Microsoft word - ckd quick reference for pcp 06-14-10.doc

CHRONIC KIDNEY DISEASE
QUICK REFERENCE QUIDE for the PRIMARY CLINICIAN
(derived from the National Kidney Foundation KDOKI Clinical Guidelines) DIAGNOSE CKD:
SPECIAL CASES
Target Patients with Hypertension, DM, Family history of CKD ACE inhibitor/ARB use
Screen by using GFR calculator to estimate GFR (eGFR)  These are safe and effective at preventing progression CKD Diagnosis:
of CKD at least up to a creatinine of 3.5 or eGFR of eGFR < 60 (lasting more than 3 months) 20ml/min (At this level, a nephrologist should Microalbumin/creatinine ratio >30 mg/g TAKE 7 ACTION STEPS (If eGFR <60):
 There may be a decrease of 25% in GFR after initiating ACEI/ARB . This is OK provided it 1. REFER TO NEPHROLOGIST IF:
stabilizes and actually portends a better prognosis.  A decrease greater than 25% however requires a Marked proteinuria out of proportion with decreased GFR. stoppage of ACEI/ARB and a work up for renal Abnormal urinalysis (persistent hematuria and/or  Stop if hyperkalemia (K>5.5) occurs. (Particular care must be taken for the patient with CKD who is on an Resistant hypertension: above target on 3 or more meds. ACE and spironolactone, as both drugs may raise 2. TAKE OFF UNSAFE MEDS:
 If serum iron/TIBC < 20%, patient is iron deficient  Rule out colon cancer by colonoscopy Reduce Allopurinol dose to 100 mg/day in general dose Be careful with Bisphosphanates. Do not use if GFR < 30  For example, write a prescription for either No oral phosphate preps like Fleets visicolfor colonoscopy Darbepoietin 40ug or Erythropoietin 20,000 units sub Be careful with IV contrast and gadolinium 3. START ACE inhibitor OR ARB unless
 Monitor CBC monthly and iron/TIBC every 3 months. Keep iron/TIBC> 20% and Hb between 10- 4. START ASA
(Acetylsalicylic acid) [81mg] daily unless Avoid or hold erythropoietin if Hgb >12.0 5. BLOOD PRESSURE CONTROL < 130/80
“SAVE AN ARM” and AVOID PICC LINES:
Education for Patients
6. GET LAB TESTS:
Have all blood draws done from your dominant arm. If you are right handed, have it drawn you’re your Urine Microalbumin/Creatinine ratio (proteinuria) right arm. PICC lines are placed to give long term antibiotics at home. Make sure a kidney specialist WHAT TO LOOK FOR IN LAB TESTS
approves their use before getting one. This is done, because if you eventually do need dialysis, the arm Hemoglobin < 12 (indicates anemia – see special cases)
will be used for access instead of the neck. DIABETES:
VITAMIN D DEFICIENCY
LIPID CONTROL:
Write prescription for Ergocalciferol 50,000 units monthly by mouth LDL > 100(CKD is a coronary artery disease CAD equivalent)  If < 30, give Vit D 50,000 units weekly for 6 weeks; BONE DISEASE:
 Once > 30, continue 50,000 units monthly
7. “SAVE AN ARM” AVOID PICC LINES IF
GFR< 45 (see Special Cases)

Source: http://www.dartnet.info/media/CKDQuickReferencePCP.pdf