How often should I monitor labs in a patient with a glomerular filtration rate (GFR) of 28?

Monitoring Labs in a Patient with GFR of 28

For a patient with a GFR of 28 mL/min/1.73 m², laboratory tests should be monitored every 3 months, including electrolytes, bicarbonate, calcium, phosphorus, parathyroid hormone, hemoglobin, albumin, and weight. 1

Core Laboratory Monitoring Schedule

Every 3 Months

• eGFR measurement to track kidney function progression 1
• Electrolytes (sodium, potassium) to detect imbalances that may require intervention 1
• Serum bicarbonate to monitor for metabolic acidosis 1
• Calcium and phosphorus to assess mineral metabolism 1
• Hemoglobin to screen for anemia 1
• Albumin and body weight to monitor nutritional status 1
• Urinary albumin-to-creatinine ratio (ACR) to track proteinuria 1

Every 3-6 Months

• Parathyroid hormone (iPTH) to monitor bone metabolism 1
• Lipid panel (triglycerides, LDL, HDL, total cholesterol) to assess cardiovascular risk 1

Additional Monitoring Considerations

Blood Pressure Monitoring

• Check blood pressure at every clinic visit 1
• Visits should occur at least every three months 1
• If patient is on erythropoietin therapy, check blood pressure with each dose 1

Vitamin D Status

• Check 25(OH) vitamin D if iPTH is elevated (>100 pg/mL) 1
• Consider bone density testing 1

Special Considerations

Medication Adjustments

• Review all medications at each visit for necessary dose adjustments based on current GFR 1, 2
• Avoid nephrotoxins such as NSAIDs 2, 3

Referral to Nephrology

• A GFR of 28 mL/min/1.73 m² falls within stage 4 CKD (GFR 15-29 mL/min/1.73 m²)
• Consider nephrology referral for specialized management of CKD complications 1, 4

Monitoring for CKD Complications

Metabolic Complications

• Correct metabolic acidosis to serum bicarbonate ≥22 mmol/L 1
• Treat hyperphosphatemia if serum phosphorus is ≥4.5 mg/dL 1
• Address hypocalcemia if corrected serum calcium is <8.5 mg/dL 1

Cardiovascular Risk Management

• Target LDL <100 mg/dL and non-HDL cholesterol <130 mg/dL 1
• Treat fasting triglycerides ≥500 mg/dL 1

Patient Education and Planning

• Discuss renal replacement therapy options 1
• If hemodialysis is anticipated, preserve veins suitable for vascular access 1
• Consider referral for transplant evaluation if appropriate 1

Remember that while GFR typically declines over time in CKD, improvement is possible with optimal management of blood pressure, proteinuria, and metabolic parameters 5. Regular monitoring as outlined above is essential for detecting complications early and adjusting treatment accordingly.