Chronic Kidney Disease

what are 5 fixed risk factors for CKD?

-advanced age

-male sex

-black race

-family history

-genetic kidney abnormality

what are 2 ways to define CKD?

-abnormality of kidney structure (albuminuria or proteinuria) for over 3 months with negative health implications

-abnormality of kidney function (decreased GFR) for over 3 months with negative health implications

what are 2 prerenal etiologies of CKD?

-heart failure

-cirrhosis

what are 3 intrinsic tubular interstitial etiologies of CKD?

-polycystic kidney disease

-nephrocalcinosis

-systemic rheumatologic disease

what are 2 intrinsic vascular etiologies of CKD?

-nephrosclerosis

-renal artery stenosis

what are 3 postrenal etiologies of CKD?

-prostate disease

-malignancy

-retroperitoneal fibrosis

what are 3 characteristics that are exclusive to AKI?

-recent onset

-marked oliguria or anuria

-progressive daily increase in creatinine

what are 2 characteristics that are exclusive to CKD?

-small kidneys on radiography

-evidence of renal osteodystrophy

what are the 3 main treatments of reversible causes of CKD?

-correct hypovolemia

-discontinue or minimize nephrotoxic medications

-relieve obstruction

what are 3 methods of prevention or delaying progression of CKD?

-primary goals are lowering of BP and proteinuria

-glycemic control

-correction of metabolic acidosis

what are the 5 factors of elevated BP pathogenesis?

-increased Na+ retention

-increased RAS activity

-increased sympathetic nervous system activity

-increased intracellular Ca2+ concentration

-decreased NO synthesis and endothelium mediated vasodilation

what are 5 general management points of elevated BP?

-goal SBP is less than 120 mmHg except transplant or dialysis recipients

-moderate intensity physical activity over 150 min/week

-Na+ restriction to less than 2 g/day

-smoking cessation

-potential benefit of evening antihypertensive administration

what are 2 recommendations for lowering elevated BP with proteinuria?

-prefer ACE inhibitor or ARB at highest tolerated dose

-avoid combination of ACE inhibitors and ARBs

what are the recommendations for lowering elevated BP without proteinuria?

no guideline based recommendations

what are the elevated BP recommendations for transplant patients?

-goal is 130/80 mmHg

-prefer dihydropyridine CCB or ARB

what are the elevated BP recommendations for dialysis patients?

-no guideline based recommendations

-goal is 130/80 mmHg

what are 3 recommendations for treatment of proteinuria?

-ACE inhibitor or ARB

-SGLT2 inhibitor

-protein restriction < 0.8 g/kg/day

what are 3 recommendations for treatment of hyperglycemia?

-goal HbA1C from <6.5% to < 8%

-prefer combination metformin and SGLT2 inhibitor

-prefer GLP1 agonists as second line agents

what are 3 recommendations for metabolic acidosis?

-goal bicarbonate 22-30 mg/dL

-high fruit and vegetable consumption

-sodium citrate or sodium bicarbonate

what drug is recommended for heart failure irrespective of proteinuria level?

SGLT2 inhibitor

what drug is recommended for those with diabetes and proteinuria?

nonsteroidal mineralocorticoid receptor antagonist with documented kidney benefit

what are the upper and lower limits of goal Hgb in anemia?

-lower: 10 g/dL without dialysis, 9 g/dL with dialysis

-upper: 11.5 g/dL

what are 4 goals for CKD mineral and bone disorders?

-lower elevated phosphate toward normal range

-avoid hypercalcemia

-optimal iPTH not known for non dialysis patients

-maintain iPTH in range of 2-9 times the upper limit of normal for dialysis patients

what are 4 interventions for CKD mineral and bone disorders?

-phosphate lowering treatment

-restrict calcium based phosphate lowering treatment

-avoid long term use of aluminum based phosphate lowering treatment

-limit dietary phosphate intake

what are 3 interventions related to severe and secondary hyperparathyroidism for CKD mineral and bone disorders?

-reserve PTH directed pharmacotherapy

-calcitriol or vitamin D analogs can be considered for non dialysis patients

-calcimimetics, calcitriol, or vitamin D analogs can be considered for dialysis patients

what are 2 calcimimetics that can be used and their considerations?

-cinacalcet: administer with/shortly after meal, monitor for hypocalcemia

-etelcalcitide: administer post dialysis, monitor for hypocalcemia

what are 3 recommendations for hyperuricemia?

-chronic: use xanthine oxidase inhibitors

-acute: use low dose colchicine or glucocorticoids

-avoid uric acid lowering therapy with asymptomatic hyperuricemia

what are the 4 indications for dialysis when kidney transplant is not an option?

-refractory volume overload, HTN, or metabolic disturbance

-pericarditis or pleuritis

-encephalopathy or neuropathy

-bleeding diathesis of uremia