TABLE 9.

Management of CKD in Diabetes

eGFR (mL/min/1.73 m2)Recommended Management
All patients• Yearly measurement of UACR, serum creatinine, and potassium
45–60• Refer to a nephrologist if possibility for nondiabetic kidney disease exists (duration of type 1 diabetes <10 years, persistent albuminuria, abnormal findings on renal ultrasound, resistant hypertension, rapid fall in eGFR, or active urinary sediment on urine microscopic examination)
• Consider the need for dose adjustment of medications
• Monitor eGFR every 6 months
• Monitor electrolytes, bicarbonate, hemoglobin, calcium, phosphorus, and parathyroid hormone at least yearly
• Assure vitamin D sufficiency
• Vaccinate against hepatitis B virus
• Consider bone density testing
• Refer for dietary counseling
30–44• Monitor eGFR every 3 months
• Monitor electrolytes, bicarbonate, calcium, phosphorus, parathyroid hormone, hemoglobin, albumin, and weight every 3–6 months
• Consider the need for dose adjustment of medications
<30• Refer to a nephrologist