pregnancy, renal artery stenosis, previous angioedema
What are contraindications of ACEi/ARBs? (3)
continue titrating to max tolerated dose
What do we do to the dose of the ACEi/ARB if there is a <30% increase in SCr?
reduce dose and repeat creatinine every 1-2 weeks until <30% above baseline
What do we do to the dose of the ACEi/ARB if there is a 31-50% increase in SCr?
discontinue ACEi/ARB
What do we do to the dose of the ACEi/ARB if there is a >50% increase in SCr?
slow CKD progression, decreased advancement to ESRD (dialysis/transplant), reduce CV events, decrease albuminuria
How have SGLT2-inhibitors been proven to help in CKD patients? (4)
canagliflozin
Which SGLT2 inhibitor is indicated for patients with T2DM ONLY?
>=30ml/min
What is the eGFR cutoff for starting Canagliflozin?
>=25ml/min
What is the eGFR cutoff for starting Dapagliflozin?
>=20 ml/min
What is the eGFR cutoff for starting Empagliflozin?
albuminuria (>200-300), T2DM, HF
What are the high priority patients for SGLT2 selection? (3)
hx of severe genital infections, significant UTI risk, hx/risk of ketoacidosis, on immunosuppressants, hypovolemia/hypotension
Who should we consider avoiding the use of SGLT2 inhibitors in? (5)
GFR; SCr
When starting a patient on an SGLT2 inhibitor, we can expect a slight
decrease in _________ and increase in ________.
T2DM + CKD + albuminuria; already on max ACEi/ARB
When do we consider adding Finerenone to a patient's medication regimen?
eGFR, potassium
What is Finerenone dosing based off of? (2)
>=25% decrease in GFR or increased albuminuria
CKD progression is defined as what?
a
Which CKD category is monitored every 6-12 months?
a) G1-2
b) G3
c) G4
d) G5
b
Which CKD category is monitored every 4-6 months?
a) G1-2
b) G3
c) G4
d) G5
c
Which CKD category is monitored every 2-4 months?
a) G1-2
b) G3
c) G4
d) G5
d
Which CKD category is monitored every 1-3 months?
a) G1-2
b) G3
c) G4
d) G5
educate patients/improve utilization of 1st line options, address barriers to utilization of highest quality meds
What is the role of the pharmacist in CKD care? (3)
NSAIDs, herbals
Which medications should patients with CKD avoid? (2)
flu, hep b, pneumococcal
Which immunizations should patients w/ CKD receive? (3)
progression to ESKD, proteinuria/albuminuria, CV risk
ACEi/ARBs have been proven to reduce what? (3)