Type 2 Diabetes and Chronic Kidney Disease

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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

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