CKD Management - BC Renal Province-wide Rounds (June 2020)

Aiza Waheed, a PGY6 Nephrologist at UBC, talks about chronic kidney disease (CKD) progression and management.
0:01:10 - Defining CKD
She begins by defining CKD, including GFR measurements. She emphasizes the importance of identifying the cause of CKD, because that has implications in the disease management.
0:05:55 - Staging and Risk Stratification
While Waheed notes that the factors for staging and risk categorization include the cause of CKD, GFR category, and degree of albuminuria, many other factors contribute to disease progression as well. She talks about proteinuria, and the kidney risk failure equation (which accounts for age, sex, GFR and Albumin-to-creatinine ratio).
0:12:26 - Pathophysiology and Natural History of CKD
Dr. Waheed talks about the variable outcomes for CKD. She notes that many outcomes of CKD involve hyperfiltration, which causes long-term damage to the kidneys. Patients with CKD are also at risk of acute kidney injury (AKI), which Dr. Waheed says can be monitored via GFR baselines. During AkI, she emphasizes the importance of withholding medications that have a hemodynamic effect and can cause further damage. Avoid initiating or increasing doses of ACEi or ARBs during this time.
0:17:20 - Management of CKD
She provides an overview of the key goals in CKD management, which largely focus on slowing disease progression. Examples to support this management include blood pressure control, ACEi and ARBs, and management of other medical conditions, such as diabetes. She notes that SGLT2 inhibitors are increasingly being used to treat both diabetes and CKD.
0:26:26 - Managing Complications of CKD
She discusses ways of managing complications of CKD, including hyperkalemia, metabolic acidosis, vitamin deficits, mineral bone deficits, anemia, cardiovascular disease, volume overload, hyperuricemia, and gout.
0:38:21 - Nephrotoxic Medications
She provides an overview of nephrotoxic medications, including NSAIDS.
0:41:39 - Summary and Q&A
Dr. Waheed provides a summary of her talk and takes questions from the audience.
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