CKD

Question 1

What is the BP goal for CKD with HTN?

Answer 1

< 120/80 mmHg

Question 2

What is the default HbA1c goal for CKD with DM? (without those factors like life expectancy)

Answer 2

< 6.5%

Question 3

Which agents help with proteinuria?

Answer 3

• ACEi/ARB
• SGLT2i
• finerenone

Question 4

What is the target Hb for those with CKD with anaemia?

Answer 4

10-11.5

Question 5

What is considered CKD with anaemia? (Hb levels for male and female)

Answer 5

M: <13
F: <12

Question 6

What is the target TSAT and ferritin goal for CKD with anaemia?

Answer 6

TSAT: 30
Ferritin: 500

Question 7

What is considered AKI?

Answer 7

• increase in SCr by 0.3 mg/dL (26.5 mol/L) within 48h
• increase in SCR by 1.5x baseline in past 7D
• urine vol < 0.5mL/kg/h in past 6h

Question 8

What can cause ATN?

Answer 8

• vancomycin
• aminoglycosides
• amp B
• contrast-induced

Question 9

Percentage of iron in iron products:
- ferrous fumarate
- ferrous gluconate
- ferrous sulfate
- iron polymaltose

Answer 9

• ferrous fumarate: 33%
• ferrous gluconate: 12%
• ferrous sulfate: 20%
• iron polymaltose: 100%

Question 10

What are short and long acting ESAs?

Answer 10

• short: epoetin alpha & beta
• long: darbepoetin alpha, methoxy polyethylene glycol-epoetin beta

Question 11

Is epoetin alpha given as IV or SC? Why?

Answer 11

IV (SC causes pure red cell aplasia)

Question 12

When to start ESA? When to stop ESA?

Answer 12

start: Hb <10
stop: Hb >11.5 (increase risk of CV events & stroke)

Question 13

When to start IV and PO iron?

Answer 13

• IV: dialysis
• PO: not on dialysis

Question 14

How long for ESA to work?

Answer 14

10 days to reach SS (time taken for erythrocyte progenitor cells to mature & release into circulation)

Question 15

Maximum increase in Hb allowed while on ESA?

Answer 15

1g/dL Q2-4w

Question 16

Adverse effects of ESA?

Answer 16

• HTN
• pure red cell aplasia
• seizures
• flu-like sx
• vascular access thrombosis

Question 17

Percentage of calcium in calcium products?

Answer 17

• calcium carbonate: 40%
• calcium acetate: 25%
• calcium citrate: 21%

Question 18

Pharm options for CKD-MBD?

Answer 18

• phosphate binders
• vitamin D analogues
• calcimimetics

Question 19

Examples of phosphate binders (calcium and non-calcium based)?

Answer 19

• calcium: calcium acetate, carbonate
• non-calcium: sevelamer, lanthanum, aluminium, sucroferric oxyhydroxide

Question 20

Examples of vitamin D & analogues for CKD-MBD?

Answer 20

• alfacalcidol
• calcitriol
• paricalcitol

Question 21

Examples of calcimimetics for CKD-MBD?

Answer 21

cinacalcet, etelcalcitide

Question 22

To take phosphate binders with or without food? Which ones can be chewed and which ones must be swallowed?

Answer 22

Take with food

Chew: lanthanum, calcium carbonate / acetate, sucroferric oxyhydroxide
Swallow: sevelamar

Question 23

Maximum duration to use aluminium?

Answer 23

4 weeks

Question 24

Frequency of all phosphate binders?

Answer 24

TDS

Question 25

What is the active form of vitamin D?

Answer 25

calcitriol

Question 26

Activation of vitamin D?

Answer 26

ergocalciferol / cholecalciferol -> add OH grp to 25th position in liver -> calcifediol -> add OH grp to 1st position in kidney -> calcitriol

Question 27

How do calcimimetics work?

Answer 27

Binds and modifies calcium sensing receptor on parathyroid gland, causing increased sensitivity to extracellular calcium, reducing PTH levels

Question 28

How to switch between cinacalcet and etelcalcitide?

Answer 28

- cinacalcet to etelcalcitide: stop cinacalcet for ≥7D before starting etelcalcitide - etelcalcitide to cinacalcet: stop etelcalcitide for ≥4w before starting cinacalcet

Question 29

How to change alfacalcidol to active form?

Answer 29

Activation by 25-hydroxylase in liver

Question 30

Bicarbonate level target for metabolic acidosis?

Answer 30

≥ 22 mEq/L

Question 31

Treatment for metabolic acidosis? With dose

Answer 31

Sodium bicarbonate 500-1000mg TDS (one 500mg capsule is 5.95 mEq of Na & bicarbonate)

Question 32

When to stop bicarbonate supplementation?

Answer 32

Once regular dialysis is initiated

Question 33

When is dialysis indicated?

Answer 33

Acidosis Electrolyte abnormalities Intoxication Overload (fluid) Uraemia

Question 34

What factors affect drug dialysability?

Answer 34

- molecular weight - water solubility (more water soluble, more dialysable) - Vd (higher Vd, less plasma drug conc, less dialysable) - protein binding (more protein binding, less plasma free drug, less dialysable) - type of dialysate

Question 35

What does PD dialysate NOT contain?

Answer 35

potassium