Chronic kidney disease and

In patients with chronic kidney disease and hypertension, ACE inhibitors and ARBs are preferred, usually in combination with a diuretic.67 ACE inhibitors in combination with a thiazide diuretic are also preferred in patients with a history of... 

Hydralazine may cause a dose-related, reversible lupus-like syndrome, which is more common in slow acetylators. Lupus-like reactions can usually be avoided by using total daily doses of less than 200 mg. Other hydralazine side effects include dermatitis, drug fever, peripheral neuropathy, hepatitis, and vascular headaches. For these reasons, hydralazine has limited usefulness in the treatment of hypertension. However, it may be useful in patients with severe chronic kidney disease and in kidney failure. 

TABLE 76-4 Dosing Recommendations for Vitamin D in Patients with Stage 5 Chronic Kidney Disease and Those on Hemodialysis0 ... 

Driieke TB, Locatelli F, Clyne N, Eckardt KU, Mac-dougall IC, Tsakiris D et al. Normalization of hemoglobin level in patients with chronic kidney disease and anemia. N Engl J Med 2006 355(20) 2071-84. 

Sevelamer For control of serum phosphorus in patients with chronic kidney disease and hemodialysis... 

Sica DA, Gehr TWB Diuretic use in stage 5 chronic kidney disease and end-stage renal disease. Curr Opin Nephrol Hypertens 2003 12 483. [PMID 12920394]... 

Cinacalcet is the first representative of a new class of drugs that activates the calcium sensing receptor (CaR). CaR is widely distributed but has its greatest concentration in the parathyroid gland. Cinacalcet blocks PTH secretion by this mechanism and is approved for the treatment of secondary hyperparathyroidism in chronic kidney disease and for the treatment of parathyroid carcinoma. 

The main features of hypocalcemia are neuromuscular—tetany, paresthesias, laryngospasm, muscle cramps, and convulsions. The major causes of hypocalcemia in the adult are hypoparathyroidism, vitamin D deficiency, chronic kidney disease, and malabsorption. Neonatal hypocalcemia is a common disorder that usually resolves without therapy. The roles of PTH, vitamin D, and calcitonin in the neonatal syndrome are under active investigation. Large infusions of citrated blood can produce hypocalcemia by the formation of citrate-calcium complexes. Calcium and vitamin D (or its metabolites) form the mainstay of treatment of hypocalcemia. 

Preventing CIN is of particular importance in patients with diabetes and chronic kidney disease, as these are two of the most powerful independent risk factors for CIN (77), Diabetics are more susceptible to (CIN) than are the nondiabetics, and diabetics with pre-existing chronic kidney disease (CKD) are at even greater risk (78). In a recently proposed CIN risk-scoring system, patient characteristics such as diabetes, age >75, chronic congestive heart failure, admission with acute pulmonary edema, hypotension, anemia and chronic kidney disease and various procedure-related characteristics including increasing volumes of contrast media, and intra-aortic balloon pump use were all found to reliably contribute to increased risk (79). 

One-year survival after percutaneous coronary intervention in patients with or without chronic kidney disease and with or without contrast-induced nephropathy. Source From Ref, 7,... 

Dangas G, lakovou I, Nikolsky E, et al. Contrast-induced nephropathy after percutaneous coronary interventions in relation to chronic kidney disease and hemodynamic variables. Am J Cardiol 2005 95 13-19. 

ACE-inhibitors may be considered as first-choice therapy in patients with all forms of primary hypertension, but they are preferred in hypertension associated with heart failure, reduced systolic left ventricular ejection fraction or diabetic nephropathy, previous MI or stroke, chronic kidney disease and patients with high coronary disease risk, based on the compelling evidence of the efficacy of these drugs in such patient populations [8]. 

Kluwe, W. M., Abdo, K. M., and Huff, 1. 1984. Chronic kidney disease and organic chemical exposures Evaluations of causal relationships in humans and experimental animals. Fundamental Applications in Toxicology A 889-901. 

U.S. Renal Data System, USRDS 2007 Annual Data Report Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2007. 

Dangas,G., lakovou, ., Nikolsky,E., Aymong,E.D., Mintz,G.S., Kipshidze,N.N., Lansky,A.J., Moussa, ., Stone,G.W., Moses,J.W., Leon,M. B., and Mehran,R. (2005) Contrast-induced nephropathy after percutaneous coronary interventions in relation to chronic kidney disease and hemodynamic variables. Am J Cardiol., 95 13-19. 

Chronic kidney disease and end-stage renal disease... 

Bostom AG, Kronenberg F, Ritz E. Predictive performance of renal function equations for patients with chronic kidney disease and normal serum creatinine levels. J Am Soc Nephrol 2002 13 2140-4. 

Patients with hypertension may develop damage to either the renal tissue (parenchyma) or the renal arteries. Chronic kidney disease presents initially as microalbuminuria (30-299 mg albumin in a 24-hour urine collection) that can progress to macroalbuminuria and overt kidney failure. The rate of kidney function deterioration is accelerated when both hypertension and diabetes are present. Once patients have an estimated glomerular filtration rate (GFR) of less than 60 mL/m per minute or macroalbuminuria, they have chronic kidney disease, and the risk of cardiovascular disease and progression to severe chronic kidney disease increases. Strict BP control to a goal of less than 130/80 mm Hg can slow the decline in kidney function. This strict control often requires two or more antihypertensive agents. 

Starting therapy with a combination of two drugs is now recommended in patients far from their BP goal, for patients in whom goal achievement may be difficult (i.e., those with diabetes or chronic kidney disease and African-Americans), or in patients with multiple compelling indications for different antihypertensive agents. However, combination therapy is often needed to control BP in patients already on therapy, and most patients reqnire two or more agents. ° °... 

Newer markers that identify patients at high risk of mortality or reinfarction that are under development but have not been incorporated currently into routine patient care include C-reactive protein, a maker of vascular inflammation elevated serum creatinine or reduced creatinine clearance, identifying patients with chronic kidney disease and brain (B-type) natriuretic peptide (BNP), which is released predominately from ventricular myocytes in response to cell stretch as the infarct remodels. Dialysis patients have a 1-year mortality rate of more than 40% following a first MI. ... 

Guidelines by the National Kidney Foundation-Kidney Disease Outcomes Quality Initiative (NKF-K/DOQI) should be used as a basis for the work-up of chronic kidney disease and the design of appropriate therapy for associated complications. 

Pereira BJ. Overcoming barriers to the early detection and treatment of chronic kidney disease and improving outcomes for end-stage renal disease. Am J Manag Care 2002 8(4 Suppl) S122-S135. 

Collins AJ, et al. Chronic kidney disease and cardiovascular disease in the Medicare population. Kidney Int Suppl 2003 87 S24—S31. 

Brophy DF, Ripley EB, Holdford DA. Pharmacoeconomic considerations in the health system management of anaemia in patients with chronic kidney disease and end stage renal disease. Expert Opin Phar-macother 2003 4 1461-1469. 

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