Therapeutics: Complications of CKD 2

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Author:
kyleannkelsey
ID:
272475
Filename:
Therapeutics: Complications of CKD 2
Updated:
2014-04-29 23:14:19
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Therapeutics Complications CKD
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Therapeutics: Complications of CKD 2
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Therapeutics: Complications of CKD 2
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  1. About _______ units of Epoetin alpha is equal to 1 mcg of darbopeotin.
    400
  2. What route is most useful for ESA therapy in ND and PD-CKD patients?
    SQ
  3. What route is most useful for ESA therapy in HD-CKD patients?
    • IV
    • To avoid Pure red cell aplasia
  4. What are the symptoms of pure red cell aplasia (PRCA)?
    • Rapid decrease in Hgb ( 0.5-1g/dL/wk)
    • Absolute reticulocyte count <10,000 units/L
    • PLT & WBCs normal
  5. When Hgb <10 and patient already on ESA, what should you do next?
    Increase dose by 25%, no more than every 4 weeks
  6. If a patient needs a downward adjustment of ESA needed per Hgb response, how would you perform this?
    Decrease ESA dose rather than withholding dose
  7. What are the SEs for ESA?
    Hypertension, Seizures
  8. What patients require a REMS submission?
    • On ESA and have cancer
    • Optional for CKD
  9. CHOIR, CREATE and TREAT studies found what?
    Treating HGB above 11g/dL increases death, stroke, MI and CV event
  10. What dose HGB need to be to start ESA therapy?
    <10 g/dL
  11. When should you adjust ESA dose as you see HGB rising?
    • ND or PD: approaching or exceeding 10 g/dL
    • HD: approaching or exceeding 11 g/dL
  12. In ND-CKD Start ESA only when Hgb _____ g/dL
    <10
  13. In ND-CKD adjust dose when Hgb ______ g/dL
    > or = to 10
  14. In HD-CKD Start ESA only when Hgb _____ g/dL
    <10
  15. In HD-CKD adjust dose when Hgb ______ g/dL
    > or = to 11
  16. For ESA therapy, how often should you monitor for Hgb or HCT?
    At least once weekly until stable, then at least monthly
  17. What is an expected change in HGB/HCT for a patient placed on ESA?
    • Expect increase in Hgb of 1 g/dL after 2-4 wks
    • Increase in Hct 1-2 %/week, but no more than 4 % in 2 weeks
  18. May need CBC with differential for a patient on ESA?
    to watch for PRCA
  19. What are some reasons that high dose of ESA would not be effective?
    • Iron deficiency
    • Hospitalization
    • Catheter insertion
    • Hhypoalbuminemia
    • Elevated CRP
    • Chronic bleeding
    • Chemotherapy & Cancer
  20. On the exam, you should use corrected or non-corrected Calcium values?
    Corrected
  21. What is the corrected Calcium equation?
    Corrected calcium= [(4 - albumin) x 0.8 mg/dL) + Serum Ca]
  22. What are the treatments for secondary hyperparathyroid in CKD?
    • Dietary PO4 restriction (800-1000mg/d)
    • Parathyroidectomy
    • Hemodialysis
    • Pharmacologic Therapy (Phosphate binders, Vitamin D, Calcimimetics)
  23. What is the MOA of Phosphate binders in preventing renal osteodystrophy and MBD-CKD?
    Binds dietary PO4 in the GI tractForms insoluble Ca, Mg or Al Phosphate that is excreted in the feces
  24. What are the pharmacologic treatment options for secondary hyperparathyroid in CKD?
    • Phosphate binders (Ca- or Non-Ca Containing)
    • Vitamin D
    • Calcimimetics
  25. What are the First line phosphate binders used in renal osteodystrophy and MBD-CKD?
    • Calcium containing ones are used first
    • Calcium carbonate (Tums®, Oscal®)
    • Calcium acetate (PhosLo®)
  26. What is the starting dose of Phosphate binder?
    • Total elemental Ca starting dose = 1000-1500 mg/day
    • Do not exceed elemental Ca 1500 mg/d, total daily intake no > 2000 mg/d (ie. oral supplement + food)
  27. When is a phosphate binder not recommended for renal osteodystrophy and MBD-CKD?
    2 consecutive serum Ca >10.2 or iPTH is <150
  28. Chronic use of phosphate binders can have what negative impact?
    May increase risk of vascular and tissue calcification

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