CKD CPT3 2023 Lecture.pdf

Chronic Kidney Disease Lisa Bromfield, PharmD  CONTENT Definition of Chronic Kidney Disease (CKD) Classification and Etiology of CKD Pathophysiology of CKD Clinical Manifestations of CKD Diagnostic Tests for CKD Treatment Goals Treatment Dialysis in CKD Renal Trans...

Chronic Kidney Disease Lisa Bromfield, PharmD  CONTENT Definition of Chronic Kidney Disease (CKD) Classification and Etiology of CKD Pathophysiology of CKD Clinical Manifestations of CKD Diagnostic Tests for CKD Treatment Goals Treatment Dialysis in CKD Renal Transplant 2  Definition of CKD …defined as abnormalities in kidney structure or function, present for 3 months or longer Structural abnormalities include: albuminuria of more than 30 mg/day, presence of hematuria or red cell casts in urine sediment, electrolyte abnormalities An abnormality in kidney function is usually indicated by a decrease in GFR 3  Definition of CKD GFR 25 kg/m2 Alcohol: Two standard drinks per day for men and one standard drink per day for women Smoking cessation 33  Nonpharmacological Treatment Renal diet restrictions If hypertension: Low-sodium diet (4.6mg/dL IV Calcium: 1st line for severe life threatening hyperphosphatemia Calcium reduces the serum phosphorous by chelation Phosphate-Binding Agents Calcium Carbonate 0.5-1G 3x per day with meals 77  Hyperphosphatemia Cont’d Oral calcium salts bind PO4 in the GI tract; elemental calcium should not exceed 1500mg/day Sevelamer HCl (RenagelR)/ Sevelamer carbonate (Renvela®) 800–1600mg TID – polymer based product; taken with meals (400, 800mg tablet) Lanthanum Carbonate (FosrenolR) – chewable tablets. Dose initially as 750 – 1500 mg /day with or pc in divided doses. Titrate up to 1000-3000mg /day q2-3 weeks. 78 Secondary Hyperparathyroidism Diagnosis KDIGO Stages 3–5 not on dialysis >ULN Stage 5 on dialysis >2× ULN 80  Secondary Hyperparathyroidism Vitamin D therapy – directly suppresses PTH synthesis and secretion and upregulates Vit D receptors Calcitriol (Rocaltrol ®) 0.25–5 mcg PO daily or TIW OR Calcitriol (Calcijex) 0.5-5 mcg IV TIW Paricalcitol (Zemplar®) 1–4 mcg PO TIW or daily Doxercalciferol (Hectoral®) 5–20 mcg PO TIW or daily 81  Secondary Hyperparathyroidism Calcimimetics – reduces PTH secretion by increasing sensitivity of the calcium sensing receptor Calcimimetics (CKD stage 5 dialysis only): cinacalcet (Sensipar®) starting dose is 30mg/d, titrate in 30mg increments to PTH goal every 2-4 weeks Maximum dose is 180mg/d. Monitor iPTH & serum Ca++ AE: N, V 82  Vitamin D deficiency Diagnosis 25-hydroxyvitamin D