The Nov. 24, 2020 session of Duke Medicine LEADS featured John K. Roberts, MD, MS, MEd, presenting "Protein, Baking Soda, and Sugar: Ingredients for Better CKD Care in 2020 and Beyond."
Here are pearls and takeaways from the session:
- To best assess proteinuria in the setting of CKD, check urine albumin/creatinine ratio (UACR). The current CKD staging framework incorporates degree of albuminuria in addition to GFR.
- Use the Kidney Failure Risk Equation to estimate a patient's risk of progression to kidney failure requiring dialysis or transplant at 2 and 5 years. This assessment is greatly influenced by albuminuria.
- Use oral sodium bicarbonate to correct metabolic acidosis in CKD. Dosing should be 0.5-1 mEq/kg/day; a general starting dose is 1300 mg BID for most patients (or 1/4 teaspoon baking soda BID).
- For patients with or without diabetes with a UACR >200 mg/g and CKD already on an ACE-I/ARB, consider starting an SGLT2 inhibitor (dapagliflozin 10 mg daily based on the DAPA-CKD trial).
Duke Medicine Learning, Education, and Discussion Series (LEADS) takes place each Tuesday at 12 p.m. Learn more and see schedule of upcoming sessions.
