20
Standards of Medical Care
Table 13. Management of CKD in Diabetes
GFR
(mL/min/1.73 m
2
) Recommendation
All patients Yearly measurement of creatinine, urinary albumin excretion, potassium
45-60 Referral to nephrolog y if possibility for nondiabetic kidney disease
exists (duration type 1 diabetes <10 years, heavy proteinuria,
abnormal findings on renal ultrasound, resistant hypertension, rapid
fall in GFR, or active urinary sediment)
Consider need for dose adjustment of medications
Monitor eGFR every 6 months
Monitor electrolytes, bicarbonate, hemoglobin, calcium, phosphorus,
parathyroid hormone at least yearly
Assure vitamin D sufficiency
Consider bone density testing
Referral for dietary counseling
30-44 Monitor eGFR every 3 months
Monitor electrolytes, bicarbonate, calcium, phosphorus, parathyroid
hormone, hemoglobin, albumin, weight every 3-6 months
Consider need for dose adjustment of medications
<30 Referral to nephrologist
Adapted from http://www.kidney.org/professionals/KDOQI/guideline_diabetes/
Neuropathy
Î All patients should be screened for distal symmetric polyneuropathy
(DPN) at diagnosis of type 2 diabetes and 5 years after the diagnosis
of type 1 diabetes and at least annually thereafter, using simple
clinical tests. (B)
Î Electrophysiological testing or referral to a neurologist is rarely needed,
except in situations where the clinical features are atypical. (E)
Î Screening for signs and symptoms of autonomic neuropathy should
be instituted at diagnosis of type 2 diabetes and 5 years after the
diagnosis of type 1 diabetes. (E)
Note: Special testing is rarely needed and may not affect management or outcomes.
Î Medications for the relief of specific symptoms related to DPN and
autonomic neuropathy are recommended since they may reduce pain
(B) and improve quality of life. (E)
