Management of CKD in diabetes
GFR | Recommended |
All patients | Yearly measurement of creatinine, UAE, potassium |
45-60 | Referral to nephrology if possibility for nondiabetic kidney disease exists (duration type 1 diabetes <10 years, heavy proteinuria, abnormal findings on renal ultrasound, resistant hypertension, rapid fall in GFR, or active urinary sediment on ultrasound) |
Consider need for dose adjustment of medications | |
Monitor eGFR every 6 months | |
Monitor electrolytes, bicarbonate, hemoglobin, calcium, phosphorus, parathyroid hormone at least yearly | |
Assure vitamin D sufficiency | |
Consider bone density testing | |
Referral for dietary counseling | |
30–44 | Monitor eGFR every 3 months |
Monitor electrolytes, bicarbonate, calcium, phosphorus, parathyroid hormone, hemoglobin, albumin, weight every 3–6 months | |
Consider need for dose adjustment of medications | |
<30 | Referral to nephrologists |
Adapted from National Kidney Foundation guidelines (available at http://www.kidney.org/professionals/KDOQI/guideline_diabetes/).