Wk 10: Biochemistry: Renal (medication) Flashcards
What happens to the number of hypertensives as GFR decreases?
Inc
When taking ACE/ARB, when should you stop/continue the medication?
- AKI: stop
- Chronic: continue (renoprotective)
What is the most common cause of end stage renal disease?
Diabetes
What should you give metformin in renal impairment?
- Caution: eGFR 30-45
- Avoid: eGFR <30
What is used for diabetes if eGFR is <30?
- SGLT2 inhibitors
- Sulphonylureas (gliclazide)
- Gliptins
What is the sulphonylurea given in renal impairment?
Gliclazide (excreted/metabolised by liver)
- Low dose + titrate: red hypo
- W/ meals, avoid at night
When would you withdraw DPP-4 inhibitors (gliptins)?
Acute pancreatitis - persistent severe abdominal pain
What is the dose of linagliptin in renal impairment?
No dose adjustment
What are the doses of sitagliptin in renal impairment?
- eGFR 30-50: 50mg OD
- eGFR <30: 25mg OD
What is the dose of saxagliptin in renal impairment?
- Mod/severe: 2.5mg OD
- Caution: severe
What is the dose of vildagliptin in renal impairment?
eGFR <50: 50mg OD
What are the requirements when a patient is on insulin?
- Monitor blood glucose levels
- Red dose
What happens in CKD 3-5 when a patient is diabetic?
Impaired gluconeogenesis = prolonged hypoglycaemia
What is used for mild pain in renal impairment?
Paracetamol 0.5-1g QDS
What is used for moderate pain in renal impairment?
Paracetamol + weak opioid +/- adjuvant
- Acute: codeine (30mg every 4-6hrs) /tramadol (50-100mg every 8hrs) /oxycodone 2.5-5mg
- Chronic: MR + breakthrough
