Crcl or eGFR assumes a stable creatinine and creatinine fluctuates in dialysis patients, making the calculation unreliable

If you can't possibly calculate, you are correct!

PCP prophylaxis is correct!

PCP is an opportunistic fungal infection that primarily infects immunocompromised patients. Can lead to severe pneumonia

Co-trim is given for 6 months post transplant

Any side effects that concern renal patients?

Extra! Does anyone know QAH infection control policy for PCP infected patients in beds?

Typically Warfarin!

Warfarin is frequently the anticoagulant of choice

- Measure INR, can reduce range for certain populations

- easily reversible... With what?

- but comes with calciphylaxis risk!!!

DOACs are not licensed in the UK for HD patients

But!

Some HD patients may be on them... which???

Apixaban most evidence (from what I've read and seen)

First, what is the difference?

​Alfacalcidol

Kidneys have a role in hydroxylating vitamin D to it's active form


Active vitamin D then works on various tissues etc for calcium and phosphate homeostasis and managing bone health


Alfacalcidol is active vitamin D, tends to be used just for secondary hyperparathyroidism

Colecalciferol

Colecalciferol is the precursor to active vitamin D, requires hydroxylation

KDIGO now recommends to supplement colecalciferol in CKD and dialysis patients that are deficient, studies show a role in lowering parathyroid hormone

(if vit D level <30, we load like any other patient)

​Both can be used simultaneously

CO2 is used to estimate bicarbonate HCO3- in the body


When CO2 is low, you can estimate low HCO3-
(95% of CO2 is in the form of bicarbonate in the body according to google AI)

When CO2 is low, the renal patient is acidotic

We monitor CO2

​Functioning kidneys will reabsorb HCO3- and excrete H+


Supplement with sodium bicarbonate (not a sodium replacement!!!)

No!! Bone marrow suppression

Could introduce if massively drop aza dose but proceed cautiously.

Note - renal patients frequently get gout

Allopurinol and Aza

No!!! Clari can severely raise tac levels

Speak to renal or consider azithromycin

Tac and clarithromycin

Interactions

Same as clari, can use but reduce tac dose to a third
(not by a third)

​Tac and fluconazole

Fine!

​Tac and lamivudine

Interactions

Are they bioequivalent???

Patients on PD
CKD patients
HD patients with clotted fistulas/removed lines

SC is for non HD patients

Use IV first line in those that have access

Tacrolimus is F506

When do you take levels?



How long do you have to be on tac before you take a level?



What level are we looking for?

Hope you enjoyed renal fun morning

If no nephros access, email lauren (she will forget if you don't put it in writing)

Extension 5453 for renal help!