U.S. Department of Health and Human Services
Indian Health Service: The Federal Health Program for American Indians and Alaska Natives
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Wednesday, September 17, 2014

Division of Diabetes Treatment and Prevention - Leading the effort to treat and prevent diabetes in American Indians and Alaska Natives


Quick Guide Cards

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Screening and Diagnosis

CKD Screening and Diagnosis video screenshot
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NOTE: Access to this information is not restricted; however, the information found here is intended for use by medical providers. Some videos contain graphic images. Patients should talk with their medical providers about any specific concerns.

 

Important Resources

  • Screen all patients with type 2 diabetes yearly:
    • Creatinine/eGFR (estimated Glomerular Filtration Rate).
    • UACR (Urine Albumin to Creatinine Ratio).
  • Prevent/slow CKD: BG and BP control, use of ACE Inhibitor/ARB.
  • Dx CKD with ≥3 mos duration of either:
    • decreased function eGFR <60 mL/min/1.73 m2 or
    • evidence of damage UACR ≥30 mg/g or other.
  • Initial work-up of CKD, including r/o causes not related to type 2 diabetes:
    • Complete U/A, UACR
    • Glucose, lytes, uric acid, Cr, BUN, Ca, Phos, CBC
    • ANA, RF, C3, C4, Hep B SAg, Hep C Ab
    • Dilated retinal exam, Renal U/S
    • if proteinuria and patient >40 y.o.: SPEP, UPEP
    • Nephrology referral if needed to sort out cause(s) of CKD
  • Albuminuria:
    • Continuous variable
    • Terms “microalbuminuria” and “macroalbuminuria” going out of use but still used for ICD9 Coding:
      • Normal = <30 mg/g
      • Microalbuminuria = 30-300 mg/g
      • Macroalbuminura = >300 mg/g

Management of Albuminuria
The following strategies should be implemented to reduce albuminuria, prevent/slow nephropathy progression and lower the risk of CVD: down arrow up arrow

  • Most important: BP control (goal <130/80).
  • Maximize ACE Inhibitor (use ARB if ACE Inhibitor not tolerated).
  • BG control.
  • Achieve lipid goals, ASA if no contraindications, tobacco cessation.
  • Protein restriction (later stages).
  • Once eGFR <60 mL/min/1.73 m2, see Type 2 Diabetes and Chronic Kidney Disease Algorithm. [PDF - 229KB]

Monitoring – post CKD diagnosis

  • Monitor eGFR and UACR at least once per year or more often after interventions and during later stages of CKD.
Overview How To Other Resources
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Division of Diabetes Treatment and Prevention | Phone: (505) 248-4182 | Fax: (505) 248-4188 | diabetesprogram@ihs.gov