Flashcards in chronic kidney disease 1 Deck (25):
What are common complications with stage 3-5>
anemia, hyperphosphatemia, secondary hyperparathyroidism, fluid and electrolye abnormalities, metabolick acidosis, malnutrition
What are these complications in stage 3-5 CKD related to?
decline in GFR
What comorbidites are common with CKD?
When should management of secondary complications to CKD be initiated?
in stages 1-4 of CKD
when is ESRD?
Where is erythropoietin produced?
What makes a minor contribution to erythropoietin production?
What is the primary cause of anemia?
decreased production of erythropoietin by the kidney
What may be the other cause?
shortened red cell survival (120 vs 60)
When do you see a decline in hemoglobin?
when gfr falls below 60
What kind of anemia can you get from decreased GFR?
normochoromic, normocytic (size and color)
What is the therapy for anemia in CKD?
chronic erythropoietic therapy and iron supplementation
What are sypmtoms of anemia?
fatgiue, depression, reduced exercise, tolerance, dyspnea, cardiovascular consequences--LVH, LVSD
What does correction of anemia do?
Does this decrease mortality?
improves physiologic and clinical parameters and quality of life
What are the agents available in the US for treating aenemia?
What are these agents?
Which one has a longer t1/2?
epoetin alfa, darboepoetin alfa
glcyoproteins manufactured by recombinant DNA, same activity as endogenous erythropoietin
darbepoetin, less frequent dosing
What is the dose for epoetin?
80-120 u/kg/week in 3 divdied doses
What is the starting dose for darbepoetin?
.45 mcg/kg/week- iv, subQ
What is the target hg/hct?
Why not 15?
you will kill themm……ahhhhhhh
When should you evaluate the dose?
What if the change in hg<1, hct (2-3%)?
increased by 25%
What if the change in hg >2 to 3 and (hct >6-8%
reduction by 25%
What is a major adverse effect if hct is raised too quickly?
What are 2 other side effects?
headache, flu like syndrome
What is the primary cause of resistance to therapy with erythropoietic agents?