What forms and assessments are recommended for a Chronic Kidney Disease (CKD) clinic?

From the Guidelines

A comprehensive CKD clinic should utilize several key forms and assessments to effectively monitor and manage patients, prioritizing annual assessments of albuminuria and GFR, as recommended by the KDIGO 2024 clinical practice guideline 1. I recommend implementing a standardized initial assessment form that captures baseline kidney function (eGFR, creatinine, BUN), proteinuria measurements (urine albumin-to-creatinine ratio), and comorbidities like diabetes, hypertension, and cardiovascular disease. Regular follow-up assessment forms should track disease progression, medication adherence, and treatment response, with more frequent assessments for individuals at higher risk of CKD progression, as outlined in the KDIGO guideline 1. Essential laboratory assessments include quarterly comprehensive metabolic panels, complete blood counts, phosphorus, calcium, PTH levels, and hemoglobin A1c for diabetic patients, as well as annual screenings for lipid panels and cardiovascular risk assessments. Patient-reported outcome measures focusing on quality of life, symptom burden, and medication side effects provide valuable subjective data, and medication reconciliation forms help prevent adverse drug interactions, particularly important as CKD patients often take multiple medications. Nutritional assessments by renal dietitians should evaluate dietary patterns, sodium intake, and protein consumption, and these comprehensive assessments enable early intervention for complications like anemia, mineral bone disorders, and metabolic acidosis, while facilitating timely referrals for renal replacement therapy planning when appropriate, as supported by guidelines for managing CKD in various patient populations 1. Regular reassessment using these standardized tools allows for personalized care plans that address the progressive nature of CKD and its multisystem effects. Key forms and assessments may include:

• Initial assessment form
• Follow-up assessment forms
• Laboratory assessment templates
• Patient-reported outcome measures
• Medication reconciliation forms
• Nutritional assessment templates These tools can help healthcare providers to monitor and manage CKD patients effectively, improving their quality of life and reducing the risk of complications and mortality.

From the FDA Drug Label

2 DOSAGE AND ADMINISTRATION

1. 1 Important Dosing Information Evaluation of Iron Stores and Nutritional Factors Evaluate the iron status in all patients before and during treatment. Administer supplemental iron therapy when serum ferritin is less than 100 mcg/L or when serum transferrin saturation is less than 20%. The majority of patients with CKD will require supplemental iron during the course of ESA therapy.

The FDA drug label does not answer the question.

From the Research

CKD Clinic Forms and Assessments

The following forms and assessments are recommended for a Chronic Kidney Disease (CKD) clinic:

• Patient information form to collect demographic and medical history data
• Physical examination form to record vital signs and physical examination findings
• Laboratory test forms to order and record results of serum creatinine, cystatin C, and other relevant tests
• Urine test forms to order and record results of albuminuria and other relevant tests
• Medication list form to record patient's current medications and dosages
• CKD staging and risk assessment tools to guide treatment, monitoring, and referral strategies 2
• Cardiovascular risk reduction assessment form to identify patients at high risk of cardiovascular disease
• Treatment plan form to document patient's treatment goals, medications, and follow-up appointments

CKD Assessment Tools

The following assessment tools are recommended for CKD clinics:

• Glomerular filtration rate (GFR) calculation using serum creatinine and cystatin C levels 3, 4
• Albuminuria measurement to assess kidney damage 2, 3
• CKD-EPI and MDRD equations to estimate GFR 5
• Cardiovascular risk assessment tools to identify patients at high risk of cardiovascular disease 2

CKD Management Guidelines

The following management guidelines are recommended for CKD clinics:

• CKD checklist to outline management guidelines for CKD 6
• Guidelines for cardiovascular risk reduction, including statins and blood pressure management 2
• Guidelines for treatment of albuminuria, including angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers 2
• Guidelines for avoidance of potential nephrotoxins, including nonsteroidal anti-inflammatory drugs 2
• Guidelines for adjustments to drug dosing, including many antibiotics and oral hypoglycemic agents 2