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Anemia and Its Management in Chronic Kidney Disease Study Guide

This guide provides a comprehensive overview of anemia associated with Chronic Kidney Disease (CKD). It details the pathophysiology, including the role of erythropoietin deficiency, and outlines the recommended management strategies. Key aspects covered include the two-step approach to treatment: first, ensuring adequate iron stores through oral or intravenous iron supplementation, and second, stimulating red blood cell production with Erythropoiesis-Stimulating Agents (ESAs) if hemoglobin level

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Chronic Kidney Disease Pathophysiology and Pharmacotherapy

Pathophysiology and Management of Chronic Kidney Disease

This content explores the normal functions of the kidney, the pathophysiology of chronic kidney disease progression, and pharmacologic therapies used to manage CKD-related complications.

  • kidney function
  • glomerular filtration rate (GFR)
  • albuminuria
  • hyperfiltration
  • ACE inhibitors
  • GLP-1 receptor agonists
  • finerenone
  • mineral and bone disorder (CKD-MBD)
  • hyperkalemia
  • metabolic acidosis
  • anemia
  • proximal tubule
  • glomerulus
  • efferent arteriole
  • afferent arteriole
  • diabetes mellitus
  • hypertension

Chronic Kidney Disease Diagnosis and Management

Diagnostic criteria for chronic kidney disease include eGFR and albuminuria, with management strategies focusing on RAAS inhibitors, SGLT2 inhibitors, and nonsteroidal MRA to delay progression.

  • Chronic kidney disease diagnosis
  • Glomerular filtration rate (eGFR)
  • Albuminuria and urine albumin-to-creatinine ratio (UACR)
  • KDIGO classification and staging
  • RAAS inhibitors (ACEi and ARB)
  • Nonsteroidal mineralocorticoid receptor antagonists (MRA)
  • Finerenone
  • Hypertension management in CKD
  • Renal pharmacology

Drug Dosing in Dialysis

Drug Dosing in Dialysis

Differentiate between hemodialysis, peritoneal dialysis, and continuous renal replacement therapy while identifying drug properties that influence removal and determining when medications require supplemental dosing.

  • Hemodialysis (HD)
  • Peritoneal Dialysis (PD)
  • Continuous Renal Replacement Therapy (CRRT)
  • Renal dose adjustment
  • Dialyzable medications
  • Supplemental dosing
  • Concentration gradient
  • Ultrafiltration
  • Creatinine clearance (CrCl)
  • Antimicrobial renal dosing

Complications of Chronic Kidney Disease

Complications of Chronic Kidney Disease

Management of mineral and bone disorder, hyperkalemia, and metabolic acidosis in chronic kidney disease.

  • CKD-MBD
  • Hyperphosphatemia
  • Secondary hyperparathyroidism
  • Vitamin D analogs
  • Calcimimetics
  • Hyperkalemia treatment
  • Metabolic acidosis
  • Potassium binding resins

Drug Properties Affecting Dialysis Removal

Drug Properties and Dialysis Removal

Drug properties such as molecular weight, hydrophilicity, protein binding, and volume of distribution determine how well drugs are removed by dialysis.

  • Small molecular weight
  • Hydrophilic properties
  • Low volume of distribution
  • Low protein binding
  • Dialyzable drugs
  • Poorly dialyzable drugs
  • Lipophilic properties

Hemodynamic Effects of NSAIDs and ACE Inhibitors

NSAIDs, ACE Inhibitors, and Renal Hemodynamics

NSAIDs and ACE inhibitors affect afferent and efferent arterioles to alter intraglomerular pressure and GFR.

  • NSAIDs
  • Prostaglandins
  • Afferent vasodilation
  • Glomerular Filtration Rate (GFR)
  • ACE Inhibitors
  • Angiotensin II
  • Efferent arteriole dilation
  • Serum Creatinine (SCr)
  • BUN
  • Potassium
  • Hemodynamic AKI

Anemia of CKD Management and Treatment

Anemia and Management in CKD

An overview of anemia of CKD including erythropoietin production, iron supplementation, and erythropoiesis-stimulating agents.

  • Anemia of CKD
  • Erythropoietin (EPO)
  • Iron supplementation
  • Oral iron
  • IV iron
  • Erythropoiesis-stimulating agents (ESA)
  • Transferrin saturation (TSAT)
  • Hemoglobin
  • Protein intake in CKD

Drug Dosing and Supplementation in Hemodialysis

Drug Dosing in Hemodialysis

Guidance on supplemental dosing for patients receiving hemodialysis and managing drug removal during dialysis sessions.

  • Supplemental dosing
  • Hemodialysis
  • Vancomycin removal
  • End-stage kidney disease
  • Drug levels
  • Levetiracetam therapy
  • High-flux hemodialysis

Drug-Induced Kidney Injury and CKD Management

Acute Tubular Necrosis and Drug-Induced AKI

Acute tubular necrosis is a common cause of drug-induced AKI involving direct toxic or ischemic injury to tubular epithelial cells.

  • Acute Tubular Necrosis (ATN)
  • Drug-Induced Kidney Disease (DIKD)
  • Aminoglycosides nephrotoxicity
  • Vancomycin and Piperacillin-tazobactam interaction
  • Amphotericin B potassium and magnesium wasting
  • Contrast-induced AKI
  • Cisplatin proximal tubule injury
  • Tenofovir proximal tubulopathy and Fanconi syndrome
  • Muddy brown granular casts
  • Fractional Excretion of Sodium (FENa)
  • Hemodynamic AKI

Managing Drugs in Chronic Kidney Disease

Pharmacists must avoid contraindicated drugs or adjust the dose and interval to protect kidney function and prevent drug-induced kidney disease.

  • Drug-induced kidney disease prevention
  • Contraindicated drugs in CKD
  • Dose adjustment and interval extension
  • Hemodynamic AKI mechanisms
  • Acute tubular necrosis (ATN)
  • Metformin lactic acidosis risk
  • NSAID hemodynamic effects
  • Maintenance dose adjustment

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