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PHRM 825 > PHRM 825: CKD and ESRD > Flashcards

PHRM 825: CKD and ESRD Flashcards

1
Q

What percent of people in ESRD are on dialysis/get a kidney transplant and which is better?

A

~70% dialysis
~30% transplant
Transplant is ALWAYS better than dialysis

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2
Q

3 major causes of CKD

A

1) Diabetes
2) HTN
3) Glomerulonephritis

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3
Q

How does KDIGO define CKD?

A

Abnormalities of kidney structure, present for >3 months with implications for health

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4
Q

What things does KDIGO use to classify the stages of CKD?

A

Cause, GFR, and albuminuria category

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5
Q

What is the definition of AKI?

A

Change to kidney function over a short period of time (couple of weeks max)

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6
Q

What stage of CKD do we start to worry about patients?

A

Stage 3

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7
Q

A 20 year old without ESRD will live an additional __ years

A

47-60

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8
Q

A 60 year old without ESRD will live an additional ___ years

A

16-23

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9
Q

A 20 year old with ESRD will live an additional ___ years

A

17-21

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10
Q

A 60 year old with ERSD will live an additional ____ years

A

4-5

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11
Q

What formula is the most commonly used to estimate Creatinine clearance?

A

Cockroft and Gault

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12
Q

3 qualities of the Cockroft and Gault formula for estimation of CrCl

A
  • Accurate for patients with stable kidney function (assuming SCr is stable)
  • Good predictor of GFR and easy to use
  • Tends to overestimate renal function in moderate to severe kidney impairment
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13
Q

What formula is the most accurate measure of GFR?

A

MDRD (includes adjustments for race and gender)

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14
Q

What is the Cockroft and Gault equation for creatinine clearance?

A

Men: CrCl = (140-age)IBW/(SCr72)
Women: [(140-age)IBW/(SCr72)]*0.85

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15
Q

What are 7 complications associated with CKD and ESRD patients?

A
  • Uremia
  • Fluid retention
  • Electrolyte imbalance
  • Mineral and Bone Disorder (CKD-MBD)
  • Anemia
  • Acid-base disorders
  • Nutrition
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16
Q

Definition of uremia

A

Cluster of symptoms which is associated with ESRD from any cause. Symptoms are due to the accumulation of waste molecules in the blood that are normally removed by the kidneys

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17
Q

What is measured to assess signs and symptoms of uremia?

A

BUN

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18
Q

What are 2 results of fluid retention?

A

Edema and increase in blood pressure

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19
Q

Should you restrict fluids for a patient with fluid retention?

A

Not generally necessary if Na+ intake is controlled, however large amounts of free water should be avoided

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20
Q

In what cases will diuretics not work?

A

When the kidneys are not working

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21
Q

____ diuretics are ineffective when CrCl < 30 mL/min

A

thiazide

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22
Q

____ diuretics will work when CrCl < 30 mL/min

A

loop

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23
Q

What diuretic can be used for patients that have a sulfa allergy to loop diuretics and what is the risk of this diuretic?

A

Ethacrinic acid; odotoxicity

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24
Q

What 3 things can cause the parathyroid gland to increase production of iPTH?

A
  • Hyperphosphatemia
  • Decreased vitamin D activation
  • Hypocalcemia
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25
Q

How does iPTH result in fractures?

A

In causes reabsorption of Ca+2 from bone

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26
Q

What is the difference between phosphate and phosphorus?

A

Phosphate –> Dietary intake

Phosphorus –> portion of phosphate measured in blood

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27
Q

What medications can treat hyperphosphatemia?

A

Phosphate binders

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28
Q

What is an important counseling point for phosphate binders?

A

Always take with food

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29
Q

How do phosphate binders work?

A

They bind dietary phosphate that is ingested in the food and the chelate is eliminated in the feces

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30
Q

What are 2 calcium containing phosphate binders?

A
  • Calcium carbonate (Tums)

- Calcium acetate (PhosLo)

31
Q

What is the max dose of elemental Ca and what can happen if it is exceeded?

A

1500 mg/day; soft-tissue calcification

32
Q

Side effects of calcium carbonate/acetate

A

Constipation

33
Q

Why is calcium acetate better than calcium carbonate?

A
  • Binds twice as much phosphate compared to calcium carbonate
  • May produce fewer hypercalcemic events when compared to calcium carbonate
34
Q

What are 6 non-calcium containing phosphate binders?

A
  • Sevelamer carbonate (Renvela)
  • Lanthanum carbonate (Fosrenol)
  • Sucroferric oxyhydroxide (Velphoro)
  • Auryzxia (ferric citrate)
  • Aluminum hydroxide (Amphojel)
  • Magnesium Carbonate (Mag-carb)
35
Q

How should you dose non-calcium containing phosphate binders?

