Primary Care Strategies for Kidney Disease: Phases of Care

Saturday, November 21, 2015

Wilf Family Center University of Minnesota Masonic Children's Hospital
Minneapolis, MN

Section Questions Answers

Guide to CKD 1. Modifiable risk factors for CKD include: E. All of the above
Screening and a. Diabetes
Evaluation -Alec b. Hypertension Rationale: Diabetes, hypertension,
Otteman, MD c. History of AKI history of AKI, and frequent NSAID
d. Frequent NSAID use use can all damage the kidneys and
e. All of the above are risk factors for CKD

2. NKF recommends the following calculator be used to A.. All of the above
estimate GFR for CKD staging:
a. CKD-EPI Rationale: CKD-EPI is less biased
than MDRD particularly at high
b. MDRD
GFRs and performs equally, or
c. Cockroft-Gault
d. All of the above better compared to the MDRD
equation in various age groups and
all BMI groups (except those with a
BMI <20) and is calibrated for the
IDMS standardized creatinine
available from all labs

Delaying 1. Target blood pressure in non-dialysis CKD with a albumin- B. 140/90mmHg

Progression - to-creatinine ratio of <30mg/g should be:
Paul Drawz, MD, Rationale: Comparison of Guideline
a. 120/80mmHg
MHS, MS Recommendations for CKD Blood
b. 140/90mmHg
Pressure Targets among reliable
c. 150/90mmHg
sources, including JAMA2014 and
d. 130/80mmHg
KDIGO2012, contain similar
recommendations as less than
140/90 mm Hg in CKD

2. A 55 year-old Caucasian-American man, with a history of E. A and C

type 2 diabetes (15 years), hypertension (3 years)
dyslipidemia (5 years) and cardiovascular disease Rationale: ACE and ARBs used in
combination have been shown to
(myocardial infarction 3 years ago). He was recently
increase adverse events,
diagnosed with CKD. His most recent labs reveal an eGFR
of 45 ml/min/1.73m2 and an ACR of 38 mg/g. Which of the particularly impaired kidney
function and hyperkalemia. NSAIDs
following should be avoided?



Primary Care Strategies for Kidney Disease: Phases of Care

Saturday, November 21, 2015
Wilf Family Center University of Minnesota Masonic Children's Hospital
Minneapolis, MN

a. ACE and ARB in combination have been shown to cause kidney

b. Daily low-dose aspirin damage and increase CKD
c. NSAIDs progression. Statins are indicated
d. Statins based on KDIGO guidelines and a
e. A and C daily low-dose aspirin is not
contraindicated in CKD.

A Primary Care 1. Vitamin D3 is the preferred vitamin D form to achieve True

Approach to normal serum vitamin D levels
Rationale: Vitamin D3 is less
Managing CKD a. True
Complications- b. False expensive and better absorbed
than Vitamin D2
Sandra Taler,
MD 2. Which CKD Stage to most of the complications of Kidney C. Stage 3
Failure start?
Rationale: Stage A is not part of
a. Stage A
CKD staging.
b. Stage 1
c. Stage 3
d. Stage 5
Kidney Disease Which of the following is NOT a reason for diuretic resistance A. Low salt diet
and Heart in patients with AHF and CKD:
Failure: Where Rationale: Low salt diet will
Medication a. Low salt diet improve efficacy of diuretic
Efficacy and
Safety Collide - b. High urinary protein
Wendy St. Peter,
PharmD, FCCP, c. Patient non-adherence
BCPS
d. Braking phenomenon: distal tubule cells hypertrophy over
time and become sodium avid.

When may NSAIDs be appropriate in patients with AHF and B. Never

CKD?
Rationale: NSAIDS are always to be
a. Anytime avoided due to potential risks of
sodium retention, fluid overload,
b. Never
acute kidney injury, and
hyperkalemia.

Primary Care Strategies for Kidney Disease: Phases of Care

Saturday, November 21, 2015
Wilf Family Center University of Minnesota Masonic Children's Hospital
Minneapolis, MN

c. If the patient rates pain greater than 6 on a scale of 1-10.

d. The patient has some at home.

