What are the guidelines for monitoring Chronic Kidney Disease (CKD)?

From the Guidelines

Chronic Kidney Disease (CKD) monitoring guidelines recommend regular assessment of kidney function, including estimated glomerular filtration rate (eGFR) and albumin-creatinine ratio (ACR), at least annually. The frequency of monitoring depends on the severity of CKD and the risk for progression, with factors such as cause of CKD, level of GFR, level of albuminuria, age, sex, and comorbidities influencing the monitoring schedule 1.

Key Monitoring Recommendations

• Assessment of eGFR and ACR: should be performed at least annually, with the exact frequency depending on the severity of CKD and the risk for progression 1.
• Frequency of monitoring: is guided by a GFR and albuminuria grid, which reflects the risk for progression by intensity of coloring, with numbers in the boxes indicating the recommended frequency of monitoring (number of times per year) 1.
• Definition of progression: is based on a change in eGFR category confirmed by a minimal percentage of change in eGFR (25% or greater), to ensure that small changes in GFR are not misinterpreted as progression 1.

Management of CKD

• Medication management: should be titrated to achieve optimal blood pressure control and reduce proteinuria, although specific medication recommendations are not provided in the guideline 1.
• BP control and proteinuria reduction: are key recommendations for preventing CKD progression and managing specific complications of CKD 1.

From the Research

Monitoring Chronic Kidney Disease (CKD)

The guidelines for monitoring CKD involve regular assessment of kidney function and detection of potential complications. Key aspects of monitoring CKD include:

• Estimating glomerular filtration rate (GFR) and measuring albuminuria to assess kidney function and detect potential kidney damage 2, 3, 4
• Monitoring serum creatinine and potassium levels, especially in patients taking angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACEIs/ARBs) 5
• Assessing for complications of CKD, such as hyperkalemia, metabolic acidosis, hyperphosphatemia, vitamin D deficiency, secondary hyperparathyroidism, and anemia 2, 3

Referral to Nephrology Specialists

Referral to nephrology specialists is recommended for patients with:

• Estimated GFR (eGFR) <30 mL/min/1.73 m2 2, 3
• Severe albuminuria (≥300 mg per 24 hours) 2, 3
• Rapid decline in eGFR 2
• Acute kidney injury 3

Management of CKD

Management of CKD involves reducing the risk of CKD progression and associated complications, such as:

• Controlling blood pressure (<140/90 mmHg) 2, 3, 6
• Using ACEIs/ARBs for patients with albuminuria and hypertension 2, 5, 3
• Managing diabetes (hemoglobin A1c ≤7%) 2, 3
• Correcting CKD-associated metabolic acidosis 2, 3
• Avoiding nephrotoxins, such as nonsteroidal anti-inflammatory drugs (NSAIDs) 2, 3