A

Take the total daily dose and divide it by the number of meals

36
Q

When should dietary phosphorus intake be restricted to 800-1000 mg per day?

A
  • Phos > 4.6 mg/dL (CKD stage 3 and 4)
  • Phos > 5.5 mg/dL (CKD stage 5)
  • PTH > target range for stage 3, 4, or 5
37
Q

What does SHPT stand for?

A

Secondary hyperparathyroidism

38
Q

What is used to treat SHPT?

A
  • Vitamin D (ergocalciferol)

- Active vitamin D sterols (calcitriol, paricalcitrol, and doxercalciferol)

39
Q

What stage(s) of CKD requires the already activated form of vitamin D?

A

Stage 5 ERSD

40
Q

What vitamin D supplements require activation?

A

Ergocalciferol (calciferol) and cholecalciferol

41
Q

Why is it better to give unactivated vitamin D when possible?

A

It allows the kidneys to activate it when the body needs it

42
Q

What is cinacalcet (sensipar) and what does it do?

A

Type II calcimimetic agent; lowers the PTH concentration

43
Q

When is Cinacalcet (sensipar) contraindicated?

A

In hypocalcemia

If Ca <7.5 mg/dL do not use - wait until Ca is = or > 8 mg/dL

44
Q

What is the equation for corrected calcium?

A

Measured Ca + 0.8*(4 - serumAlb)

45
Q

What are the signs and symptoms of anemia in CKD patients?

A
  • Fatigue
  • Dizziness
  • HA
  • Decreased cognition
46
Q

Decreased MCV = _____ anemia

A

Microcytic

47
Q

Increased MCV = _____ anemia

A

Macrocytic

48
Q

Causes of microcytic anemia

A
  • Iron deficiency

- Aluminum toxicity

49
Q

Causes of macrocytic anemia

A
  • Folate deficiency

- B12 deficiency

50
Q

Normal MCV value

A

80-96 um^3

51
Q

Normal RDW value

A

11.5-14.5%

52
Q

What does MCV stand for?

A

Mean corpuscular value

53
Q

What does RDW stand for?

A

Red cell distribution width

54
Q

Anemia treatment goals

A
  • Reverse signs and symptoms of tissue oxygen deprivation and left ventricular hypertrophy
  • Increase exercise tolerance and capacity
  • Optimize survival
  • Increase quality of life
55
Q

What is the best assessment parameter for anemia and why?

A

Hemoglobin (Hb); it is more stable than hematocrit (Hct)

56
Q

What is normal hemoglobin for women?

57
Q

What is normal hemoglobin for men?

58
Q

When does KDIGO suggest iron supplementation in regards to TSAT and serum ferritin?

A

TSAT <30%

Serum ferritin <500 ng/mL

59
Q

What level is low in an absolute iron deficiency?

60
Q

What level is low in a functional iron deficiency?

61
Q

What is the transport form of iron?

62
Q

What is the storage form of iron?

63
Q

Side effects of oral iron

A
  • Stomach upset (hurts to absorb)
  • Best absorbed in acidic environment
  • Enteric coated –> Not absorbed as well
  • Avoid patients on meds that increase pH (proton pump inhibitor)
  • Separate from Ca by 2 hours
64
Q

When should Erythropoiesis Stimulating Agents (ESA) be used?

A

After all other correctable causes of anemia have been addressed

65
Q

ESA adverse effects?

A
  • Pure Red Cell Aplasia PRCA: antibodies develop to erythropoietin; d/c drug permanently
  • HTN: 23% of CKD patients with an increase in hemoglobin are at risk for increased cardiac arrest, seizures, stroke, exacerbation of CKD, HTN, acute myocardial infarction
66
Q

What is the #1 cause of ESA therpay failure?

A

Lack of vitamins or iron

67
Q

What metabolic disorder are ESRD patients at risk of getting?

A

Metabolic acidosis

68
Q

What are the protein requirements for someone in CKD stage 3,4 (GFR<30 ml/min)?

A

0.8 g/kg/day

69
Q

What are the protein requirements for someone in ESRD?

A

1.2 g/kg/day

70
Q

What are the energy requirements in kcal for ESRD/CKD patients < 60

A

35 kcal/kg/day

71
Q

What are the energy requirements in kcal for ESRD/CKD patients > 60

A

30-35 kcal/kg/day

72
Q

What is a common complication of CKD patients?

A

Uremic bleeding

73
Q

Signs and symptoms of uremic bleeding

A
  • Purpura
  • Ecchymoses
  • Epistaxis
  • Bleeding from hemodialysis access site
74
Q

Treatment for uremic bleeding

A
  • Red cell transfusions
  • Cryoprecipitate (fraction of blood containing factor VIII, fibrinogen, fibronectin)
  • DDAVP
  • Conjugated estrogens

PHRM 825 (36 decks)

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