kg/day
Sodium intake in CKD:
Protein intake in any CKD patient:
Do not exceed 1.3 g/kg/day in any adult with CKD
CKD w/ diabetes goals:
HbA1c of 7.0%
Reduce proteinuria
Initiate anti-diabetes medications
CKD w/ diabetes goals:
HbA1c of 7.0%
Reduce proteinuria
Initiate anti-diabetes medications
When to d/c ACEI or ARB:
SCr increases suddenly by > 30%, hyperkalemia, or hypotensive
When to titrate ACEI or ARB:
Every 1 to 3 months until goal is reached
Protein intake in dialysis:
1.2 g/kg/day
Sodium intake in CKD:
What to do in CKD w/ diabetes if ACR is not 30-50% after 4-6 weeks:
-Increase dose of ACEI/ARB
What to do in CKD w/ diabetes if ACR 30-50% after 4-6 weeks
- Check BP
- If BP is at target, check BP every 3 months
- If BP is not at target, increase dose of ACEI/ARB and/or add thiazide diuretic (add loop if edema is present), then recheck in 4-6 weeks
CKD w/ diabetes goals:
HbA1c of 7.0%
Reduce proteinuria
Initiate anti-diabetes medications
Metformin continuation in GFR:
- Continue if GFR > 45 mL/min
- Review if GFR is 30-44 mL/min
- Discontinue if GFR
ACEI/ARB contraindications:
- Pregnancy
- Renal artery stenosis
- Hx of angioedma
What are the BP goals in CKD w/ HTN and w/o diabetes, stage 5?
- Before dialysis: > 120/60
- After dialysis:
When to start ACEI or ARB in CKD w/ diabetes:
- Urine albumin > 30 mg/24 hours
- Use w/ caution if GFR
When to reassess ACR in CKD w/ diabetes:
Every 4-6 weeks
What to do if ACR is not 30-50% after 4-6 weeks:
-Increase dose of ACEI/ARB
What to do if ACR 30-50% after 4-6 weeks
- Check BP
- If BP is at target, check BP every 3 months
- If BP is not at target, increase dose of ACEI/ARB and/or add thiazide diuretic (add loop if edema is present)
What to do in CKD w/ diabetes if BP is not at target after ACEI/ARB dose increase and/or thiazide (or loop) is added after 4-6 weeks:
- Add DHP CCB
- If required, add other anti-hypertensives (beta-blocker or alpha-blocker to reach BP target)
What to do in CKD w/ diabetes if BP target is not at goal after addition of beta-blocker or alpha blocker to ACEI/ARB/diuretic combo:
-Add clonidine, hydralazine, or minoxidil
What are the BP goals in CKD w/ HTN and w/o diabetes, stages 1-4?
- 30 mg/24 hours
What are the BP goals in CKD w/ HTN and w/o diabetes, stage 5?
- Before dialysis: > 120/60
- After dialysis:
What agent(s) are indicated in CKD w/ proteinuria?
- First-line: ACEI/ARB: slows CKD progression
- Non-DHP CCBs (verapamil, diltiazem): decreases amount of protein filtered in glomerulus –> most beneficial in reducing proteinuria when BP
