TCI CKD Flashcards
CKD is defined a s abnormalities of kidney structure or function that are present for ___ months
> 3 months
What 3 things is CKD classified based on?
- Cause
- GFR category
- Albuminuria category
What is the GFR for patients who have end stage renal disease?
<15 ml/min/1.73 m^2
What type of patients are classified as end stage renal disease patients?
- Patients on dialysis
- Renal transplantation patients
what are the 2 main factors contributing to CKD?
- Diabetes
- Hypertension
What are 6 progression risk factors of CKD?
- Diabetes Mellitus
- Hypertension
- Proteinuria
- Smoking
- Obesity
- Glomerular disease
What is the final common pathological manifestation of many chronic kidney diseases?
Renal fibrosis
True or False: Many patients are asymptomatic until a significant amount of renal function has been loss
True
What are 3 laboratory tests used for CKD?
- BUN
- Scr
- Urine albumin
What are 4 signs of CKD (stages 4-5)?
- Edema
- “Foaming” of urine
- Urinary output changes
- Abdominal Distension
What are 4 non-pharm treatments for CKD?
- Exercise
- Diet
- Smoking cessation
- Alcohol restriction
How often should CKD patients exercise?
30 minutes of moderate intensity exercise 5x/week
At what BMI should patients lose weight?
BMI >25 kg/m2
If a patient has HTN, what should they change in their diet?
sodium restriction to less than 5 gm
For alcohol restriction, how many drinks should men have? and women?
Men: 2 drinks per day
Women: 1 drink per day
How would you treat CKD pharamcologically?
By treating the underlying conditions
What vaccines should patients with CKD receive?
- Hep B
- Influenza
- Pneumococcal
How would you treat stage A1 albuminuria?
no interventions
How would you treat stage A2 or higher albuminuria?
Begin low dose ACEi/ARB therapy
When should you use caution in the use of ACEi/ARBs?
If eGFR <30 ml/min/m2
If BP <110/70 mmHg
when should the eGFR be repeated in patients taking an ACEi/ARB?
in 2-4 weeks
when should the BP and ACR be repeated in patients taking ACEi/ARBs?
in 4-6 weeks
how often is the dose of ACEi/ARBs increased in regards to albuminuria?
until albuminuria is reduced by 30-50% or if there are side effects such as a greater than 30% decrease in eGFR or elevation in serum potassium occurs
if a patient is on the max dose of ACEi/ARBs and has an ACR > 300 mg/g what should be initiated?
an SGLT-2 inhibitor
if a patient has stage A2 albuminuria + HTN, what should be initiated?
ACEi/ARBs
what is the target urine albumin for patients that have stage A2 albuminuria + HTN?
<30 mg/g or a decrease by 30-50%
what is the target BP for patients that have stage A2 albuminuria + HTN?
< or equal to 120 mmHg
what is the target BP for patients that what is the target urine albumin for patients that have stage A2 albuminuria + HTN and have a kidney transplant?
< or equal to 130/80 mmHg
what should patients be treated with who have stage A2 albuminuria + diabetes?
SGLT-2
what could you consider adding for patients already on an ACEi/ARB for BP control if they have stage A2 albuminuria + HTN?
- Thiazide diuretics
- Aldosterone Antagonists
- Non-DHP CCBs
what can patients who have stage A2 albuminuria + diabetes use if their serum potassium is </= 5 mEq/L?
Finerenone (Kerendia)
for reproductive warnings regarding kerendia, what should patients have/do?
- a negative pregnancy test
- use >/= 2 effcetive methods of birth control (at least one being a physical barrier)
what is the goal systolic BP for patients with HTN and CKD?
<120 mmHg
what are the first line hypertensive agents for patients who had a kidney transplant?
- Dihydropyridine CCB
- ARB
what is the goal A1c for patients with diabetes?
6.5-7%
what is first line therapy for patients with CKD and diabetes?
- SGLT-2 +/- metformin
(can add on a GLP-1 if glucose not under control)
when should you discontinue the use of metformin?
GFR <30
what ARC can finerenone be used at?
ACR >30
what is the goal for ESAs in non-dialysis CKD?
> 10 g/dL
when should you start an ESA for patients on hemodialysis or peritonial dialysis?
when Hb is 9-10 g/dL
what is the goal for transferrin saturation?
> 30%
what is the goal serum ferritin?
> 500 ng/dL
what should a patients diet include if they are anemic? 3
- iron
- folic acid
- B12
with ESAs, what is an acceptable rate of increase in Hb per month?
1-2 g/dL
when should you decrease the dose of ESAs?
if Hb increases by >1 g/dL in 2 weeks or >2 g/dL in 4 weeks
what should you decrease the dose of ESAs by if the Hb increases too fast?
25-50%
when should you increase the dose of ESAs by 25%?
if Hb increases by <1 g/dL in 4 weeks
what ESA allows for once monthly dosing?
Methoxy Polyethylene Glycol Epoetin Beta (Mircera)
what type of agent is daprodustat?
Hypoxia-Inducible factor prolyl hydroxylase inhibitor
what are 5 ADRs of daprodustat?
- thromboembolisms
- risk of hospitalization for HF
- HTN
- GI erosion
- Malignancy
how is daprodustat administered?
enterally
what does the dose of daprodustat depend on in patients on dialysis and not receiving an ESA?
Hgb
what does the dose of daprodustat depend on in patients on dialysis and not switching from an ESA?
current dose of the ESA
what is daprodustat approved in?
patients with anemia of CKD who are on dialysis for at least 4 months
what is the normal HgB range for males?
13.6-16.9
what is the normal HgB range for females?
11.9-14.8
what is the technical definition of anemia for males?
<13.6
what is the technical definition of anemia for females?
<11.9
what is the lowest HgB level that would prompt a prescriber to administer packaged red blood cells?
HgB <7
what should you not use ESAs to increase Hb to?
> 11.5
according to KDIGO what is the Hgb level that classifies non- hemodialysis patients as anemic?
<12 g/dL
what is the goal Hgb for Hd patients on ESA?
Hgb > 9
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