Trigger CKD part 1 Flashcards
proteinuric CKD increases risk for what
CV mortality
anemia, fatigue, and anorexia begin appearing in what stages of CKD
3-4
when do electrolyte abnormalities become present in CKD
stages 3-4
marked deceased in ADLs is seen in what CKD stage
5
what medication is used to reduce glomerular HTN
ACE/ARB
prior to starting this medication, evaluate potassium and serum cr levels
ACE/ARB
when in CKD are thiazides most effective
early CKD
when in CKD are loops most effective
late CKD
what does cholesterol look like in CKD
NORMAL
what does HDL and lipoprotein A look like in CKD
HDL is deceased
lipoprotein A is increased
when do you use ezetimibe in CKD
2nd line for treatment of CAD
“statins - 1st line (said in class)
PSK9 inhibitors and ezetimibe (2nd line in adjunct to statin)
fibrates (paired with statins)”
Cardiovascular complication associated with uremia
pericarditis
what is pericarditis associated with?
uremic CKD
s/s: friction rub
pericarditis
s/s: cardiac tamponade and uremic pericardial efffusion
pericarditis
s/s: retrosternal Chest pain
pericarditis
what is always an indication of hospitalization and immediate initiation of hemodialysis in CKD patients
pericarditis
s/s: proximal muscle weakness
osteitis fibrosa cystica
caused by hypovitaminosis D and use of bisphosphonates
osteomalacia
brown tumors on Xray
osteitis fibrosa cystica
what physiologic changes occur in the heart with CKD
left ventricular hypertrophy and diastollic dysfunction
SE includes inceased vascular calcification or hypercalcemia
calcium carbonate and calcium acetate (calcium phosphate binders for treating hyperphosphatemia)
SE of osteomalacia and neurologic complications
aluminum hydroxide
what phosphate binder is used for short durations (<3 weeks)
aluminum hydroxide
what phosphate binder is used if phosphate levels are severe (>7)
aluminum hydroxide
what meds are used to manage PTH in CKD
Vit D3 - calcitriol
cincalet (sensipar)
SE is inceased serum calcium and phosphorus
calcitriol (vit d3)
SE of hypocalcemia
cincalet
deceased renal clearance of hepcidin in CKD leads to what complication
iron deficiency anemia
when is treatment of iron deficiency anemia contraindicated
if ferritin levels are >500-800 even if iron saturation is <20%
when is ferric citrate used
treatment of iron deficiency anemia in CKD
can also use:
ferrous sulfate
ferrous gluconate
ferrous fumerate but ferric citrate was bolded in powerpoint
what complication in CKD is caused by platelet dysfunction
hypocoagulability
treated with desmopressin
hypocoagulability
s/s: difficulty concentrating
ealry uremic encephalopathy
s/s: lethargy, confusion, seizure coma
later uremic encephalopathy
PE: asterixis, weakness, AMS
uremic encephalopathy
TCAs or anticonvulsants are given for pain in this complication
uremic neuropathy
when do you start hemodialysis or peritoneal dialysis
GFR of 5-10
what 4 signs are indications of need for dialysis in CKD patients
- GFR<10
- Uremic symptoms (pericarditis, encephalopathy, neuropathy)
- metabolic disturbances (hyperkalemia, hyponatremia, met acidosis, ect)
- fluid overload unresponsive to diuretics
(i just cant get this into my brain)
at what point in CKD should you STOP metformin use?
serum Cr>1.5 or GFR <30
remember if a CKD pt is struggling with hypoglycemia in CK we can start them on
petechiae and purpura are s/s of what complication in CKD
hypocoagulability
can be caused by NSAIDS and BB
hyperkalemia
Triamterine SE is…
hyperkalemia
what vascular access option for hemodialysis requires 6-8 weeks of preparation
arteriovenous fistula
what vascular access option for hemodialysis requires 2 weeks for preparation and has a higher risk of infection
prosthetic graft
what vascular access option for hemodialysis is temporary and has the highest risk of infection
indwelling vascular catheter
what are examples of phosphorus containing drugs to avoid in CKD
cathartic laxatives
what are examples of magnesium containing drugs to avoid in CKD
laxatives/antacids
what are examples of nephrotoxic drugs to avoid in CKD
NSAIDS, IV contrast
what are examples of renally excreted drugs to adjust in CKD
insulin, BB, ABX
what opioid should be stopped in CKD
morphine
cloudy dialysate indicates what
peritonitis
