chronic kidney disease 1

Question 1

What are common complications with stage 3-5>

Answer 1

anemia, hyperphosphatemia, secondary hyperparathyroidism, fluid and electrolye abnormalities, metabolick acidosis, malnutrition

Question 2

What are these complications in stage 3-5 CKD related to?

Answer 2

decline in GFR

Question 3

What comorbidites are common with CKD?

Answer 3

cardiovascular disease

Question 4

When should management of secondary complications to CKD be initiated?

Answer 4

in stages 1-4 of CKD

Question 5

when is ESRD?

Answer 5

stage 5

Question 6

Where is erythropoietin produced?

Answer 6

kidney 90%

Question 7

What makes a minor contribution to erythropoietin production?

Answer 7

the liver

decreased

Question 8

What is the primary cause of anemia?

Answer 8

decreased production of erythropoietin by the kidney

Question 9

What may be the other cause?

Answer 9

shortened red cell survival (120 vs 60)

Question 10

When do you see a decline in hemoglobin?

Answer 10

when gfr falls below 60

Question 11

What kind of anemia can you get from decreased GFR?

Answer 11

normochoromic, normocytic (size and color)

Question 12

What is the therapy for anemia in CKD?

Answer 12

chronic erythropoietic therapy and iron supplementation

Question 13

What are sypmtoms of anemia?

Answer 13

fatgiue, depression, reduced exercise, tolerance, dyspnea, cardiovascular consequences–LVH, LVSD

Question 14

What does correction of anemia do?

Does this decrease mortality?

Answer 14

improves physiologic and clinical parameters and quality of life
no

Question 15

What are the agents available in the US for treating aenemia?
What are these agents?
Which one has a longer t1/2?

Answer 15

epoetin alfa, darboepoetin alfa
glcyoproteins manufactured by recombinant DNA, same activity as endogenous erythropoietin
darbepoetin, less frequent dosing

Question 16

What is the dose for epoetin?

Answer 16

80-120 u/kg/week in 3 divdied doses

Question 17

What is the starting dose for darbepoetin?

Answer 17

.45 mcg/kg/week- iv, subQ

Question 18

What is the target hg/hct?

Why not 15?

Answer 18

11-12, 33-36%

you will kill themm……ahhhhhhh

Question 19

When should you evaluate the dose?

Answer 19

2-4 weeks

Question 20

What if the change in hg<1, hct (2-3%)?

Answer 20

increased by 25%

Question 21

What if the change in hg >2 to 3 and (hct >6-8%

Answer 21

reduction by 25%

Question 22

What is a major adverse effect if hct is raised too quickly?

Answer 22

hypertension

Question 23

What are 2 other side effects?

Answer 23

headache, flu like syndrome

Question 24

What is the primary cause of resistance to therapy with erythropoietic agents?

Answer 24

iron deficiency

Question 25

When should EPO be started?

Answer 25

after iron status has been evaluated