Therapeutics: CKD 2
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What needs to be monitored when you put a CKD patient on an ACEI or ARB?
- SCr and K at initiation and dose increase (watch for hyperkalemia)
- Increase dose Q1-3months
- Another rspot urine test to see if proteinuria is decerasing
What is the target/goal for ARBs or ACEIs in CKD (other than with HTN as indicated by JNC-8)?
Max tolerated dose for HTN
What is the course of medications/therapy for a progressing CKD patient with HTN?
- 1) ACEI or ARB
- 2) Diuretic
- 3) Add LA CCB or low dose BB if patient has angina, HF or arrhythmia
- 4) Low dose BB or different CCB
- 5) LA-alpha blocker, central alpha-agonist or vasodilator therapy
According to KDOQI, when would you give a CKD patient both an ACEI and an ARB and what precautions should you take in doing so?
Overt and persistent proteinuria
What are the risks of giving an ACEI and ARB to a CKD patient?
- Hyperkalemia (watch judiciously)
- Higher risk of dialysis
- (no benefit to hospitalizations or mortality in HF patients)
According to the ALTITIUDE study, adding Aliskiren (Tekturna) to an ARB or ACEI has what risks?
Increased risk of stroke, hyperkalemia, hypotension, ESRD or death
According to the FDA and ALTITUDE studies, what drug is CI in CKD patients on ARBs or ACEIs?
What is the MOA of Aliskiren (Tekturna)?
Direct renin inhibitor
What are non-pharmacologic treatments for CKD in Diabetes according to ADA and the KDOQI and KDIGO?
- Tight glycemic control (A1C <7%)
- HTN control
- Smoking cessation
- Weight management (BMI 20-25) exercise 30 min 5X/week
- Treatment for anemia
- Associated with rate of CKD progression
- Prolonged anemia leads to LVH, CHF
What effect do lipid lowering therapies have on patients with CKD and HLD?
- Decreases proteinuria
- Slow GFR decline
What are the KDIGO suggestions for HLD in CKD?
Do not give Statins or Ezetimibe/Statin (Vytorin) combos unless patient was already on at time of CKD diagnosis
What are the 2013 ACC/AHA guidelines for HLD and CKD?
What dose is recommended for G3a-5 stage CKD by KDIGO for Lovastatin?
What dose is recommended for G3a-5 stage CKD by KDIGO for Fluvastatin?
What dose is recommended for G3a-5 stage CKD by KDIGO for Atorvastatin?
What dose is recommended for G3a-5 stage CKD by KDIGO for Rosuvastatin?
What dose is recommended for G3a-5 stage CKD by KDIGO for Simvastatin/Ezetimibe (Vytorin)?
What dose is recommended for G3a-5 stage CKD by KDIGO for Pravastatin?
What dose is recommended for G3a-5 stage CKD by KDIGO for Simvastatin?
What dose is recommended for G3b-5 stage CKD by KDIGO for Pitavastatin?
If you have a G1-G2 CKD stage rating, what dose of statin is recommended by KDIGO?
Normal dose abased on ACSVD guidelines
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