Parenteral Nutrition
Debunking Hyperkalemia Myths: What Clinicians Need to Know
H yperkalemia is a life-threatening electrolyte disturbance with significant implications for patient care. Despite its seriousness, several myths persist in clinical practice. In this article, we'll address these myths and provide evidence-based recommendations. Introduction to hyperkalemia Hyperkalemia affects 2.6-2.7% of the U.…
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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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Nephrology and Urology
Can we use fondaparinux in RENAL patients?
As a clinical pharmacy specialist, it is important to address the safety of using fondaparinux ( Arixtra ) in renal patients with a creatinine clearance (CrCl) less than 30 mL/min. Fondaparinux is primarily used subcutaneously (SQ) for the treatment and prevention of deep vein thrombosis (DVT) and pulmonary embolism (PE). According to the 2018 American Society of …
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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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UTI
Antibiotics for urinary tract infections in ELDERLY patients
As a clinical pharmacist, you will be asked more, which antibiotics should be recommended for urinary tract infections in elderly patients? It depends on whether it's a "complicated" UTI or not. We know all UTIs in older MEN are considered complicated due to possible prostate involvement. UTIs in women can also be complicated due to a catheter, obstr…
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Tadalafil
Daily CIALIS for benign prostatic hyperplasia
As a clinical pharmacist, you will hear about using daily Cialis (tadalafil) for benign prostatic hyperplasia (BPH) , not just erectile dysfunction. It's just been approved for this use. Cialis and other phosphodiesterase-5 inhibitors seem to enhance smooth muscle relaxation in the prostate, bladder, and urethra. But don't expect a large improvement in BPH sy…
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Pain Management
Consider kidney risks before using an NSAID
As a hospital pharmacist, you will be asked more, which NSAID is preferred in patients with kidney disease?.. There is NOT a “safest” NSAID for the kidneys . You might’ve heard that short-acting NSAIDs (ibuprofen, etc) are least kidney toxic. But this isn’t supported by evidence. The real key is to use the lowest NSAID dose for the s…
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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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Side Effects
Kidney problems when CLARITHROmycin is combined with CCBs
As a clinical pharmacist, you will get alerts about kidney problems when clarithromycin is combined with a calcium channel blocker (amlodipine, etc). Do your part... Clarithromycin is a strong 3A4 inhibitor that can slow the metabolism of calcium channel blockers and increase their levels. This can lead to hypotension , edema, bradycardia an…
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Nephrotoxicity
Improve safety with IV contrast agents
As a hospital pharmacist, you will field questions about the safe use of IV contrast. Think of IV contrast as two classes that aren’t interchangeable... Gadolinium-based contrast ( Magnevist, Omniscan, etc) is often used for MRI, and Iodine-based ( Omnipaque, Ultravist, Visipaque, Optiray, etc) for CT. Evaluate allergies. Iodine-base…
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Renal Function
CrCl and eGFR are NOT interchangeable
As a hospital pharmacist, you can help colleagues determine the best way to estimate kidney function and adjust medications. Dosing based on estimated glomerular filtration rate (eGFR) is in labeling for more medications (meropenem/vaborbactam, baricitinib, etc). But CrCl and eGFR are NOT interchangeable, despite some guidance suggesting they are. Using eGFR when …
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UTI
Antibiotic options for UTI in pregnancy
As a pharmacist, pregnant women will ask you about antibiotic safety for urinary tract infections (UTIs) partly due to new media headlines. A recent CDC report highlights that nitrofurantoin or TMP/SMX accounts for over 40% of prescribtion to treat a UTI in the first trimester and cautions about birth defects with these antibiotics. But this doesn't mean these…
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