Anemia of CKD
The guidelines recommend initiating iron supplementation for CKD patients when transferrin saturation (TSAT) and ferritin levels are at or below which thresholds?
TSAT </= 30% and ferritin < 500 ng/mL
What is the primary mechanism by which the kidney maintains phosphate homeostasis in a healthy state?
By regulating the renal excretion of phosphate.
This type of kidney injury results from hypoperfusion of the renal parenchyma with or without systemic arterial hypotension.
What is prerenal acute kidney injury?
What is the primary adaptive response of the kidneys to an increased systemic acid load?
Increase urinary ammonium (NH4+) excretion.
How is Ferric Pyrophosphate Citrate (FPC) administered to provide iron to hemodialysis patients?
Through the dialysate during hemodialysis session.
In the initial stages of chronic renal failure, what is the primary compensatory mechanism that helps maintain normal serum phosphate concentrations as the glomerular filtration rate begins to decline?
Increased secretion of PTH (parathyroid hormone)
Prescribe the current American College of Radiology Guidelines or European Society of Cardiology guidelines treatment regimen for intravascular volume expansion for patients undergoing angiography.
Isotonic saline at an infusion rate of 100 ml/hour for 6 to 12 hours before and 4 to 12 hours after angiograph OR isotonic saline at a rate of 1 to 1.5 ml per kilogram/hour for 12 hours before and up to 24 hours after the procedure.
The metabolism of which dietary components contributes the most to the daily nonvolatile acid load?
Sulfur-containing amino acids from animal protein.
In this anemia, there is a defect in the freeing of iron from macrophages and/or the loading of iron onto plasma transferrin resulting in low serum iron and iron-binding capacity, increased serum ferritin and often normocytic erythrocytes.
What is anemia of chronic inflammation or disease
Observational studies have identified hyperphosphatemia as a strong and unique risk factor for what outcome in dialysis patients?
Cardiovascular mortality
T/F: The federal policy AAKH (Advancing American Kidney Health) initiative seeks to increase rates of home dialysis use and transplantation.
True
In a patient with Chronic Kidney Disease (CKD), what is the primary reason that Net Acid Excretion (NAE) decreases as the disease progresses?
Reduced ammonium excretion capacity
Which novel iron-based phosphate binder is effective at controlling hyperphosphatemia but does not significantly increase a patient's iron stores?
Sucroferric oxyhydroxide (Velphoro)
A randomized trial comparing calcium acetate and sevelamer hydrochloride found that they had similar efficacy in controlling hyperphosphatemia. However, what was a key difference in their side-effect profiles?
Hypercalcemia was more common with calcium acetate.
What is the recommended target for serum phosphate levels for dialysis patients?
<5.5 mg/dL
According to clinical practice guidelines, what serum total carbon dioxide (tCO2) concentration is the threshold for diagnosing and considering treatment for metabolic acidosis in CKD?
Consistently < 22 mEq/L.
What is the primary concern that led to black box warnings for Erythropoietin-Stimulating Agents (ESAs) when targeting higher hemoglobin levels?
An increased risk of cardiovascular events, hypertension and thromboembolism.
These meds remain a standard therapy to reduce phos because they are effective, affordable and safe and they have the added benefit of providing supplemental calcium.
What are calcium-containing phosphate binders.
In addition to oral alkali replacement to increase/maintain HCO3- to >22 mmol/L in patients with metabolic acidosis in advanced CKD this nutrition intervention may increase the plasma HCO3- level and slow progression of disease.
What is eating fruits and vegetables.
How does the compensatory increase in per-nephron ammonia production in early CKD paradoxically contribute to further kidney injury?
High tissue ammonia concentrations activate the complement pathway and induce inflammation and kidney tissue fibrosis.