Fast Five Quiz: Is Your Knowledge of Chronic Kidney Disease Sufficient?

Vecihi Batuman, MD; Patrick Rossignol, MD


July 21, 2022

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.


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