Primary Care

Chronic kidney disease

Questions discussed in this category

Do you recommend genetic testing for patients with a family history of polycystic kidney disease and who meet the imaging criteria, but the specific genetic variant in the family is unknown?

1 Answer available

How do you counsel patients with CKD who are on a PPI given a prior observational study showing an association between PPI use and incident CKD?

Lazarus et al., PMID 26752337

3 Answers available

Do you offer home administration of ESAs for your patients with anemia of chronic kidney disease?

3 Answers available

How long do you monitor proteinuria after starting an SGLT-2 inhibitor before considering adding another medication if proteinuria is not at goal?

2 Answers available

Do you recommend using a risk equation or eGFR alone in deciding when to refer a patient with advanced CKD for vascular access placement?

4 Answers available

How do you approach the management of ADPKD in pregnancy, considering the need to stop tolvaptan therapy?

1 Answer available

Do you recommend holding metformin in a patient with chronic kidney disease who has an upcoming CT contrast study?

4 Answers available

Are recurrent UTIs a contraindication to SGLT2i use?

4 Answers available

Would you stop denosumab in a patient with chronic kidney disease if they develop asymptomatic hypocalcemia after the injection?

4 Answers available

Would you recommend oral or intravenous iron in a chronic kidney disease stage 4 patient who is not on an ESA and has a hemoglobin of 12.7 g/dl and an iron saturation of less than 20%?

3 Answers available

Would you consider restarting a SGLT2i at a reduced dose in a patient who you previously discontinued the medication because of an associated significant decline in eGFR?

1 Answer available

How do you approach managing patients with diabetic kidney disease and proteinuria who develop hypoglycemia after initiation of a SGLT2 inhibitor?

1 Answer available

What is your approach to managing hyperkalemia in pregnant patients with chronic kidney disease?

1 Answer available

When would you repeat a kidney ultrasound with post void residual measurement for a patient with chronic kidney disease from bladder outlet obstruction who is started on tamsulosin?

1 Answer available

Would you avoid SGLT2 inhibitors in patients with nephrostomy tubes?

1 Answer available

Would you avoid SGLT2 inhibitors in patients with urinary incontinence requiring incontinence briefs due to concern with genitourinary hygiene and risk for infections?

4 Answers available

At what serum bicarbonate level do you initiate alkali therapy for patients with chronic kidney disease?

3 Answers available

Do you recommend patients with chronic kidney disease avoid supplements containing creatine?

1 Answer available

What are your criteria for starting tolvaptan in adult patients diagnosed with autosomal dominant polycystic kidney disease?

1 Answer available

Is your decision to prescribe empagliflozin for CKD patients without albuminuria influenced by a recent cost-utility analysis showing that empagliflozin was not cost-effective for this group?

Odawara et al., Clinical Journal of the American Society of Nephrology 2024

2 Answers available

Do you recommend SGLT2i use for patients with chronic kidney disease, diabetes mellitus, and polycystic kidney disease?

See dapagliflozin drug insert form which states Farxiga is not recommended for patients with PKD.

3 Answers available

Do you recommend uric acid lowering therapies for asymptomatic hyperuricemia in chronic kidney disease?

1 Answer available

What is your approach to patients with advanced chronic kidney disease who are taking aluminum containing medications?

Aluminum hydroxide/magnesium hydroxide (i.e. Maalox).

2 Answers available

Would you start an SGLT2 inhibitor in patients with diabetic kidney disease who also have a history of prior toe amputation?

3 Answers available

Do you recommend using vitamin D analogs for patients with CKD and a high PTH but a normal 25-hydroxy vitamin D level?

3 Answers available

What is your approach to genetic counseling prior to obtaining genetic testing in young asymptomatic patients suspected of having autosomal dominant polycystic kidney disease?

1 Answer available

If a patient who has tolerated allopurinol for a prolonged period of time is subsequently found to be positive for the HLA-B*58:01 gene, how would you manage urate-lowering therapy thereafter?

1 Answer available

Do you prefer allopurinol or febuxostat for patients with chronic kidney disease who are receiving treatment for asymptomatic hyperuricemia?

4 Answers available

Do you recommend a ketogenic diet for patients with autosomal dominant polycystic kidney disease?

1 Answer available

What approaches do you take to prevent worsening kidney function for patients with chronic kidney disease who have an upcoming outpatient CT scan with iodinated contrast?

5 Answers available

Would you recommend starting an SGLT2 inhibitor in a proteinuric CKD patient with chronic asymptomatic bacteriuria?

2 Answers available

Given the cardioprotective and renoprotective effects of SGLT2 inhibitors, should we consider administering to patients with well controlled type 1 diabetes despite the risk of DKA?

3 Answers available

Do you recommend stopping a SGLT2i indefinitely if a patient with chronic kidney disease and diabetes develops euglycemic diabetic ketoacidosis?

1 Answer available

What is your approach to lab and imaging monitoring in a patient with an elevated creatinine following a unilateral nephrectomy?

