- vancomycin - aminoglycosides - amp B - contrast-induced

CKD Flashcards by Rowene Ng

What is the BP goal for CKD with HTN?

< 120/80 mmHg

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What is the default HbA1c goal for CKD with DM? (without those factors like life expectancy)

< 6.5%

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Which agents help with proteinuria?

ACEi/ARB
SGLT2i
finerenone

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What is the target Hb for those with CKD with anaemia?

10-11.5

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What is considered CKD with anaemia? (Hb levels for male and female)

M: <13
F: <12

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What is the target TSAT and ferritin goal for CKD with anaemia?

TSAT: 30
Ferritin: 500

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What is considered AKI?

increase in SCr by 0.3 mg/dL (26.5 mol/L) within 48h
increase in SCR by 1.5x baseline in past 7D
urine vol < 0.5mL/kg/h in past 6h

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What can cause ATN?

vancomycin
aminoglycosides
amp B
contrast-induced

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Percentage of iron in iron products:
- ferrous fumarate
- ferrous gluconate
- ferrous sulfate
- iron polymaltose

ferrous fumarate: 33%
ferrous gluconate: 12%
ferrous sulfate: 20%
iron polymaltose: 100%

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What are short and long acting ESAs?

short: epoetin alpha & beta
long: darbepoetin alpha, methoxy polyethylene glycol-epoetin beta

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Is epoetin alpha given as IV or SC? Why?

IV (SC causes pure red cell aplasia)

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When to start ESA? When to stop ESA?

start: Hb <10
stop: Hb >11.5 (increase risk of CV events & stroke)

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When to start IV and PO iron?

IV: dialysis
PO: not on dialysis

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How long for ESA to work?

10 days to reach SS (time taken for erythrocyte progenitor cells to mature & release into circulation)

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Maximum increase in Hb allowed while on ESA?

1g/dL Q2-4w

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Adverse effects of ESA?

HTN
pure red cell aplasia
seizures
flu-like sx
vascular access thrombosis

Percentage of calcium in calcium products?

calcium carbonate: 40%
calcium acetate: 25%
calcium citrate: 21%

Pharm options for CKD-MBD?

phosphate binders
vitamin D analogues
calcimimetics

Examples of phosphate binders (calcium and non-calcium based)?

calcium: calcium acetate, carbonate
non-calcium: sevelamer, lanthanum, aluminium, sucroferric oxyhydroxide

Examples of vitamin D & analogues for CKD-MBD?

alfacalcidol
calcitriol
paricalcitol

Examples of calcimimetics for CKD-MBD?

cinacalcet, etelcalcitide

To take phosphate binders with or without food? Which ones can be chewed and which ones must be swallowed?

Take with food

Chew: lanthanum, calcium carbonate / acetate, sucroferric oxyhydroxide
Swallow: sevelamar

Maximum duration to use aluminium?

4 weeks

Frequency of all phosphate binders?

TDS

What is the active form of vitamin D?

calcitriol

Activation of vitamin D?

ergocalciferol / cholecalciferol -> add OH grp to 25th position in liver -> calcifediol -> add OH grp to 1st position in kidney -> calcitriol

How do calcimimetics work?

Binds and modifies calcium sensing receptor on parathyroid gland, causing increased sensitivity to extracellular calcium, reducing PTH levels

How to switch between cinacalcet and etelcalcitide?

- cinacalcet to etelcalcitide: stop cinacalcet for ≥7D before starting etelcalcitide - etelcalcitide to cinacalcet: stop etelcalcitide for ≥4w before starting cinacalcet

How to change alfacalcidol to active form?

Activation by 25-hydroxylase in liver

Bicarbonate level target for metabolic acidosis?

≥ 22 mEq/L

Treatment for metabolic acidosis? With dose

Sodium bicarbonate 500-1000mg TDS (one 500mg capsule is 5.95 mEq of Na & bicarbonate)

When to stop bicarbonate supplementation?

Once regular dialysis is initiated

When is dialysis indicated?

Acidosis Electrolyte abnormalities Intoxication Overload (fluid) Uraemia

What factors affect drug dialysability?

- molecular weight - water solubility (more water soluble, more dialysable) - Vd (higher Vd, less plasma drug conc, less dialysable) - protein binding (more protein binding, less plasma free drug, less dialysable) - type of dialysate

What does PD dialysate NOT contain?

potassium