Renal 1. Renal replacement therapy should be considered if the D. All of the above
Replacement patient is experiencing:
Rationale: Dialysis can help
Therapy: a. Hyperkalemia
regulate potassium, acid/base
Options and b. Metabolic acidosis
Choices -Marc c. Fluid overload balance and fluid. When the
kidneys can no longer balance,
Weber, MD d. All of the above
renal replacement therapy should
be considered

2. Types of Hemodialysis access include: D. All of the above

a. Fistula
b. Graft Rationale: Fistulas, grafts, and
c. Catheter catheters are all established types
d. All of the above of hemodialysis access.
The Patient What did Matt (our patient representative) offer as some D. All of the above
Provider suggestions to health care professionals providing care to
Intersection: A patients with chronic kidney disease? Rationale: There are ways
CKD Story -Matt healthcare professionals can
Rongstad- a. Individualize care to patients along the spectrum of approach patients with CKD to
Patient and Sara very engaged to overwhelmed. engage them as much as possible
Ruiz, Renal RD
and optimize patient-related
b. Be proactive in helping patients weigh risks and outcomes.
benefits of treatment options

c. Provide education for prevention strategies of dialysis

and CKD progression

d. All of the above

Which of the following statements accurately describes Matt’s B. He needed to use multiple
experience with the healthcare system: pharmacies.

a. Insurance questions were easy to figure out. Rationale: The healthcare system,
including pharmacy providers, is

Primary Care Strategies for Kidney Disease: Phases of Care

Saturday, November 21, 2015
Wilf Family Center University of Minnesota Masonic Children's Hospital
Minneapolis, MN

b. He needed to use multiple pharmacies. tough to navigate for patients.

Health care professionals need to
c. It was clear to him which doctors were managing which consider challenges and complexity
conditions and who to go to for questions.
of the system itself as care is
d. His healthcare systems communicated well between provided.
each other.

The Dialysis Benefits of preserving residual kidney function in dialysis S. All of the above
Unit: Behind patients include:
Closed Doors - Rationale: residual kidney function
Andrew a. Less dietary restriction contributes to removal of potential
Kummer, MD uremic toxins, helps regulate fluid
MPH b. Better quality of life and electrolyte imbalance, and may
c. Better survival enhance nutritional status and
QOL.
d. All of the above

It is not necessary to avoid nephrotoxins, such as NSAIDs, if B. False

patient is on dialysis and has residual kidney function.
As indicated above, residual kidney
a. T should be maintained if possible,
thus the importance of avoiding
b. F
nephrotoxins as part of this
strategy.

Kidney 1. Which of the following Is not absolute contraindications to D. GFR <20mL/min

Transplantation renal transplant?
-John Silkensen, Rationale: GFR of <20mL/min is
a. Active substance abuse
MD when patients should be referred
b. Active malignancy
for a consultation about renal
c. Life expectancy less than 2 years
transplant. All other answer
d. GFR <20mL/min
choices are contraindications to
transplant

2. A patient with progressive CKD is considering a kidney D. All of the above

transplant. Which one of the following statements is
Rationale: All of the statements are
correct?

Primary Care Strategies for Kidney Disease: Phases of Care

Saturday, November 21, 2015
Wilf Family Center University of Minnesota Masonic Children's Hospital
Minneapolis, MN

a. CKD patients can be referred to a transplant center correct regarding transplant

when their GFR is < 20 mL/min/1.73m2
b. Pre-emptive and live kidney transplants are
associated with better graft survival
c. Most common cause of kidney transplant loss is
death with a functional transplant
d. All of the above
Through the 1. When should a patient be referred to Nephrology? D. All of the above
Lens of a a. eGFR 60 or below
Primary Care b. Presence of proteinuria/ microalbuminuria or Rationale: According to KDIGO
Professional - microscopic hematuria irrespective of the eGFR 2012, patients should be referred
David c. Strong family history to Nephrology when eGFR is at or
Macomber, MD, d. All of the above below 60, there is a presence of
PhD proteinuria/ microalbuminuria or
microscopic hematuria irrespective
of the eGFR, or if the patient has a
strong family history.

2. The most important nutrition goal/s for patients with CKD D. All of the above
include:
a. Limit Na, decrease HTN Rationale: There are several
b. Reduce Protein important nutrition goals for
c. Glycemic Control/Weight patients with CKD, including
d. All of the above limiting Sodium, decreasing
hypertension (if elevated), reduce
protein intake, and maintaining a
proper weight.