Encephalopathy, peripheral neuropathy, and pericarditis are all indications for renal replacement therapy in patients with CKD. Other indications for renal replacement therapy in patients with CKD include:
Severe metabolic acidosis
Intractable severe hyperkalemia
Intractable volume overload
Failure to thrive and malnutrition
Intractable gastrointestinal symptoms
In asymptomatic adult patients, a GFR of 5-9 mL/min/1.73 m², irrespective of the cause of the CKD or the presence of absence of other comorbidities
Treatment of abnormal mineral homeostasis in patients with CKD includes:
Maintaining serum calcium levels
Lowering serum parathyroid hormone levels
Providing osteoporosis prophylaxis
Lowering high serum phosphorus levels
Definitive evidence on the benefit of lowering phosphate levels in CKD is lacking, and guideline recommendations vary. The 2017 KDIGO Implementation Task Force guidelines recommend maintaining serum phosphate levels within the normal range in CKD stages III-V and lowering levels toward normal in stage VD. 2013 United Kingdom National Institute for Health and Clinical Excellence guidelines provide recommendations only for stages IV, V, and VD.
The evidence for the benefits and risks of correcting metabolic acidosis is limited. According to Navaneethan and colleagues, low to moderate certainty evidence suggest that oral alkali supplementation or a reduction in dietary acid intake may slow the rate of kidney function decline and potentially reduce the risk for end-stage kidney disease in patients with CKD and metabolic acidosis.
The Italian Society of Nephrology recommends statin therapy or a statin plus ezetimibe for all patients with CKD ≥ 50 years of age with an estimated GFR of < 60 mL/min/1.73 m2 who are not being treated with long-term dialysis or kidney transplantation. Other recommendations include:
Treatment with statins or statin/ezetimibe should not be initiated in adults with dialysis-dependent CKD
Patients already being treated with a statin at the time of dialysis should continue statin therapy
Adult kidney transplant patients should be treated with a statin because of an increased risk for coronary events
Adults 18-49 years of age with an estimated GFR of < 60 mL/min/1.73 m2 who are not being treated with dialysis or kidney transplantation should be treated with statins if they have coronary disease, diabetes, prior ischemic stroke, or an estimated 10-year incidence of coronary death or nonfatal myocardial infarction > 10%
Learn more about treating CKD.
Medscape © 2022 WebMD, LLC
Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.
Cite this: Vecihi Batuman, Patrick Rossignol. Fast Five Quiz: Is Your Knowledge of Chronic Kidney Disease Sufficient? - Medscape - Jul 21, 2022.