Clinical Practice Guidelines for Halting Progression of Chronic Kidney Disease

The following office practice guidelines are a result of the Kidney Dialysis Outcomes Quality Initiative (K–DOQI) and represent recommendations by the National Kidney Foundation.

Parameter	Goal	How to Get to Goal
Estimated GFR	Stable	Cockcroft–Gault or MDRD
Blood Pressure	<130/80 mmHg	Combine diet and drugs
Urine Albumin/creatinine	<300 mg/g	Uptitrate BP drugs + RAAS blockers
RAAS blockade	ACEi, ARB, MRA	Use max dose ACEi first
HgbA1c	<6.5%	Insulin/oral agents as needed
Hemoglobin	>11 and <13 g/dl	Iron and ESPs
LDL cholesterol	<100 mg/dl (<70, very high risk)	Statins, Ezetimibe, others
Parathyroid Hormone	55-70 Stage 3, 71–110 Stage 4	Vitamin D, Phosphate, binders
25-OH vitamin D3 level	>30 ng/dl	If <30 ng/dl, Rs: ergocalciferol
Smoking	Cessation	Cessation programs, medication
Weight Loss	Ideal body weight	Patient education
Exercise	45 minutes aerobic 3–4/week	Patient education

MDRD = Modification of Diet in Renal Disease
RAAS = renin-angiotensin–aldosterone system
ACEi = angiotensin converting enzyme inhibitor
ESP = erythrocyte stimulating protein.

This table was created by Robert Toto, MD and presented during a Grand Rounds presentation at UTSW Medical Center on May 25, 2007.