Monitoring and Management of Chronic Kidney Disease

Core Laboratory Monitoring Schedule

The American Diabetes Association recommends monitoring laboratory tests every 3 months, including electrolytes, bicarbonate, calcium, phosphorus, parathyroid hormone, hemoglobin, albumin, and weight, for a patient with a GFR of 28 mL/min/1.73 m² 1
The American College of Physicians recommends eGFR measurement every 3 months to track kidney function progression 2, 3
The American Diabetes Association recommends monitoring electrolytes, such as sodium and potassium, every 3 months to detect imbalances that may require intervention 1, 4
The National Kidney Foundation recommends monitoring serum bicarbonate every 3 months to detect metabolic acidosis 5, 4
The National Kidney Foundation recommends monitoring calcium and phosphorus every 3 months to assess mineral metabolism 5, 4
The National Kidney Foundation recommends monitoring hemoglobin every 3 months to screen for anemia 5, 4
The National Kidney Foundation recommends monitoring albumin and body weight every 3 months to monitor nutritional status 6
The American College of Physicians recommends monitoring urinary albumin-to-creatinine ratio every 3 months to track proteinuria 2, 3

The National Kidney Foundation recommends checking blood pressure at every clinic visit, with visits occurring at least every three months 6
The National Kidney Foundation recommends checking blood pressure with each dose of erythropoietin therapy 5
The National Kidney Foundation recommends checking 25(OH) vitamin D if parathyroid hormone is elevated 5
The American Diabetes Association recommends considering bone density testing 1

The American Diabetes Association recommends reviewing all medications at each visit for necessary dose adjustments based on current GFR 1
A GFR of 28 mL/min/1.73 m² falls within stage 4 CKD, and the National Kidney Foundation recommends considering nephrology referral for specialized management of CKD complications 7, 1

The National Kidney Foundation recommends correcting metabolic acidosis to serum bicarbonate ≥22 mmol/L 5
The National Kidney Foundation recommends treating hyperphosphatemia if serum phosphorus is ≥4.5 mg/dL 5
The National Kidney Foundation recommends addressing hypocalcemia if corrected serum calcium is <8.5 mg/dL 6
The National Kidney Foundation recommends targeting LDL <100 mg/dL and non-HDL cholesterol <130 mg/dL 6
The National Kidney Foundation recommends treating fasting triglycerides ≥500 mg/dL 6

The National Kidney Foundation recommends discussing renal replacement therapy options 6
The National Kidney Foundation recommends preserving veins suitable for vascular access if hemodialysis is anticipated 6, 7
The National Kidney Foundation recommends considering referral for transplant evaluation if appropriate 6, 7