Why is this important?
- Early CKD detection/treatment decreases development of kidney failure 30-70%.
- Screen, diagnose, monitor and treat CKD complications.
- Early preparation for kidney replacement therapy (transplant, dialysis) improves outcomes.
- Screen all patients with type 2 diabetes yearly:
- Creatinine/eGFR (estimated Glomerular Filtration Rate).
- UACR (Urine Albumin to Creatinine Ratio).
- Dx CKD: ≥3 mos duration of either:
- decreased function - eGFR <60 mL/min/1.73 m2 or
- evidence of damage - UACR ≥30 mg/g or other.
- BG and BP control (ACE inhibitor/ARB) decreases CKD progression.
- R/O potential causes of CKD not related to type 2 diabetes.
- eGFR <60 mL/min/1.73 m2: monitor/treat CKD complications:
- Edema/fluid overload
- Metabolic bone disease
- Monitor patients more closely if:
- Amount of albuminuria is high (e.g., UACR >1000 mg/g) or
- Rate of albuminuria increases rapidly.
- Nephrology referral:
- If unsure of cause of CKD (e.g., renal biopsy needed).
- Difficulty controlling complications of CKD.
- Usually once eGFR <30 mL/min/1.73 m2.
- Rapid progression of CKD.