Developed by the IHS Division of Diabetes Treatment and Prevention Revised 2010 1 Type 2 Diabetes and Chronic Kidney Disease CKD is an eGFR
Type 2 Diabetes and Chronic Kidney Disease CKD is an eGFR 60ml/min
2 > 60ml/min
3 3 to 59 ml/min
4 5 15 to 29 40 yrs & UACR is positive, then check SPEP and UPEP.
Referrals Nephrololgist: Make a referral when the eGFR = 30mg/mL, start calcitriol If 25(OH)D < 30mg/mL, start ergocalciferol (Vit D2) Follow Ca, PO4, iPTH, and 25(OH)D; if Ca or PO4 is above target or if iPTH below target, hold calcitriol and/or calcium.
Table 2. Stage of CKD and Metabolic Monitoring Goals CKD Stage 3 4 5
eGFR 30-59 15-29 < 15
iPTH goal 35-70 70-110 150-300
PO4 goal 2.7-4.6 2.7-4.6 3.5-5.4
Ca goal 8.4-9.5 8.4-9.5 8.4-9.5
Developed by the IHS Division of Diabetes Treatment and Prevention Revised 2010
Ca X PO4 55
*Drugs are not on the IHS National Core Formulary
Table 4. Other Medication Medication
Dose
*Cinacalcet
30-180mg daily
iPTH effect Decrease
PO4 effect
Ca effect
Comments
Decrease
Significant Do not use if Ca decrease 60 Annual Annual Annual Annual
GFR 30-59
GFR 15-29
Each visit Each visit Every 3 to 6 months* Every 3 months Every 3 months Every 3 months
Each visit Each visit Each Visit* Every 3months Every 3 months Every 3 months
GFR < 15 not on dialysis Each visit Each visit Each Visit* Every 3 months Every 3 months Every 3 months
Every 3 months At least annually At least annually
Every 3 months Every 3 months Every 3 months
Every 3 months Every 3 months Every 3 month
Monitor more often if values are worsening or on medications that affect these labs *Frequency of checking depends on rate of rise of urine albumin
Reference: KDOQI/NKF and UK Renal Assoc 4th Ed. Clinical Practice Guidelines for Complications of CKD. ADA Clinical Practice Recommendations 2010. J Am Soc Nephrol 2010; 21:2-6.
Developed by the IHS Division of Diabetes Treatment and Prevention Revised 2010