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CKD Treatment Algorithm

This document outlines the treatment and management of chronic kidney disease (CKD) based on disease stage. It describes the involvement of primary care, nephrology, recommended labs and monitoring, risk assessment, education, and referrals needed at each stage of CKD from stage 1-2 through stage 5. Management becomes more intensive as kidney function declines and nephrology involvement increases in later stages.

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519 views1 page

CKD Treatment Algorithm

This document outlines the treatment and management of chronic kidney disease (CKD) based on disease stage. It describes the involvement of primary care, nephrology, recommended labs and monitoring, risk assessment, education, and referrals needed at each stage of CKD from stage 1-2 through stage 5. Management becomes more intensive as kidney function declines and nephrology involvement increases in later stages.

Uploaded by

yehezkieldward
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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CKD Treatment Algorithm

CKD Stage 1 - 2

CKD Stage 3

CKD Stage 4

CKD Stage 5

eGFR 60
mL/min/1.73 m2
Urinary albumin-creatinine (ACR) > 30 mg/g x 2

eGFR 30 - 59
mL/min/1.73 m2

eGFR 15 - 29
mL/min/1.73 m2

eGFR < 15
mL/min/1.73 m2

PRIMARY CARE
Assess Complications

CO-MANAGEMENT
Assess Complications

NEPHROLOGY
Assess Complications

NEPHROLOGY
Assess Complications

LABS
BP monitoring q 3-12 mo.
eGFR q 3-12 mo.
Urinalysis q 6-12 mo.
Lipids q 2 mo.
If diabetic, Hgb A1C and
microalbuminuria q 12 mo.
Hgb > 11 q 3-6 mo < 11 q 1-3
mo
Lytes and glucose q 12 mo.
PTH, Ca & P q 3-12 mo.

LABS
BP monitoring q 3-6 mo.
eGFR q 3-6 mo.
Lipids q 12 mo.
If diabetic, Hgb A1C and
microalbuminuria q 12 mo.
Hgb q 3-6 mo, monthly if on ESA
PTH, Ca, P. q 3-6 mo.

LABS
BP monitoring q 3-12 mo.
eGFR q 12 mo.
Urinalysis q 3 -12 mo. to assess hematuria, proteinuria,
microalbuminuria
Lipids q 12 mo.
If diabetic, Hgb A1C and microalbuminuria q 12 mo.
Hgb q 12 mo. if > 11 gm/dL
RISK ASSESSMENT
Avoidance of nephrotoxic agents & dyes
Spare non-dominant arm above wrist from venipuncture and IV
catheters
Immunizations
-Flu vaccine q 12 mo.
-Pneumovax, as indicated
-Hep B vaccine, as indicated
Assess cardiovascular risk:
- Smoking cessation
- Physical activity
EDUCATION
Cardiovascular risk
Medications to avoid
Immunizations

RISK ASSESSMENT
Avoidance of nephrotoxic
agents & dyes
Spare non-dominant arm above
wrist from venipuncture/IV cath
Avoid subclavian and PICC lines
Immunizations
-Flu vaccine q 12 mo.
-Pneumovax, as indicated
-Hep B vaccine, as indicated
Assess cardiovascular risk:
- Smoking cessation
- Physical activity
EDUCATION
Cardiovascular risk
Medications to avoid
Immunizations
Nutrition: Diet low in salt & K+
Renal bone disease

Prepared by the Renal Network of the Upper Midwest, Inc.


Please call 1-800-973-3773 for questions or reprint requests.
The Kidney Disease Outcomes Quality Initiative (KDOQI) recommendations for
Chronic Kidney Disease: Evaluation, Classification, and Stratification were
used to develop portions of these documents.

RISK ASSESSMENT
Avoidance of nephrotoxic agents
& dyes
Spare non-dominant arm above
wrist from venipuncture/IV cath
Avoid subclavian and PICC lines
Immunizations
-Flu vaccine q 12 mo.
-Pneumovax, as indicated
-Hep B vaccine, as indicated
Assess cardiovascular risk:
- Smoking cessation
- Physical activity
EDUCATION
Cardiovascular risk
Medications to avoid
Immunizations
Nutrition: Diet low in salt, phos
& K+
Renal bone disease
Anemia
Vascular access placement
Modality options
REFERRALS
Surgeon for fistula only
placement if hemodialysis
modality choice
Transplant center for eval

LABS
eGFR q 1-3 mo.
Lipids q 12 mo.
If diabetic, Hgb A1C and
microalbuminuria q 12 mo.
Hgb monthly
PTH, Ca, P q 1-3 mo.
Measure 25(OH)D
HBV titer
RISK ASSESSMENT
Avoidance of nephrotoxic
agents & dyes
Spare non-dominant arm above
wrist from venipuncture/IV cath
Avoid subclavian and PICC lines
Immunizations
-Flu vaccine q 12 mo.
-Pneumovax, as indicated
-Hep B vaccine, as indicated
Assess cardiovascular risk:
- Smoking cessation
- Physical activity
EDUCATION
Cardiovascular risk
Medications to avoid
Immunizations
Nutrition: Advise diet low in
fluids, salt, phos. & K+
Renal bone disease
Anemia
Vascular access monitoring
Modality options
Evaluation for kidney transplant
REFERRALS
Surgeon for fistula only
placement if hemodialysis
modality choice
Transplant center for eval

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