Nephrology and Urology
Erythropoietin (EPO) dosing in anemia of CKD
Erythropoiesis-stimulating agents (ESAs) like erythropoietin (EPO) are integral for managing anemia in chronic kidney disease (CKD) . The recommended initial EPO dosing varies based on the route of administration and the patient’s clinical situation. For subcutaneous (SC) administration, start with a dose ranging from 50 to 100 U/…
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Optimizing Meds
Optimizing meds in patients with HFrEF and CKD
Few patients with chronic kidney disease (CKD) are on optimized meds for heart failure with reduced ejection fraction (HFrEF) . It’s a delicate balance... Hyperkalemia can occur with an ACEI or ARB, Entresto (sacubitril/valsartan), or an aldosterone antagonist. Plus, these meds or SGLT2 inhibitors ( Forxiga, etc ) can cause an initial bump in serum creatinine…
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Proteinuria
CKD Management Medtweetorial
CKD is classified based on the GFR and albuminuria. Based on the GFR ( Figure 1 ), it can be divided into five stages: G1 (GFR ≥ 90 mL/min/1.73 m²), G2 (GFR 60–89), G3 (subdivided into G3a with a GFR 45 to 59 and G3b with a GFR 30–44), G4 (GFR 15–29), and G5 (GFR < 15 not on renal replacement therapy). In CKD, starting dialysis based only on a target GFR do…
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Renagel
How to choose PHOSPHATE binder for CKD patients
As a clinical pharmacist, you should know how to choose a phosphate binder for patients with chronic kidney disease . These have similar efficacy for lowering phosphate levels , but vary in adverse effects, cost, and pill burden. Aluminum hydroxide isn't used chronically anymore. Aluminum accumulates and leads to bone disease, dementia, and death. …
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Type-2 Diabetes
Finerenone (Kerendia) role for Diabetic Kidney Disease
As a hospital pharmacist, you will hear about a new medication finerenone ( Kerendia ) for patients with chronic kidney disease (CKD) due to type 2 diabetes. It's the first "nonsteroidal mineralocorticoid receptor antagonist", and is approved to slow CKD progression and improve CV outcomes in these patients. Finerenone is thought to limit fibrosis and …
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Type-2 Diabetes
Optimize management of CKD in patients with diabetes
As a clinical pharmacist, you should optimize treatment of chronic kidney disease (CKD) in patients With diabetes. Patients with CKD have a much higher rate of hospitalization, especially if they have diabetes. Use a hospital stay to optimize treatment. Ensure patients are on an ACEI or ARB to manage blood pressure (BP) . Continue to us…
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Nutrition
Nutrition for patients with CKD
Overview ㅡ Chronic kidney disease CKD usually takes a long time to develop and does not go away. the kidneys continue to work, just not as well as they should. Wastes may build up so gradually. Salts containing phosphorus and potassium may rise to unsafe levels, causing heart failure , bone problems and anemia . Dietary factors may have an effect on the progress…
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Renal Function
eGFR and Creatinine clearance
Think with me ㅡ The physician is about to prescribe rivaroxaban ( Xarelto ) to someone with atrial fibrillation (AF). Their eGFR is 45. The recommended dose in AF is 20 mg once daily, but the dose should be reduced to 15 mg once daily if creatinine clearance is 15–49 mL/min. Should physician prescribe 15 or 20 mg? You decide you had better calculate the patient’s c…
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Renal Function
Expect a serum creatinine bump when starting an ACEI or ARB in kidney disease
How to safely use ACEIs or ARBs in patients with chronic kidney disease, this is an important question. We know these medications slow the progression of kidney disease. But blocking angiotensin can reduce kidney filtration and sometimes lead to a bump in serum creatinine (SCr) and potassium. See " Algorithm (1) of using ACEI or ARB after AKI ". …
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Nephrology and Urology
Antibiotic dosing requirements in patients with chronic kidney disease and dialysis
OVERVIEW ― We're getting questions about how to dose oral antibiotics with dialysis since medication labels and references may conflict or be murky. KEY POINTS Recommend usual doses of antibiotics that aren't renally cleared including azithromycin, clindamycin, and doxycycline. But advise adjusting other antib…
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