Management of Chronic Kidney Disease

Monitoring and Assessment

The American Society of Nephrology recommends monitoring blood pressure at every clinic visit (at least every three months) for patients with GFR <30 mL/min/1.73 m² 2
The American Society of Nephrology suggests checking serum albumin and body weight every three months to monitor nutritional status 2
The American Society of Nephrology recommends screening for dyslipidemias by measuring triglycerides, LDL, HDL, and total cholesterol 1
The American Society of Nephrology advises evaluating for secondary causes of dyslipidemia including comorbid conditions and medication effects 1
Consider measuring BNP/NT-proBNP and troponin levels with caution, as interpretation must account for reduced GFR, according to the American Journal of Kidney Diseases 4

The American Society of Nephrology recommends targeting blood pressure <130/80 mmHg in patients with GFR <30 mL/min/1.73 m² 2
The American Society of Nephrology suggests using ACE inhibitors or ARBs as first-line agents for hypertension management 2

The American Journal of Kidney Diseases recommends considering bicarbonate supplementation to maintain serum bicarbonate within normal range for patients with metabolic acidosis 5
The American Society of Nephrology advises targeting LDL cholesterol to <100 mg/dL, non-HDL cholesterol to <130 mg/dL, and treating fasting triglycerides ≥500 mg/dL 1
The American Society of Nephrology recommends monitoring for vitamin D deficiency and considering supplementation if 25(OH) vitamin D levels are <30 ng/mL 2
The American Society of Nephrology suggests addressing hypocalcemia (serum calcium <8.5 mg/dL) with elemental calcium supplementation after addressing phosphorus issues 2

The Kidney International recommends restricting dietary protein to 0.8 g/kg/day for patients with GFR <60 mL/min/1.73 m² and nephrotic-range proteinuria 6
The Kidney International advises avoiding protein restriction below 0.6 g/kg/day due to safety concerns and risk of malnutrition 6
The Kidney International suggests restricting dietary sodium to <2.0 g/day to reduce edema, control blood pressure, and reduce proteinuria 6
The Kidney International recommends targeting caloric intake of 30-35 kcal/kg/day for patients with GFR <60 mL/min/1.73 m² 6
The American Society of Nephrology advises encouraging regular physical activity and providing counseling to increase physical activity; refer to physical therapy if mobility is limited 1

The American Society of Nephrology recommends adjusting medication dosages based on GFR levels, particularly for drugs with renal clearance 3
The American Society of Nephrology advises avoiding nephrotoxic medications (e.g., NSAIDs) in patients with decreased GFR 3

The American Society of Nephrology recommends discussing RRT modality options with patients who have GFR <30 mL/min/1.73 m² 1
The American Society of Nephrology suggests noting that no specific GFR threshold alone should determine when to initiate RRT 1
The American Journal of Kidney Diseases advises considering initiating RRT in patients with GFR <20 mL/min/1.73 m² who have evidence of malnutrition that does not respond to nutritional intervention 2
The American Society of Nephrology recommends referring patients willing to have renal transplantation for transplant evaluation 1
The American Society of Nephrology suggests preserving veins suitable for vascular access placement if hemodialysis is planned 1
The American Society of Nephrology advises referring for surgery to construct primary AV fistula if hemodialysis is the chosen modality 1

The American Society of Nephrology recommends providing structured education regarding preparation for RRT 1
The American Society of Nephrology advises encouraging patients to maintain employment and referring to vocational counseling per patient preference 1

The American Journal of Kidney Diseases recommends considering that patients with low GFRs are generally at increased bleeding risk, and antiplatelet medications further increase this risk 4
The American Journal of Kidney Diseases advises recognizing that elevated troponin in CKD patients has good prognostic accuracy despite reduced diagnostic accuracy for acute coronary syndrome 4