Chronic Kidney Disease

Question 1

What is ACR ratio?

Answer 1

Albumin to creatinine ratio

Question 2

What ACR do non-diabetics have?

Answer 2

2 mg/mmol

Question 3

What are some potential causes for transient albuminuria?

Answer 3

• recent major exercise
• urinary tract infection
• febrile illness
• decompensated congestive HR
• menstruation
• acute severe elevation in BG (ex. DKA)
• acute severe elevation in BP

Question 4

What is the definition of microalbuminuria?

Answer 4

ACR > or equal to 2 mg/mmol

2-20 = microalbuminuria

Question 5

BP target for diabetics

Answer 5

140/90

Question 6

What is normal K+ range?

Answer 6

3.5-5.2 mmol/L

Question 7

Normal albumin level?

Answer 7

40 g/L

Question 8

If albumin decreases, what does calcium do?

Answer 8

begins to behave like it is higher

Question 9

For every 10 g/L drop in albumin, calcium behaves as ____ higher

Answer 9

0.2

Question 10

How does kidney disease affect phosphorus levels?

Answer 10

• Our kidneys filter phosphate easily
• When kidneys aren’t working 100%, it is not filtering phosphates
• Phosphates increased in blood and interact with Ca2+
• This can cause calcium-phosphate deposition in the body in tissues or heart and cause cause itchy skin
• Bad for heart and skin

Question 11

What happens if Ca binds with phosphates ?

Answer 11

-Ca concentration in blood decreases

-

Question 12

What happens if Ca binds with phosphates ?

Answer 12

• Ca concentration in blood decreases
• Parathyroid senses that
• Wants to find calcium (FROM YOUR BONES)
• Calcium is taken out of your bones
• Bones are getting weaker and tries to repair them, lays down fibrous tissue instead of normal bone layer
• Causes hyperparathyroidism

Question 13

How do you treat this?

Answer 13

• Have to limit phosphate intake or use phosphate binders (binds in the stomach, doesn’t affect Ca2+)
• We use calcium carbonate (Apo-Cal 250 TID with meals) - as a phosphate binder
• If you use more and more Apo-Cal to bind phosphate, some of the Ca2+ gets absorbed and can cause high ca2+ levels

Question 14

What do you want phosphate levels to be?

Answer 14

around 1.8 mmol/L

Question 15

go over cases

Answer 15

okay

Question 16

Low phosphate foods

Answer 16

• soda crackers
• popcorn
• vegetables

Question 17

High phosphate foods

Answer 17

• pizza
• chocolate
• cheese

Question 18

What are phosphate binders used for?

Answer 18

to treat high blood phosphorus levels

Question 19

List examples of phosphate binders that bind dietary phosphate

Answer 19

• calcium acetate
• calcium carbonate
• calcium liquid
• aluminum hydroxide
• lanthanum and sevelamer bind dietary phosphate

Question 20

Why are phosphate binders used?

Answer 20

Phosphate binders are used to lower the amount of phosphorus absorbed from food to limit development of bone and blood vessel disease

Question 21

Aluminum hydroxide and calcium carbonate may also be prescribed as ______

Answer 21

antacids

Question 22

Calcium preparations may also be prescribed as ?

Answer 22

calcium supplements

Question 23

When these medications are prescribed as calcium supplements or antacids, how should you take them in relation to meals?

Answer 23

take between meals

Question 24

Phosphate binders cause phosphate to be removed in the ____ rather than being absorbed into the blood.

Answer 24

stool

Question 25

How do you take these meds as phosphate binders in relation to meals?

Answer 25

Take it just before eating so that it can bind to the phosphorous in the food.

If you forget to take it with a meal, it is still helpful to take it up to 30 mins after a meal

Question 26

Special considerations for Lanthanum (Fosrenol) ?

Answer 26

Should be taken during or immediately after a meal. Taking a dose on an empty stomach can cause nausea and vomiting. Chew the tablet completely before swallowing. Do not swallow tablets whole.

Question 27

Special considerations for Sevelamer (Renagel) ?

Answer 27

Sevelamer should be taken just before eating.
Swallow the tablet whole.
Renagel should not be cut or chewed. The contents of Sevelamer tablets expand in water and could cause choking if cut, chewed, or crushed.

Question 28

Phosphate binders may interfere with the absorption of which drugs?

Answer 28

• iron supplements
• antibiotics
• digoxin
• ranitidine
• antiseizure meds
• antiarrhythmic meds

Take them at least 1 hour before or 3 hours after your phosphate binder

Question 29

What do you do if you miss a dose of your phosphate binder?

Answer 29

If you forget to take your phosphorus binder and it is within 30 minutes of eating, take your usual dose. If it is more than 30 minutes since you ate then skip the dose. DO NOT DOUBLE YOUR NEXT DOSE

Question 30

What are some possible side effects of phosphate binders?

Answer 30

Constipation, diarrhea, intestinal gas and/or stomach discomfort may occur. If you have problems with constipation, contact your doctor regarding a stool softener or other laxative. Contact your doctor if you experience mood or mental changes, bone pain, muscle weakness, tiredness or weight loss.

Question 31

Counselling points for diet for people on phosphate binders

Answer 31

Avoid or limit high-phosphorous foods as advised by your doctor and dietician. High-phosphorous foods include dairy products, chocolate, nuts, bran muffins, etc.