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Critically Ill Exam 3 > TCI CKD > Flashcards

TCI CKD Flashcards

1
Q

CKD is defined a s abnormalities of kidney structure or function that are present for ___ months

A

> 3 months

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2
Q

What 3 things is CKD classified based on?

A
  1. Cause
  2. GFR category
  3. Albuminuria category
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3
Q

What is the GFR for patients who have end stage renal disease?

A

<15 ml/min/1.73 m^2

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4
Q

What type of patients are classified as end stage renal disease patients?

A
  1. Patients on dialysis
  2. Renal transplantation patients
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5
Q

what are the 2 main factors contributing to CKD?

A
  1. Diabetes
  2. Hypertension
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6
Q

What are 6 progression risk factors of CKD?

A
  1. Diabetes Mellitus
  2. Hypertension
  3. Proteinuria
  4. Smoking
  5. Obesity
  6. Glomerular disease
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7
Q

What is the final common pathological manifestation of many chronic kidney diseases?

A

Renal fibrosis

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8
Q

True or False: Many patients are asymptomatic until a significant amount of renal function has been loss

A

True

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9
Q

What are 3 laboratory tests used for CKD?

A
  1. BUN
  2. Scr
  3. Urine albumin
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10
Q

What are 4 signs of CKD (stages 4-5)?

A
  1. Edema
  2. “Foaming” of urine
  3. Urinary output changes
  4. Abdominal Distension
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11
Q

What are 4 non-pharm treatments for CKD?

A
  1. Exercise
  2. Diet
  3. Smoking cessation
  4. Alcohol restriction
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12
Q

How often should CKD patients exercise?

A

30 minutes of moderate intensity exercise 5x/week

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13
Q

At what BMI should patients lose weight?

A

BMI >25 kg/m2

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14
Q

If a patient has HTN, what should they change in their diet?

A

sodium restriction to less than 5 gm

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15
Q

For alcohol restriction, how many drinks should men have? and women?

A

Men: 2 drinks per day
Women: 1 drink per day

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16
Q

How would you treat CKD pharamcologically?

A

By treating the underlying conditions

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17
Q

What vaccines should patients with CKD receive?

A
  1. Hep B
  2. Influenza
  3. Pneumococcal
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18
Q

How would you treat stage A1 albuminuria?

A

no interventions

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19
Q

How would you treat stage A2 or higher albuminuria?

A

Begin low dose ACEi/ARB therapy

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20
Q

When should you use caution in the use of ACEi/ARBs?

A

If eGFR <30 ml/min/m2
If BP <110/70 mmHg

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21
Q

when should the eGFR be repeated in patients taking an ACEi/ARB?

A

in 2-4 weeks

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22
Q

when should the BP and ACR be repeated in patients taking ACEi/ARBs?

A

in 4-6 weeks

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23
Q

how often is the dose of ACEi/ARBs increased in regards to albuminuria?

A

until albuminuria is reduced by 30-50% or if there are side effects such as a greater than 30% decrease in eGFR or elevation in serum potassium occurs

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24
Q

if a patient is on the max dose of ACEi/ARBs and has an ACR > 300 mg/g what should be initiated?

A

an SGLT-2 inhibitor

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25
Q

if a patient has stage A2 albuminuria + HTN, what should be initiated?

A

ACEi/ARBs

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26
Q

what is the target urine albumin for patients that have stage A2 albuminuria + HTN?

A

<30 mg/g or a decrease by 30-50%

27
Q

what is the target BP for patients that have stage A2 albuminuria + HTN?

A

< or equal to 120 mmHg

28
Q

what is the target BP for patients that what is the target urine albumin for patients that have stage A2 albuminuria + HTN and have a kidney transplant?

A

< or equal to 130/80 mmHg

29
Q

what should patients be treated with who have stage A2 albuminuria + diabetes?

A

SGLT-2

30
Q

what could you consider adding for patients already on an ACEi/ARB for BP control if they have stage A2 albuminuria + HTN?

A
  1. Thiazide diuretics
  2. Aldosterone Antagonists
  3. Non-DHP CCBs
31
Q

what can patients who have stage A2 albuminuria + diabetes use if their serum potassium is </= 5 mEq/L?

A

Finerenone (Kerendia)

32
Q

for reproductive warnings regarding kerendia, what should patients have/do?

A
  1. a negative pregnancy test
  2. use >/= 2 effcetive methods of birth control (at least one being a physical barrier)
33
Q

what is the goal systolic BP for patients with HTN and CKD?

A

<120 mmHg

34
Q

what are the first line hypertensive agents for patients who had a kidney transplant?

A
  1. Dihydropyridine CCB
  2. ARB
35
Q

what is the goal A1c for patients with diabetes?

A

6.5-7%

36
Q

what is first line therapy for patients with CKD and diabetes?

A
  1. SGLT-2 +/- metformin
    (can add on a GLP-1 if glucose not under control)
37
Q

when should you discontinue the use of metformin?

A

GFR <30

38
Q

what ARC can finerenone be used at?

A

ACR >30

39
Q

what is the goal for ESAs in non-dialysis CKD?

A

> 10 g/dL

40
Q

when should you start an ESA for patients on hemodialysis or peritonial dialysis?

A

when Hb is 9-10 g/dL

41
Q

what is the goal for transferrin saturation?

A

> 30%

42
Q

what is the goal serum ferritin?

A

> 500 ng/dL

43
Q

what should a patients diet include if they are anemic? 3

A
  1. iron
  2. folic acid
  3. B12
44
Q

with ESAs, what is an acceptable rate of increase in Hb per month?

A

1-2 g/dL

45
Q

when should you decrease the dose of ESAs?

A

if Hb increases by >1 g/dL in 2 weeks or >2 g/dL in 4 weeks

46
Q

what should you decrease the dose of ESAs by if the Hb increases too fast?

A

25-50%

47
Q

when should you increase the dose of ESAs by 25%?

A

if Hb increases by <1 g/dL in 4 weeks

48
Q

what ESA allows for once monthly dosing?

A

Methoxy Polyethylene Glycol Epoetin Beta (Mircera)

49
Q

what type of agent is daprodustat?

A

Hypoxia-Inducible factor prolyl hydroxylase inhibitor

50
Q

what are 5 ADRs of daprodustat?

A
  1. thromboembolisms
  2. risk of hospitalization for HF
  3. HTN
  4. GI erosion
  5. Malignancy
51
Q

how is daprodustat administered?

A

enterally

52
Q

what does the dose of daprodustat depend on in patients on dialysis and not receiving an ESA?

A

Hgb

53
Q

what does the dose of daprodustat depend on in patients on dialysis and not switching from an ESA?

A

current dose of the ESA

54
Q

what is daprodustat approved in?

A

patients with anemia of CKD who are on dialysis for at least 4 months

55
Q

what is the normal HgB range for males?

A

13.6-16.9

56
Q

what is the normal HgB range for females?

A

11.9-14.8

57
Q

what is the technical definition of anemia for males?

A

<13.6

58
Q

what is the technical definition of anemia for females?

A

<11.9

59
Q

what is the lowest HgB level that would prompt a prescriber to administer packaged red blood cells?

A

HgB <7

60
Q

what should you not use ESAs to increase Hb to?

A

> 11.5

61
Q

according to KDIGO what is the Hgb level that classifies non- hemodialysis patients as anemic?

A

<12 g/dL

62
Q

what is the goal Hgb for Hd patients on ESA?

A

Hgb > 9

63
Q

SKIP ME

A

Critically Ill Exam 3 (9 decks)

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