Diabetes, BP, and Lipid Management in CKD

what is the recommended A1C target for CKD?

<= 7%

T/F: as CKD progresses (stage 4-5) the A1C target gets more strict

false

what are some lifestyle and self-management techniques for patients with diabetes and CKD?

healthy diet, exercise, smoking cessation, and healthy weight

what are the four first-line drug therapies for patients with diabetes and CKD?

metformin (T2D), SGLT2 inhibitor (T2D), RAS blockade (HTN), and statin

what are some additional drugs that have heart and kidney protection that could be used in diabetes + CKD?

GLP-1 RA (T2D), antiplatelet therapies (ASCVD), and ns-MRA (T2D)

what are some risk factor controls that should be utilized in patients with diabetes and CKD?

lipid management, glycemic control, and blood pressure control

when should risk factors be reassessed in patients with diabetes and CKD?

every 3-6 months

T/F: controlling blood pressure helps slow the progression of diabetic nephropathy

true

what is the goal systolic BP in adults with CKD

<120 mmHg

what medications should be utilized as first-line agents for lowering BP in CKD patients with albuminuria > 30 mg/day

ACEi or ARBs

elderly patients (>65 years old) should have _____________________ BP goals

individualized

what are alternative medications to decrease proteinuria if ACEi or ARBs are contraindicated?

MRA and Non-DHP CCB

which medications can be used to treat hypertension if the patient does not have CKD stage G1-G4 or A2

ACEi, ARB, CCB, thiazide

normal BP

<120 mmHg systolic AND <80 mmHg diastolic

elevated BP:

120-129 mmHg systolic AND <80 mmHg diastolic

stage I HTN:

130-139 mmHg systolic OR 80-89 mmHg diastolic

stage II HTN:

>= 140 mmHg systolic OR >= 90 mmHg diastolic

what is the recommended sodium intake for HTN management in CKD

< 2 grams/day (<5 grams/day NaCl '“table salt”)

what is the recommended exercise regimen for HTN management in CKD patients

moderate intensity 30 minutes 5x a week

what is the recommended weight loss for HTN management in CKD

weight loss to a BMI of 20-25 kg/m2

what are the alcohol recommendations for HTN in CKD?

<= 2 drinks per day for males and<= 1 drink per day for females

T/F: statins are mostly eliminated via the kidneys

false

what are the lipid recommendations for stage 3-5 CKD (adults >= 50 years old) not on dialysis

statin treatent (1A)

what are the lipid recommendations for stage 1-2 CKD (adults >= 50 years old) not on dialysis

statin treatment (1B)

what are the lipid recommendations for stage 1-5 CKD (adults 18-49 years old) not on dialysis

statin treatment if history of coronary heart disease, diabetes mellitus, ischemic stroke, or 10-year ASCVD > 10% (2A)

what are the lipid recommendations for stage 5 CKD on dialysis

do not initiate statins (2A) if the statin was already given at time of dialysis initiation, continue therapy (2C)