Renal

Question 1

Threshold for starting ESA

Answer 1

Hb < 10 g/dL

Question 2

Treatment goal for CKD-associated anemia

Answer 2

• Hb 10-11.5 g/dL (KDIGO 2012)
• Reduce anemia symptoms
• Prevent need for blood infusion
• Prevent MACEs from overcorrection

Question 3

Which epoetin should not be administered through SC?

Answer 3

Epoetin alfa

Question 4

Usual dose for RECORMON

Answer 4

SC 20 IU/kg 3 times weekly
IV 40 IU/kg 3 times weekly
Max 720 IU/kg/week

Question 5

Usual dose for Darbepoetin alfa

Answer 5

ND: 0.45 mcg/kg q2 weeks

Dialysis: 0.75 mcg/kg/week q2 weeks

Question 6

Threshold for initiating iron therapy

Answer 6

• Ferritin < 500 ng/mL
• TSAT <30%

Question 7

Targets for iron therapy

Answer 7

• Ferritin >100 ng/mL (non-HD) or >200 ng/mL (HD)
• TSAT >20%

Question 8

Common doses for oral iron supplementation

Answer 8

PO Ferrous sulfate 200 mg (65 mg) TDS
PO Ferrous fumarate 200 mg (66 mg) TDS
PO Ferrous gluconate 300 mg (36 mg) 2 tab TDS

Question 9

Common doses for IV iron supplementation

Answer 9

Iron sucrose as IV push
Loading: 200 mg x 5 doses
Maintenance: 200 mg every month

Question 10

Corrected calcium calculation

Answer 10

Corrected [] = Measured [] + 0.22 (40 - Albumin) mmol/L

Question 11

Goals of treatment for MBD

Answer 11

• Reduce risk of mortality (prevent hyper P, Ca, iPTH)
• Promote normal skeletal function
• Reduce risk of cardiovascular morbidity & mortality

Question 12

CYP effects of drugs used for MBD

Answer 12

Calcitriol/alfacalcidol: 3A4 substrate
Cinacalcet/etelcalcetide: 3A4/1A2 substrate, 2D6 inhibitor

Question 13

Common doses for vitamin D

Answer 13

PO Calcitriol or Alfacalcidol 0.25-0.5 mcg 3 times weekly

Question 14

Signs and symptoms of serum calcium imbalance

Answer 14

Hypo: Tetany, cramps, seizures, QTc prolongation
Hyper: Polyuria, constipation, nephrolithiasis

Question 15

Dose of cinacalcet

Answer 15

PO 25 mg OD initially

Question 16

Classification of 25(OH) Vit D levels

Answer 16

Normal: >30 ng/mL
Insufficient: 16-30 ng/mL
Deficient: 5-15 (mild)

Question 17

Threshold for treating metabolic acidosis

Answer 17

CO2 <20-22 mmol/L
Treated with PO Sodium Bicarbonate 500 mg BD-TDS

Question 18

Nutritional requirements in CKD

Answer 18

• 25-35 kcal/kg/day
• Protein 0.6-0.8 g/kg/day (ND)
• Protein 1-1.2 g/kg/day (HD/PD)

Question 19

Dose of finerenone

Answer 19

Indicated for eGFR >25, DKD and albuminuria
PO 10 mg OD

Question 20

BP target for CKD

Answer 20

For all:
SBP <120 (SPRINT trial)

Question 21

Highest doses for ACE inhibitors

Answer 21

Enalapril/Lisinopril: max 40 mg per day

Question 22

Expected Hb increase with epoetin treatment

Answer 22

• Expected 1-2 g/dL rise per month
• If <1 g/dL increase per month, increase dose by 25%
• If >1 g/dL increase q2 weeks, reduce dose by 25%
• Hold if Hb >13 g/dL until <12-12.5, then restart at lower dose
• To start monitoring 2 weeks post initiation and dose adjustment (~10 days to reach steady state)

Question 23

% of oral iron content

Answer 23

Ferrous gluconate (12%) - Sangobion
Ferrous sulfate (20%) - Iberet folic
Ferrous fumarate (33%) - Feroglobin B12

Question 24

CYP effects of cinacalcet

Answer 24

3A4/2D6 substrate
2D6 inhibitor

Question 25

Switching from etelcalcitide to cinacalcet

Answer 25

Discontinue etelcalcetide for at least 4 weeks prior to initiating cinacalcet, and ensure serum Ca normal

Question 26

Characteristics of urine output for AKI

Answer 26

Prerenal: SG >1.018, FENa <1, serum urea to Cr ratio > 20:1

Intrinsic: SG <1.012, FENa >2, serum urea to Cr ratio 10:1 to 15:1

Question 27

eGFR cutoffs for SGLT2 inhibitors

Answer 27

Dapagliflozin:
HF & DKD: may continue at 10 mg OD if <25
DM: Not recommended if <45

Empagliflozin:
HF & CKD: no data for <20
DM: Not recommended if <30

Generally not initiated if eGFR >20 for CKD. May continue if current use and until dialysis

Question 28

Definition of PD peritonitis

Answer 28

• Cloudy dialysate or abdominal pain
• Dialysate WBC >0.1 x 10^9/L or >100/mm3 + at least 50% PMN
• Positive dialysate culture

Question 29

Empiric treatment for PD peritonitis

Answer 29

IP cephalosporins + AG/ceftazidime
IP vancomycin + AG/ceftazidime
IP cefepime

Treatment duration:
- 21 days for MSSA/corynebacterium, enterococci, GNB or polymicrobial
- 14 days (streptococci, other gram +ve eg coagulase -ve staphylococcus)

Question 30

Threshold to use adjusted body weight for CrCl

Answer 30

When actual > 20% higher than ideal body weight