3 Answers available

Do you recommend dietary protein restriction in your patients with chronic kidney disease?

1 Answer available

Do you prefer sodium bicarbonate or sodium citrate in your chronic kidney disease patients with metabolic acidosis?

1 Answer available

Would you consider adding an SGLT2i for a patient with proteinuric kidney disease who is already on maximal dose ACEi/ARB and has a UACR < 300 mg/g?

3 Answers available

Are you offering GLP-1 agonists to patients with CKD and diabetes mellitus?

4 Answers available

Is the phosphorus-lowering benefit of patiromer compelling enough to switch a patient with chronic hyperkalemia and hyperphosphatemia from sodium zirconium cyclosilicate to patiromer?

2 Answers available

Do you recommend decreasing the loop diuretic dose when starting an SGLT2 inhibitor in a CKD patient given its natriuretic and osmotic diuretic effects?

2 Answers available

Do you prefer celecoxib over a nonselective NSAID in patients with chronic kidney disease?

4 Answers available

In which patients with non-proteinuric chronic kidney disease would you initiate a SGLT2i?

3 Answers available

Do you pursue any additional testing in your patients with chronic kidney disease who are found to have "small hypodensities too small to characterize" on renal ultrasound?

2 Answers available

Do you restrict topical diclofenac use in your patients with chronic kidney disease?

3 Answers available

How do you choose between the different vitamin D analogs for patients with CKD, an elevated PTH, and a normal 25-hydroxy vitamin D level?

4 Answers available

Would you consider using finerenone for proteinuric CKD associated with type 1 diabetes mellitus?

3 Answers available

Do you add a separate dose of losartan for patients with heart disease and proteinuric kidney disease who are on maximal doses of sacubitril/valsartan but continue to experience proteinuria?

6 Answers available

How often do you screen for cerebral aneurysms in patients with autosomal dominant polycystic kidney disease who do not have a family history of intracranial aneurysms or for whom the family history is unknown?

1 Answer available

Do you recommend starting SGLT2 inhibitors for patients with a normal creatinine but who have microalbuminuria and are unable to tolerate ACEi or ARBs?

1 Answer available

Do you obtain periodic kidney ultrasounds in patients with stable chronic kidney disease to evaluate for changes in kidney size that might reflect progression of kidney disease not detected with serum studies?

2 Answers available

Would you recommend switching a diabetic CKD patient on oral semaglutide to the subcutaneous form since the benefits in CKD have primarily been reported in studies using subcutaneous GLP-1 receptor agonists?

1 Answer available

How early do you involve palliative care in the management of a CKD Stage 5 patient who does not wish to pursue renal replacement therapy?

1 Answer available

Which medications do you recommend for lactating mothers with kidney disease and proteinuria that persists post-delivery?

1 Answer available

What are some measures to prevent flares of loin pain-hematuria syndrome?

1 Answer available

How do you manage proteinuria in a patient with type 1 diabetes mellitus who has orthostatic hypotension and is unable to tolerate ACEi/ARBs?

3 Answers available

Is reduction in proteinuria with SGLT2i dose dependent?

2 Answers available

What is the minimum eGFR at which we should avoid initiating SGLT2i therapy?

1 Answer available

What criteria do you use, if any, to recommend statin therapy for patients with polycystic kidney disease?

1 Answer available

How do you approach urate-lowering therapy in patients with advanced chronic kidney disease?

What doses of allopurinol do you use, and how frequently do you titrate the dose?

1 Answer available

How much decrease in eGFR do you tolerate before discontinuing finerenone started in patients with diabetic kidney disease?

2 Answers available

How much decrease in eGFR do you tolerate before discontinuing a SGLT2i started in patients with diabetic kidney disease?

1 Answer available

Do you use alkali therapy in those with stable chronic kidney disease and a normal serum bicarbonate level who have a low urine pH?

1 Answer available

Would you recommend AV fistula placement in a CKD Stage 5 patient who is over the age of 80?

2 Answers available

Below what eGFR would you consider discontinuing lithium in a bipolar disorder patient with chronic kidney disease?

1 Answer available

Do you recommend initiating an ACE inhibitor or ARB in a patient with proteinuric CKD Stage 5?

1 Answer available

In which patients with chronic kidney disease and low 25-OH vitamin D levels do you prefer weekly ergocalciferol to daily cholecalciferol supplementation?

1 Answer available

How do you approach treatment of osteoporosis in patients with CKD who develop a fragility fracture while on denosumab?

1 Answer available

How do you approach prophylaxis against glucocorticoid-induced osteoporosis in patients with end-stage renal disease on dialysis?

1 Answer available

Papers discussed in this category

The New England journal of medicine, 2019-06-13

Canagliflozin and Renal Outcomes in Type 2 Diabetes and Nephropathy.

Clin J Am Soc Nephrol, 2021 Apr 20

Clinical Implications of an Acute Dip in eGFR after SGLT2 Inhibitor Initiation.

FASEB J, 2023 Apr

Acute kidney injury in diabetes mellitus: Epidemiology, diagnostic, and therapeutic concepts.

