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WorksheetsChronic Kidney Disease-Heeter
Total questions: 47
Worksheet time: 40mins
What is an important counseling point when starting a patient on cinacalcet therapy?
Take with food
Take on an empty stomach
Take in the morning
Take in the evening
When is an ESA usually initiated in a patient with chronic kidney disease?
When Hgb drops below 10g/dL
After iron stores are at goal
Before correcting iron stores
When Hgb drops below 10g/dL AND iron stores are goal.
What are common complications of CKD?
Hypertension
Anemia
Secondary Hyperparathyroidism
Metabolic Acidosis
What electrolyte abnormalities are MOST common in patients with advanced chronic kidney disease?
hypernatremia
hyponatremia
hyperkalermia
hypokalemia
What are options to supplement bicarbonate in a patient that has chronic kidney disease with chronic metabolic acidosis?
Sodium bicarbonate
Alkalinizing salts
Citrate/citric acid preparations
Calcitriol
What are the K/DOQI recommendations for dietary phosphate in a patient with uncontrolled secondary hyperparathyroidism?
800-1000mg/day
400-800mg/day
1000-1200mg/day
600-800mg/day
When should the K/DOQI recommendation of dietary phosphate restriction be implemented in a patient with secondary hyperparathyroidism?
for most patients with stage 3,4 and 5 CKD
when serum phosphorous reaches ~4.5mg/dL
for most patients with early stage CKD
when serum phosphorous falls below ~4.5mg/dL
What is the goal TSat for a patient with Stage IV CKD on hemodialysis?
>20%
<20%
>30%
<30%
Which vitamin D supplements requires activation in the kidney?
Ergocalciferol
Cholecalciferol
Calcitriol
Paricalcitol
Doxercalciferol
What are initiation factors for chronic kidney disease?
Diabetes Mellitus
Hypertension
Glomerulonephritis
Proteinuria
What are progression factors for chronic kidney disease?
Hyperglycemia
Uncontrolled hypertension
Glomerulonephritis
Proteinuria
Hypotension, allergic reactions, injection-site reactions, and headaches are potential side effects of:
Oral iron supplementation
IV iron supplementation
Oral vitamin D supplementation
IV vitamin D supplementation
Constipation, nausea, and abdominal cramping
are potential side effects of:
Oral iron supplementation
IV iron supplementation
Oral vitamin D supplementation
IV vitamin D supplementation
A patient is currently taking ferrous sulfate 325mg PO TID. How much elemental iron is the patient receiving per day?
65mg
195mg
450mg
975mg
What is the mechanism of lanthanum in the management of hyperphosphatemia?
Phosphate-binding agent
Diuretic
Calcimimetic therapy
Vitamin D supplementation
What is the goal protein restriction for a patient weighing 90kg with stage IV CKD (eGFR = 20 ml/min/1.73 m2)?
90g/day
72g/day
117g/day
81g/day
What is the goal hemoglobin for a patient with chronic kidney disease?
11g/dL
4g/dL
21g/dL
15g/dL
What is the goal blood pressure for patients with chronic kidney disease?
<120/80 mmHg
<110/70 mmHg
<140/80 mmHg
<130/70 mmHg
Which agents may be used to reduce the degree of proteinuria in a patient with chronic kidney disease?
ACEI
ARB
Diuretic
dihydropyridine CCB
What urine albumin to creatinine ratio is consistent with microalbuminuria?
30-299 mcg/mg
<30 mcg/mg
>299 mcg/mg
<20 mcg/mg
A patient with ESRD is on intermittent hemodialysis. During his dialysis session today, he becomes severely hypotensive. What is the most appropriate treatment for his current state?
fluid
decrease filtration rate
vitamin E
midodrine
What are benefits of CRRT over intermittent hemodialysis?
Less risk of fluid overload
Less hypotension
Removes solutes with lower MWs
More fluid and therapeutic drug dosing allowed
What are disadvantages of CRRT over intermittent hemodialysis?
risk of bleeding
limited mobility
removes solutes with higher MWs
anticoagulation
What is the most common complication of peritoneal dialysis?
peritonitis
hernia
back pain
decreased appetite
What is the preferred method of hemodialysis access?
Arteriovenous fistula
Catheter
Arteriovenous graft
Stage 1 CKD ≥ (a) mL/min (enter numbers only)
Stage 2 CKD (a) mL/min (enter number range only)
Stage 3 CKD (a) mL/min (enter number range only)
Stage 4 CKD (a) mL/min (enter number range only)
Stage 5 CKD < (a) mL/min (enter numbers only)
T/F Patients with normal renal function may still have CKD if there is evidence of structural damage to the kidney.
True
False
What is first line medication treatment for diabetic CKD when GF is >30 ?
Metformin
SGLT2i
GLP-1
DPP-4i
What is first line treatment of HTN in CKD?
ACEI
ARB
Diuretic
CCB
T/F Patients should start with high dose of and ACEI/ARB and decrease at 4-week intervals to control proteinuria.
True
False
T/F KDIGO guidelines provide recommendations for hypertension for CKD patients not on HD
True
False
How would you adjust ESA dosing for a patient whose Hgb increases less than 1g/dL over 4 weeks?
Increase ESA dose by 25%
Decrease ESA dose by 25%
No adjustment
Discontinue ESA
How would you adjust ESA dosing for a patient whose Hgb increases more than 1/dL over 2 weeks?
Increase ESA dose by 25%
Decrease ESA dose by 25%
No adjustment
Discontinue ESA
What is the most common adverse event reported for ESA therapy?
Headache
Nausea
Vomiting
Hypertension
__________ decreases reabsorption of phosphate in the kidney and increases intestinal absorption of calcium and phosphate
Aluminum
Vitamin D
Ferrous sulfate
Magnesium
Which oral calcium product is preferred for correcting calcium and phosphorous?
Calcium carbonate
Calcium citrate
Calcium acetate
Calcium chloride
What is the K/DOQI recommendation for total dose of elemental calcium?
Not to exceed 1500mg/day
Not to exceed 5000mg/week
Not to exceed 2500mg/day
Not to exceed 1000mg/day
Which of the following is a non-elemental phosphate binder?
Lanthanum
Sevelamer
Magnesium
Aluminum
Iron may chelate to medication and _________ absorption.
increase
decrease
Which of the following is associated with a decrease in mortality for HD patients?
Vit D therapy
Phosphate-binding therapy
Calcium Supplementation
Restricted protein intake
T/F Starting dialysis earlier improved survival according to the IDEAL study.
False
True
T/F Prevention of thrombosis during HD with antiplatelets/anticoagulants is NOT recommended.
True
False
T/F UFH and Citrate solution are used for anticoagulation during CRRT
True
False
