Renal Flashcards
Threshold for starting ESA
Hb < 10 g/dL
Treatment goal for CKD-associated anemia
- Hb 10-11.5 g/dL (KDIGO 2012)
- Reduce anemia symptoms
- Prevent need for blood infusion
- Prevent MACEs from overcorrection
Which epoetin should not be administered through SC?
Epoetin alfa
Usual dose for RECORMON
SC 20 IU/kg 3 times weekly
IV 40 IU/kg 3 times weekly
Max 720 IU/kg/week
Usual dose for Darbepoetin alfa
ND: 0.45 mcg/kg q2 weeks
Dialysis: 0.75 mcg/kg/week q2 weeks
Threshold for initiating iron therapy
- Ferritin < 500 ng/mL
- TSAT <30%
Targets for iron therapy
- Ferritin >100 ng/mL (non-HD) or >200 ng/mL (HD)
- TSAT >20%
Common doses for oral iron supplementation
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
Common doses for IV iron supplementation
Iron sucrose as IV push
Loading: 200 mg x 5 doses
Maintenance: 200 mg every month
Corrected calcium calculation
Corrected [] = Measured [] + 0.22 (40 - Albumin) mmol/L
Goals of treatment for MBD
- Reduce risk of mortality (prevent hyper P, Ca, iPTH)
- Promote normal skeletal function
- Reduce risk of cardiovascular morbidity & mortality
CYP effects of drugs used for MBD
Calcitriol/alfacalcidol: 3A4 substrate
Cinacalcet/etelcalcetide: 3A4/1A2 substrate, 2D6 inhibitor
Common doses for vitamin D
PO Calcitriol or Alfacalcidol 0.25-0.5 mcg 3 times weekly
Signs and symptoms of serum calcium imbalance
Hypo: Tetany, cramps, seizures, QTc prolongation
Hyper: Polyuria, constipation, nephrolithiasis
Dose of cinacalcet
PO 25 mg OD initially
Classification of 25(OH) Vit D levels
Normal: >30 ng/mL
Insufficient: 16-30 ng/mL
Deficient: 5-15 (mild)
Threshold for treating metabolic acidosis
CO2 <20-22 mmol/L
Treated with PO Sodium Bicarbonate 500 mg BD-TDS
Nutritional requirements in CKD
- 25-35 kcal/kg/day
- Protein 0.6-0.8 g/kg/day (ND)
- Protein 1-1.2 g/kg/day (HD/PD)
Dose of finerenone
Indicated for eGFR >25, DKD and albuminuria
PO 10 mg OD
BP target for CKD
For all:
SBP <120 (SPRINT trial)
Highest doses for ACE inhibitors
Enalapril/Lisinopril: max 40 mg per day
Expected Hb increase with epoetin treatment
- 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)
% of oral iron content
Ferrous gluconate (12%) - Sangobion
Ferrous sulfate (20%) - Iberet folic
Ferrous fumarate (33%) - Feroglobin B12
CYP effects of cinacalcet
3A4/2D6 substrate
2D6 inhibitor
Switching from etelcalcitide to cinacalcet
Discontinue etelcalcetide for at least 4 weeks prior to initiating cinacalcet, and ensure serum Ca normal
Characteristics of urine output for AKI
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
eGFR cutoffs for SGLT2 inhibitors
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
Definition of PD peritonitis
- Cloudy dialysate or abdominal pain
- Dialysate WBC >0.1 x 10^9/L or >100/mm3 + at least 50% PMN
- Positive dialysate culture
Empiric treatment for PD peritonitis
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)
Threshold to use adjusted body weight for CrCl
When actual > 20% higher than ideal body weight
