Conclusion Since chronic kidney disease has the potential to affect near- ly 15% of Americans, it is important to be aware of the disease process and treatment of this common disease state. The signif- icant disease burden can affect many aspects of a patient’s life and health. Complications associated with chronic kidney disease are numerous, and treatment can be overwhelming to patients. References • Arora, P. (2021). Chronic kidney disease. Medscape. https://emedicine.medscape.com/ article/238798-overview#showall • Berkoben, M., & Quarles, D. (2021). Management of hyperphosphatemia in adults with chronic kidney disease. https://www.uptodate.com/contents/management-of- hyperphosphatemia-in-adults-with-chronic-kidney-disease • Berns, J. (2021a). Treatment of iron deficiency in nondialysis chronic kidney disease (CKD) patients. https://www.uptodate.com/contents/treatment-of-iron-deficiency-in-nondialysis- chronic-kidney-disease-ckd-patients?source=related_link • Berns, J. (2021b). Treatment of anemia in nondialysis chronic kidney disease. https://www. uptodate.com/contents/treatment-of-anemia-in-nondialysis-chronic-kidney-disease • Centers for Disease Control and Prevention (CDC). (2021). Chronic kidney disease in the United States, 2021. https://www.cdc.gov/kidneydisease/publications-resources/ckd- national- facts.html • Cho, M. E., & Beddhu, S. (2021). Dietary recommendations for patients with nondialysis chronic kidney disease. https://www.uptodate.com/contents/dietary-recommendations-for- patients-with-nondialysis-chronic-kidney-disease • DiPiro, J., Yee, G., Posey, L. M., Haines, S. T., Nolin, T. D., & Ellingrod, V. (2019). Pharmacotherapy: A pathophysiologic approach (8th ed.) McGraw-Hill. • Inker, L., & Perrone, R. (2021). Calculation of the creatinine clearance. https://www.uptodate. com/contents/calculation-of-the-creatinine-clearance • Kheiri, B., Abdalla, A., Osman, M., Ahmed, S., Hassan, M., & Bachuwa, G. (2018). Vitamin D deficiency and risk of cardiovascular diseases: a narrative review. Clinical Hypertension, 24, 9. https://doi.org/10.1186/s40885-018-0094-4 • Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. (2021). KDIGO 2021 clinical practice guideline for the management of blood pressure in chronic kidney disease. Kidney Int Suppl, 99 (3S). https://kdigo.org/wp-content/uploads/2016/10/KDIGO- 2021-BP-GL.pdf • Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. (2013a). KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl, 3 , 1-150. https://kdigo.org/wp- content/uploads/2017/02/ KDIGO_2012_CKD_GL.pdf
Pharmacists are perfectly poised to help educate patients on the disease process and treatment, and ensure patients are treated appropriately in order to slow disease progression and prevent adverse effects. Being aware of current treatment guidelines and recommendations allows pharmacy professionals to better serve patients with chronic kidney disease. • Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. (2013b). KDIGO 2013 clinical practice guideline for lipid management in chronic kidney disease. Kidney Int Suppl, 3 (3). https://kdigo.org/wp-content/uploads/2017/02/KDIGO-2013-Lipids-Guideline- English.pdf • Kovesdy, C. P. (2021). Pathogenesis, consequences, and treatment of metabolic acidosis in chronic kidney disease. https://www.uptodate.com/contents/pathogenesis-consequences- and-treatment-of-metabolic-acidosis-in-chronic-kidney-disease • National Institute of Diabetes and Digestive and Kidney Diseases. (2016a). Causes of chronic kidney disease . https://www.niddk.nih.gov/health-information/kidney-disease/ chronic-kidney- disease-ckd/causes • National Institute of Diabetes and Digestive and Kidney Diseases. (2016b). Kidney disease statistics for the United States. https://www.niddk.nih.gov/health-information/health- statistics/ kidney-disease • National Kidney Foundation. (2021). CKD-EPI creatinine equation, 2021. https://www. kidney.org/professionals/kdoqi/gfr_calculator/formula • Peralta et al., C. A., Norris, K. C., Li, S., Chang, T. I., Tamura, M. K., Jolly, S. E., . . . KEEP Investigators. (2012). Blood pressure components and end-stage renal disease in persons with chronic kidney disease: The Kidney Early Evaluation Program (KEEP). Arch Intern Med, 172 (1), 41-47. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1108640 • Quarles, L. D., & Berkoben, M. (2021). Management of secondary hyperparathyroidism in adult dialysis patients. https://www.uptodate.com/contents/management-of-secondary- hyperparathyroidism-in-adult-dialysis-patients • Rosenberg, M. (2021). Overview of the management of chronic kidney disease in adults. https://www.uptodate.com/contents/overview-of-the-management-of-chronic-kidney-disease- in-adults • U.S. Department of Health and Human Services. (2019). Advancing American kidney health. http://aspe.hhs.gov/sites/default/files/private/pdf/262046/ AdvancingAmericanKidneyHealth.pdf • U.S. Renal Data System (USRDS). (2020). USRDS annual data report: Epidemiology of kidney disease in the United States . National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases . https://adr.usrds.org/2020/
THE COMPLICATIONS OF CHRONIC KIDNEY DISEASE, SECOND EDITION Self-Assessment Answers and Rationales
1. The correct answer is D. Rationale: Renal diets can involve decreasing potassium, sodi- um, and phosphorus intake to prevent overaccumulation of these substances. 2. The correct answer is A. Rationale: The National Kidney Foundation recommends using the CKD-EPI creatinine equation to estimate GFR. This equation takes age, sex, race, and serum creatinine level into account to calculate an estimated glomerular filtration rate. 3. The correct answer is C. Rationale: Using the CKD-EPI creatinine equation and the given information about Sally results in an estimated GFR of 44 mL/ min/1.73m 2 . 4. The correct answer is C. Rationale: With a GFR of 44 mL/min/1.73m 2 , Sally would fall into Stage 3b, moderately reduced GFR (30–44 mL/min/1.73 m 2 ).
5. The correct answer is D. Rationale: Lisinopril, an ACE inhibitor, has been shown to de- crease the risk of long- term dialysis and mortality. 6. The correct answer is B. Rationale: To reduce cardiovascular risk in patients with chronic kidney disease, treatment with a statin or statin plus ezetimibe for adults aged 50 years and older with an estimated GFR of less than 60 mL/min/1.73m2 who are not on long-term dialysis is rec- ommended. 7. The correct answer is D. Rationale: Paricalcitol, doxercalciferol, and calcitriol appear to have comparable efficacy in reducing parathyroid hormone lev - els, and studies have not shown a preference for one agent over the others.
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