CKD Updated #2

Question 1

What are reasons to hold ACE inhibitors or ARBs?

Answer 1

• Hyperkalemia – uncontrolled
• Symptomatic hypotension
• AKI (30% rise within 4 weeks)
• Uremic symptoms in ESRD

Question 2

How does hypertension lead to CKD?

Answer 2

Increased intraglomerular pressure damages the glomerulus, leading to decreased GFR over time.

Question 3

How does hypertension affect the heart in CKD patients?

Answer 3

It increases heart workload and can cause left ventricular hypertrophy (LVH)

Question 4

When are ACE inhibitors or ARBs especially indicated in CKD?

Answer 4

In patients with albuminuria

Question 5

Who should get SGLT2 inhibitors?

Answer 5

Patients with:
* Type 2 diabetes + CKD
* AND eGFR >20

Question 6

What is the primary benefit of SGLT2 inhibitors in CKD?

Answer 6

They slow progression of CKD by reducing intraglomerular pressure.

Question 7

Where do SGLT2 inhibitors act in the nephron?

Answer 7

Proximal tubule

Question 8

Can SGLT2 inhibitors be used in CKD patients without diabetes?

Answer 8

Yes, especially if albuminuria or heart failure is present

Question 9

What level of albuminuria supports SGLT2 inhibitor use?

Answer 9

Urine ACR >200 mg/g

Question 10

Should SGLT2 inhibitors be used in CKD patients with heart failure?

Answer 10

Yes, regardless of albuminuria

Question 11

When should SGLT2 inhibitors be continued until?

Answer 11

Until dialysis or kidney transplant is initiated

Question 12

When should SGLT2 inhibitors be temporarily held?

Answer 12

During prolonged fasting, surgery, or critical illness

Question 13

What MRA is commonly used in CKD progression?

Answer 13

Finerenone

Question 14

Which patients are candidates for finerenone?

Answer 14

CKD with type 2 diabetes, albuminuria >30 mg/g, on ACEi/ARB, with normal potassium

Question 15

What is the major adverse effect of finerenone?

Answer 15

Hyperkalemia

Question 16

What must be monitored when using finerenone?

Answer 16

Potassium levels

Question 17

When should GLP-1 receptor agonists be used in CKD?

Answer 17

When glycemic targets are not met despite metformin and SGLT2 inhibitor use

Question 18

What is the stepwise therapy for CKD progression?

Answer 18

ACEi/ARB → SGLT2 inhibitor → Finerenone → GLP-1 receptor agonist

Question 19

When are calcium channel blockers used in CKD?

Answer 19

As add-on therapy when blood pressure is not controlled with ACEi/ARB

Question 20

Which diuretics are preferred in early CKD (eGFR >30)?

Answer 20

Thiazide diuretics

Question 21

Which diuretics are preferred in advanced CKD (eGFR <30)?

Answer 21

Loop diuretics

Question 22

What is the main risk of steroidal MRAs in CKD?

Answer 22

Hyperkalemia

Question 23

How does finerenone differ from spironolactone?

Answer 23

It is more selective, has lower hyperkalemia risk, and provides kidney protection.

Question 24

What is recommended for patients ≥50 with CKD and eGFR <60?

Answer 24

Statin or statin + ezetimibe

Question 25

What is recommended for patients ≥50 with CKD and eGFR >60?

Answer 25

Statin alone

Question 26

What is the key decision factor for statin use in CKD?

Answer 26

Age and cardiovascular risk

Question 27

Name conditions that qualify younger CKD patients for statin therapy.

Answer 27

Diabetes, coronary artery disease, prior stroke, or >10% 10-year CV risk

Question 28

What is a simple rule for statin use in CKD?

Answer 28

Age ≥50 → treat; Age <50 → treat only if high risk