Both ACEIs and ARBs are the drugs of choice to prevent progression of proteinuric
CKD
An increase of 20 to 30% of the creatinine level is acceptable
Just make sure to confirm the creatinine stabilizes and does not continue to increase
Also a serum potassium of 5.5 mEq/L is acceptable as long as it is stable and as long
as the patient is aware of dietary restrictions
Serum creatinine and potassium levels should be ordered within one week of increase
in dose of ACEI or ARB
If a patient has an increase in creatinine from 1.5 to 1.9 (<30% increase) CONTINUE
THE ACEI
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If the same patient has an increase in creatinine from 1.5 to 2.2 (>30% increase) STOP
THE ACEI
Pearl # 6: Anemia in Patients with CKD Should be Treated, but not Overtreated
Anemia of Chronic Disease can lead to fatigue, left ventricular hypertrophy, and
increased risk of cardiovascular events
Hemoglobin target for CKD should be between 11 – 12 g/dL NOT to exceed 13g/dL
Overcorrection of hemoglobin can result in higher risk of stroke, thrombosis, and
hypertension
Correct all other reversible causes of anemia
Pearl # 7: Phosphate-Containing Bowel Preps Should be Used With Caution
Sodium phosphate bowel preparations are more convenient than some other preps
(Easier to use)
However, some studies have suggested that they can cause phosphate nephropathy
leading to AKI or worsening CKD
Instead use polyethylene glycol for the bowel prep (only downside is the volume that
has to be consumed; Does not cause volume or electrolyte shifts)
Pearl # 8: Patients With Severe CKD Should Avoid Magnesium- or Aluminum-