chronic kidney disease 1 Flashcards Preview

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Flashcards in chronic kidney disease 1 Deck (25):
1

What are common complications with stage 3-5>

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

2

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

decline in GFR

3

What comorbidites are common with CKD?


cardiovascular disease

4

When should management of secondary complications to CKD be initiated?

in stages 1-4 of CKD

5

when is ESRD?

stage 5

6

Where is erythropoietin produced?


kidney 90%

7

What makes a minor contribution to erythropoietin production?

the liver
decreased

8

What is the primary cause of anemia?

decreased production of erythropoietin by the kidney

9


What may be the other cause?

shortened red cell survival (120 vs 60)

10


When do you see a decline in hemoglobin?

when gfr falls below 60

11


What kind of anemia can you get from decreased GFR?

normochoromic, normocytic (size and color)

12


What is the therapy for anemia in CKD?

chronic erythropoietic therapy and iron supplementation

13

What are sypmtoms of anemia?

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

14

What does correction of anemia do?
Does this decrease mortality?

improves physiologic and clinical parameters and quality of life
no

15

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

16

What is the dose for epoetin?

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

17


What is the starting dose for darbepoetin?


.45 mcg/kg/week- iv, subQ

18

What is the target hg/hct?
Why not 15?

11-12, 33-36%
you will kill themm……ahhhhhhh

19

When should you evaluate the dose?

2-4 weeks

20


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

increased by 25%

21


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


reduction by 25%

22

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

hypertension

23

What are 2 other side effects?

headache, flu like syndrome

24

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

iron deficiency

25

When should EPO be started?

after iron status has been evaluated