CKD and Complications

Question 1

What is the definition of anemia of CKD?

Answer 1

hemoglobin <13g/dL (males) or <12 (females)

Question 2

What are the four goals of therapy for anemia of CKD?

Answer 2

increase oxygen-carrying capacity, improve quality of life, prevent/alleviate symptoms and complications of anemia, and decrease the need for blood transfusions

Question 3

At what GFR does anemia generally begin?

Answer 3

<45 mL/min

Question 4

The redistribution of drug from tissue stores makes TDM unreliable during what phase?

Answer 4

post-dialysis equilibrium

Question 5

What is the most common cause of erythropoietin resistance?

Answer 5

iron deficiency

Question 6

How often should an iron panel be done in ESRD patients?

Answer 6

every 3 months

Question 7

What are the two goals of iron deficiency therapy?

Answer 7

Tsat > 30%, serum ferritin >500 ng/mL

Question 8

What are side effects of oral iron therapy?

Answer 8

GI upset, dark stools, many drug interactions

Question 9

What are side effects of IV iron therapy?

Answer 9

INFECTIONS, dyspnea/wheezing, myalgias, hypotension, flushing edema, chest pain, injection site reactions

Question 10

What forms of oral iron therapy have the most and least percent elemental iron?

Answer 10

most = polysacccharide iron and ferric citrate, least = ferrous sulfate

Question 11

What is the dosing regimen for most oral iron therapies? Why?

Answer 11

once daily or every other day; decreases the rise in hepcidin

Question 12

ferric gluconate brand name, iron content and dosing?

Answer 12

Ferrlecit, 12.5, 125mg TIW x 8 doses

Question 13

iron sucrose brand name, iron content and dosing?

Answer 13

Venofer, 20, 100mg 1-3x weekly

Question 14

Iron dextran brand name, iron content and dosing?

Answer 14

Dexferrum, 50, 50-100mg q week x10 weeks

Question 15

LMW iron dextran brand name, iron content and dosing?

Answer 15

InFed, 50, 50-100mg q week x 10 weeks

Question 16

Ferumoxytol brand name, iron content and dosing?

Answer 16

Feraheme, 30, 510mg x2 3-8 days apart

Question 17

Ferric carboxymaltose brand name, iron content and dosing?

Answer 17

Injectafer, 50, 750mg x2 7 days apart

Question 18

What are the four types of ESAs?

Answer 18

epoetin alfa, darbepoetin alfa, methoxy PEG epoetin beta, epoetin alfa-epbx

Question 19

When should initiation of ESA happen as per KDIGO and FDA?

Answer 19

KDIGO = Hb 9-10 g/dL, FDA = <10 g/dL

Question 20

What is the target Hb in ND-CKD as per KDIGO and FDA?

Answer 20

KDIGO = 11.5 MAX, FDA = 10

Question 21

What is the target Hb in ESRD as per KDIGO and FDA?

Answer 21

KDIGO = 11.5 MAX, FDA = 10-11

Question 22

What is the goal change in HGB per month?

Answer 22

1-2 g/dL

Question 23

When should dose adjustments be performed when on erythropoiesis stimulating agents?

Answer 23

every 4 weeks, by increments of 25% of ESA dose

Question 24

What are nine causes of ESA resistance?

Answer 24

iron deficiency, ACEi, hyperparathyroidism, aluminum toxicity, folate and/or B12 deficiency, infection, malignancy, trauma, inflammation

Question 25

What are adverse effects of ESA therapy?

Answer 25

HTN, hypercoaguability, hypersensitivity reactions, pure red blood cell apasia (PRBCA)

Question 26

What are the two goals of ESA therapy?

Answer 26

prevent blood transfusions, imrpove QoL

Question 27

What is the conversion for epoetin to darbepoetin?

Answer 27

200 units of epoetin = 1mcg darbepoetin

Question 28

What is the formula for corrected calcium?

Answer 28

corrected calcium = measured calcium + 0.8(4-albumin)

Question 29

What are three consequences of CKD-MBD?

Answer 29

CV disease, bone disease, calciphylaxis/CUA

Question 30

What are the first three steps, in order, for treating CKD-MBD?

Answer 30

phosphate binders, activated vitamin D, calcimimetics

Question 31

For phosphate binders, if the serum calcium is normal-high, use ____, and if low use ____?

Answer 31

non-calcium based binders, calcium based binders

Question 32

What is the first line non-calcium based binder?

Answer 32

sevelamer carbonate

Question 33

What is a chewable non-calcium based binder?

Answer 33

lanthanum carbonate

Question 34

What is a non-calcium based binder used in iron deficiency anemia?

Answer 34

ferric citrate

Question 35

What is a non-calcium based binder used to reduce pill burden?

Answer 35

sucroferric oxyhydroxide

Question 36

What are the two calcium based binders?

Answer 36

calcium acetate and calcium carbonate

Question 37

For lowering PTH, if the serum calcium is normal-high, use ____, and if low use ____?

Answer 37

calcimimetics, activated vitamin D and analogs

Question 38

Which calcimimetic is PO and which is IV?

Answer 38

PO = cinacalcet, IV = etelcalcitide

Question 39

What vitamin D therapy mimics the endogenous chemical?

Answer 39

calcitriol

Question 40

What vitamin D therapies cause less hypercalcemia?

Answer 40

paricalcitriol and doxercalciferol