PHRM157: Chronic Kidney Disease
Immunizations in CKD (3)
- Flu - Pneumococcal - Hepatitis B
Kidney damage includes ____________ damage (proteinuria, glomerulonephritis) and __________ damage (polycystic kidneys)
- Functional (proteinuria, glomerulonephritis) - Structural (polycystic kidneys)
Monitoring Parameters for ACE-I and ARBs in CKD (3)
- Hypotension - Decreased GFR - Hyperkalemia
When to decrease dose or discontinue ACE-I and ARB in CKD (3)
- Hypotension - eGFR declines by > 30% from baseline value - Hyperkalemia
Criteria for CKD (either of the following present for > 3 months) - (2)
- Markers of kidney damage: ACR > 30 mg/g - Decreased GFR: < 60 mL/min/1.73 m^2
Guidelines for CKD (2)
- National Kidney Foundation - Kidney Disease Outcomes Quality Initiative (NKF - KDOQI) - KDIGO Clinical Practice Guidelines
Protein intake in GFR < 30 mL/min/1.73 m^2
0.8 g/kg/day
Leading causes of CKD (3)
1. Diabetes 2. Hypertension 3. Glomerulonephritis
Diabetes & CKD: - Target HbA1C of _____% recommended to prevent or delay progression of the microvascular complications
7.0%
Sodium intake in CKD
< 2 g/day
What is considered first-line in CKD PATIENTS WITH URINE ALBUMIN > 30 mg/24 hours? - Per JNC8 and KDIGO
ACE-I or ARBs - Decrease BP - Decrease proteinuria
CKD is defined as abnormalities of kidney structure or function, present for how long?
More than 3 months
What Stage of CKD according to NKF: - GFR > 90 with persistent kidney damage
Stage 1 (normal or high)
What Stage of CKD according to NKF: - GFR: 60-89 with persistent kidney damage
Stage 2 (mildly decreased)
What Stage of CKD according to NKF: - GFR: 45-59
Stage 3a (mildly to moderately decreased)
What Stage of CKD according to NKF: - GFR: 30-44
Stage 3b (moderately to severely decreased)
What Stage of CKD according to NKF: - GFR < 15-29
Stage 4 (severely decreased)
What Stage of CKD according to NKF: - GFR < 15
Stage 5 (kidney failure)
What is recommended for adults aged >/= 50 years with CKD-ND, adults aged 18-49 years with CKD-ND with one or more of the following: - Known coronary disease (MI or coronary revascularization - Diabetes - Prior ischemic stroke - Estimated 10-year incidence of coronary death or non-fatal MI > 10%
Statin
What drug class is preferred in moderate/severe CKD?
Loop diuretics
BP Goal in CKD-ND per JNC8 Guidelines
BP Goal < 140/90
What drug classes used to treat diabetes are usually avoided in CrCl < 30 mL/min?
Metformin Alpha-glucosidase inhibitors Glyburide GLP-1 agonists MAGG
Statin use is recommended in which of the following: - CKD-Not on Dialysis (CKD-ND), CKD-in Dialysis (CKD-5D)
CKD-ND
True or False: - HbA1C < 7.0% is recommended in patients at risk of hypoglycemia
FALSE - HbA1C < 7.0% NOT recommended in patients at risk of hypoglycemia
KDIGO Goal BP in CKD patients with urine albumin excretion *> 30 mg/24 hours*
Goal < 130/80
KDIGO Goal BP in CKD patients with urine albumin excretion *< 30 mg/24 hours*
Goal <140/90
Many patients use what to treat diabetes in CKD?
Insulin
What 2 drug classes are used first for hypertension in CKD?
Thiazide or loop diuretics
If patients are already receiving statins at the time of dialysis initiation, can these agents be continued?
Yes
Patients with eGFR > _____ mL/min may be treated with any statin as recommended in the general population
eGFR > 60 mL/min
