eGFR < 60ml/min OR abnormalities of kidney structure/ function for >=3 months (albuminuria)
What are the requirements for diagnosing CKD? (2)
>= 90; normal
G1=
60-89; mildly decreased
G2=
45-59; mild-moderate decrease
G3a =
30-44; moderate-severe decrease
G3b =
15-29; severely decreased
G4 =
< 15; kidney failure
G5=
< 30 mg/g; normal-mild increase
A1 uACR =
30-300 mg/g; microalbuminuria
A2 uACR =
> 300 mg/g; macroalbuminuria
A3 uACR =
ACR >=30 mg/g
Albuminuria =
change to urine volume/composition, edema/weight gain, SOB, fatigue/weakness, confusion, N/V, loss of appetite, peripheral neuropathy
What are symptoms of CKD? (8)
lifestyle, control BP, manage diabetes, control albuminuria
What are the strategies to prevent CKD progression? (4)
exercise >=30 min a week x 5 days/week, weight loss, smoking cessation, limit alcohol
What are the lifestyle interventions? (4)
< 2.3 g/day
What are the sodium restrictions for CKD 3-5?
< 2 g/day
What are the sodium restrictions for CKD + HTN?
potassium; phosphorus
What electrolytes should patients adjust to keep in normal range? (2)
0.6-0.8 g/kg/day
What are the protein restrictions for CKD?
<130/80; <120
What are ACC/AHA BP goals?
What are KDIGO BP goals?
when albuminuria is present
When are ACEi or ARB's 1st line?
< 6.5-7%
What is the target A1c?
metformin
What is the 1st line agent for DM + CKD?
GFR <45ml/min; <30ml/min
Metformin should be used with caution in patients with what GFR?
When do we discontinue it?
SGLT2 inhibitor
What medication do we use when GFR is >= 20ml/min?
alternatively; add on
GLP-1 agonists are used ______ or ______ to an SGLT2 inhibitors.
titrate to max tolerated dose
How do we dose ACEi/ARBs?
with or without diabetes; persistent albuminuria despite ACEi/ARB
When do we give SGLT2 inhibitors? (2)
lower end; especially if GFR < 30ml/min
Which dose do we start with for ACEi/ARB?
patient experiences: vomiting, diarrhea, volume depletion; risk of AKI
When do we hold the dose of ACEi/ARBs? (3)