Monitoring

Your Organizational Guidance

ebpracticenet urges you to prioritize the following organizational guidance:

Chronisch nierlijden (multidisciplinaire aanpak)Published by: WORELLast published: 2017GPC pluridisciplinaire sur la néphropathie chronique (IRC)Published by: Groupe de travail Développement de recommandations de première ligneLast published: 2017

Patients with risk factors for CKD, such as diabetes, hypertension, or cardiovascular disease, should be evaluated with estimated glomerular filtration rate (GFR; based on creatinine and, if available, cystatin C) and measurement of albuminuria (urine albumin-to-creatinine ratio). See Screening.

CKD progression

For those with established CKD, the rate of progression of CKD should be serially assessed starting in GFR category G3a/G3b disease.

For patients with diabetes and CKD, the American Diabetes Association recommends monitoring with urinary albumin and eGFR 1-4 times per year, depending on the stage of disease (e.g., 1-2 times a year if G1 to G3a and normal or moderately increased albuminuria; 3-4 times a year if severely increased albuminuria or G4 or G5).[63]

Patients should be screened for anemia and bone mineral disorders at least every 6-12 months with a hemoglobin, calcium, phosphorus, and intact parathyroid hormone (PTH). For those in GFR category G4 disease, hemoglobin, calcium, phosphorus should be monitored every 3-6 months and intact PTH every 6-12 months. For patients in GFR category G5 CKD, anemia should be evaluated with a monthly hemoglobin, and bone mineral disease with a calcium and phosphorus every 1-3 months and an intact PTH every 3-6 months. Lipids should be checked annually for all patients with CKD.

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