Kidney Int Rep, 2022 May 05

Prescribing SGLT2 Inhibitors in Patients With CKD: Expanding Indications and Practical Considerations.

N Engl J Med, 2020 Oct 23

Effect of Finerenone on Chronic Kidney Disease Outcomes in Type 2 Diabetes.

Circulation, 2020 Aug 29

Renal and Cardiovascular Effects of SGLT2 Inhibition in Combination With Loop Diuretics in Patients With Type 2 Diabetes and Chronic Heart Failure: The RECEDE-CHF Trial.

Kidney360, 2021 Feb 01

Real-Life Prescribing of SGLT2 Inhibitors: How to Handle the Other Medications, Including Glucose-Lowering Drugs and Diuretics.

Ann Intern Med, 2019 Jul 30

Sodium-Glucose Cotransporter-2 Inhibitors and the Risk for Severe Urinary Tract Infections: A Population-Based Cohort Study.

Kidney Int, 2019 Jan

Hemodialysis vascular access in the elderly-getting it right.

Gastroenterology, 2019-09

Safety of Proton Pump Inhibitors Based on a Large, Multi-Year, Randomized Trial of Patients Receiving Rivaroxaban or Aspirin.

Kidney360, 2022 Jan 04

Do Proton-Pump Inhibitors Cause CKD and Progression of CKD?: COMMENTARY.

Diabetes Metab, 2021 Dec 13

Acute renal injury events in diabetic patients treated with SGLT2 inhibitors: A comprehensive review with a special reference to RAAS blockers.

The New England journal of medicine, 2013 Jul 10

Case records of the Massachusetts General Hospital. Case 23-2013. A 54-year-old woman with abdominal pain, vomiting, and confusion.

Clin J Am Soc Nephrol, 2021 Feb 18

Patients with Protein-Truncating Mutations and Mild ADPKD.

Hypertension (Dallas, Tex. : 1979), 2020 Jan 27

Orthostatic Hypotension, Cardiovascular Outcomes, and Adverse Events: Results From SPRINT.

Circulation, 2021 Dec 14

Effect of the Glucagon-Like Peptide-1 Receptor Agonists Semaglutide and Liraglutide on Kidney Outcomes in Patients With Type 2 Diabetes: Pooled Analysis of SUSTAIN 6 and LEADER.

JAMA neurology, 2022 Apr 01

Association of Intensive vs Standard Blood Pressure Control With Cerebral Blood Flow: Secondary Analysis of the SPRINT MIND Randomized Clinical Trial.

Biomedicine & pharmacotherapy = Biomedecine & pharmacotherapie, 2022 Oct 31

Empagliflozin reduces kidney fibrosis and improves kidney function by alternative macrophage activation in rats with 5/6-nephrectomy.

Kidney international, 2022 Nov

Executive summary of the KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease: an update based on rapidly emerging new evidence.

Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, 2023 Jan 18

The rationale, design and baseline data of FLOW, a kidney outcomes trial with once-weekly semaglutide in people with type 2 diabetes and chronic kidney disease.

Cardiovascular diabetology, 2024 Feb 08

Cardiorenal effectiveness of empagliflozin vs. glucagon-like peptide-1 receptor agonists: final-year results from the EMPRISE study.

The New England journal of medicine, 2024 May 24

Effects of Semaglutide on Chronic Kidney Disease in Patients with Type 2 Diabetes.

The New England journal of medicine, 2022 Nov 04

Empagliflozin in Patients with Chronic Kidney Disease.

Kidney360, 2023 Nov 22

All Patients with ADPKD Should Undergo Screening for Intracranial Aneurysms: PRO.

Diabetes, obesity & metabolism, 2024 Apr 28

Real-world effectiveness of sodium-glucose cotransporter-2 inhibitors on the progression of chronic kidney disease in patients without diabetes, with and without albuminuria.

The New England journal of medicine, 2018-03-29

Cardiovascular Safety of Febuxostat or Allopurinol in Patients with Gout.

Lancet, 2020 Nov 09

Long-term cardiovascular safety of febuxostat compared with allopurinol in patients with gout (FAST): a multicentre, prospective, randomised, open-label, non-inferiority trial.

Arthritis care & research, 2012-10

2012 American College of Rheumatology guidelines for management of gout. Part 1: systematic nonpharmacologic and pharmacologic therapeutic approaches to hyperuricemia.

Proceedings of the National Academy of Sciences of the United States of America, 2005 Mar 02

HLA-B*5801 allele as a genetic marker for severe cutaneous adverse reactions caused by allopurinol.

Journal of the American Society of Nephrology : JASN, 1994-11

Pregnancy outcome and its relationship to progression of renal failure in autosomal dominant polycystic kidney disease.

International journal of women's health, 2020 May 25

Management of Autosomal Dominant Polycystic Kidney Disease (ADPKD) During Pregnancy: Risks and Challenges.

Advances in kidney disease and health, 2023 Sep

Pregnancy in Autosomal Dominant Polycystic Kidney Disease.

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