CKD

CKD diagnosis

Abnormal / Damage (Markers) for at least 3m

or

GFR less than 60ml/min/1.73m² for 3m (no kidney damage) even if the patient does not have Albuminuria

Markers of Kidney Damage

Albuminuria= UACR >/= 30 mg/g (diabetic kidney disease)

Electrolyte or tubular abnormalities= Renal tubular acidosis, renal phosphate wasting, falconi syndrome (inadequate reabsorption in the proximal renal tubules of the kidney)

Structural abnormalities on imaging

History of kidney transplantation

GFR- G1

>/= 90 (normal/high)

GFR- G2

60-89 (mildly decreased)

GFR- G3a

45-59 (mildly to moderate decreased)

GFR- G3b

30-44 (mildly to severely decreased)

GFR- G4

15-29 (SEVERLY DECREASED)

GFR- G5

<15 KIDNEY FAILURE

UACR- A1

<30 mg/g (<3 mg/mmol)

UACR- A2

30-300 mg/g (3-30 mg/mmol)

UACR- A3

>300 mg/g (>30 mg/mmol)

First-line Antihypertensive in CKD with ALBUMINURIA

ACE inhibitors & ARBs

KDIGO 21/24 Systolic Blood Pressure goal for non-Dialysis CKD

<120mmHg

allowable serum creatinine clearance after starting ACEi/ARBs

increase in serum creatinine of up to 30% (or a drop in eGFR of up to 25%) above baseline is considered allowable and expected after starting or increasing the dose of an ACE inhibitor (ACEi) in CKD patients

Within 4 weeks of initiation or dose increase

Normal Serum Creatinine

0.6 to 1.2 mg/dL for men

0.5 to 1.1 mg/dL for women

Creatinine Decreased

Reduced muscle mass

Malnourished

Aging

Creatinine Increased

Dehydration

HF

Acute or chronic renal failure

Urinary tract obstruction

nephrotoxic drugs

Hypothyroidism

eGFR initiation threshold for SGLT2 inhibitors in CKD

Empagliflozin

Dapagliflozin

Initiate if eGFR >/= 20

in patients that have T2DM & CKD

or

HF irrespective of level of albuminuria

eGFR CONTRAINDICATION threshold for Metformin

Stop if eGFR is < 30

DO not initiate if eGFR is 30-45 only reduce to 500mg

Serum potassium prerequisite to initiate Finerenone

serum potassium threshold must be ≤ 4.8 mEq/L prior to initiation

And

patients must have an eGFR- 25 or more with UACR a2-a3

first-line to manage blood pressure after kidney transplant

Dihydropyridine Calcium Channel Blockers like-

Amlodipine

Nifedipine

Monitor/ Follow-up for blood pressure management

Check BP, Serum Creatinine, & k+ within 2-4 weeks after starting or increasing an ACE/ARB

Chlorthalidone (Thalitone) role in CKD

thiazide-like diuretic used for hypertension, including CKD stage 4 (eGFR 15-29)

Loop Diuretics role in CKD

managing significant fluid volume overload because they maintain their efficacy even at very low glomerular filtration rates (GFR)

Statin Indication in CKD

For ASCVD prevention in adults aged >/equal to 50 years old

eGFR <60