CKD survey - Challenge: Thomas Part 2

Q.1

A number of secondary complications are associated with CKD, which of the following has the greatest impact on mortality?

CVD
Gout
Hyperkalaemia
Metabolic acidosis
Secondary hyperparathyroidism

CVD. In terms of overall mortality, CVD is the most notable secondary complication of CKD¹⁷

Q.2

If Thomas developed T2D, what treatment would be recommended by 2020 KDIGO guidelines to be co-administered with the SGLT2i he is currently receiving?

Alogliptin
Empagliflozin
Lixisenatide
Metformin

Metformin. The addition of metformin to a SGLT2 inhibitor is recommended in most patients with an eGFR of ≥30 mL/min/1.73 m², diabetes, and CKD⁵

Q.3

If Thomas’ CKD progresses to ESRD, what complications would be associated with a late referral to a specialist?

Worse health status at the initiation of kidney replacement therapy
Higher mortality after starting dialysis
Reduced access to transplant
All of the above

All of the above. Late referral is associated with a worse health status at the initiation of kidney replacement therapy, higher mortality after starting dialysis, and a reduced access to transplants¹⁸

Q.4

CKD progression is also associated with a higher prevalence of anaemia, which of these novel treatments is approved for renal anaemia in CKD patients not yet on dialysis?

AGE inhibitors
Epigenetic regulators
HIF-PH inhibitors
Nrf2 activators

HIF-PH inhibitors have been approved for renal anaemia in CKD patients not yet on dialysis¹⁹

Q.5

The ultimate goal of Thomas’ treatment is to delay disease progression and prevent the need for a kidney transplant. What is the half-life of a transplanted kidney?

<20 years
21–30 years
31–40 years
>41 years

<20 years. The half-life of a transplanted kidney is <20 years; patients will therefore likely continue needing CKD treatments during their life²⁰