Chronic Kidney Disease: Treatment. Slowing the Progression of CKD Protein Restriction – KDOQI...
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Transcript of Chronic Kidney Disease: Treatment. Slowing the Progression of CKD Protein Restriction – KDOQI...
![Page 1: Chronic Kidney Disease: Treatment. Slowing the Progression of CKD Protein Restriction – KDOQI guidelines - 0.60-0.75 g/kg per day – Sufficient energy.](https://reader036.fdocuments.us/reader036/viewer/2022082422/5697bfdb1a28abf838cb0960/html5/thumbnails/1.jpg)
Chronic Kidney Disease:Treatment
![Page 2: Chronic Kidney Disease: Treatment. Slowing the Progression of CKD Protein Restriction – KDOQI guidelines - 0.60-0.75 g/kg per day – Sufficient energy.](https://reader036.fdocuments.us/reader036/viewer/2022082422/5697bfdb1a28abf838cb0960/html5/thumbnails/2.jpg)
Slowing the Progression of CKD
• Protein Restriction – KDOQI guidelines - 0.60-0.75 g/kg per day– Sufficient energy intake - 35 kcal/kg
• Reducing Intraglomerular Hypertension and Proteinuria– Antihypertensive therapy - 125/75 mmHg – ACE inhibitors and ARBs inhibit the
vasoconstriction of the efferent arterioles
![Page 3: Chronic Kidney Disease: Treatment. Slowing the Progression of CKD Protein Restriction – KDOQI guidelines - 0.60-0.75 g/kg per day – Sufficient energy.](https://reader036.fdocuments.us/reader036/viewer/2022082422/5697bfdb1a28abf838cb0960/html5/thumbnails/3.jpg)
• Slowing Progression of Diabetic Renal Disease
– Control of Blood Glucose• Preprandial plasma glucose - 5.0–7.2 mmol/L (90–130 mg/dL)• Hemoglobin A1C should be < 7%
– Use and dose of oral hypoglycemics needs to be reevaluated• Chlorpropamide - prolonged hypoglycemia• Metformin – lactic acidosis• Thiazolidinediones – increase renal salt and water reabsorption
– As renal function declines, less insulin is required for glycemic control
![Page 4: Chronic Kidney Disease: Treatment. Slowing the Progression of CKD Protein Restriction – KDOQI guidelines - 0.60-0.75 g/kg per day – Sufficient energy.](https://reader036.fdocuments.us/reader036/viewer/2022082422/5697bfdb1a28abf838cb0960/html5/thumbnails/4.jpg)
• Managing Other Complications of Chronic Kidney Disease– Medication Dose Adjustment• >70% excretion is non-renal –may not need adjustment• Metformin, meperidine, oral hypoglycemics and NSAIDs
should be avoided• Antibiotics, antihypertensives, and antiarrhythmics –
reduction in dosage or change in dose interval
– Preparation for Renal Replacement Therapy • Clear indications – pericarditis, encephalopathy,
intractable muscle cramping, anorexia, malnutrition, fluid and electrolyte abnormalities
![Page 5: Chronic Kidney Disease: Treatment. Slowing the Progression of CKD Protein Restriction – KDOQI guidelines - 0.60-0.75 g/kg per day – Sufficient energy.](https://reader036.fdocuments.us/reader036/viewer/2022082422/5697bfdb1a28abf838cb0960/html5/thumbnails/5.jpg)
• Recommendation for the optimal time for initiation of renal replacement therapy – Delaying renal replacement therapy leads to a
worse prognosis on dialysis or with transplantation
• Patient Education– Social, psychological, and physical preparation– Educational programs should be commenced no
later than stage 4 CKD