The management recommendations presented here are based upon recommendations from the National Kidney Foundation's K/DOQI (Kidney Disease Outcomes Quality Initiative)™ clinical practice guidelines, an evidence–based approach to Chronic Kidney Disease (CKD) care, as they apply to adults.

The evaluation and treatment of patients with CKD requires understanding of separate but related concepts of diagnosis, comorbid conditions, severity of disease, complication of disease, and risks for loss of kidney function and cardiovascular disease.

 

Stages of Chronic Kidney Disease: A Clinical Action Plan
Stage	Description	GFR (mL/min/1.73 m²)	Action
1	Kidney Damage with Normal or ↑ GFR	>90	Diagnosis and treatment, Treatment of comorbid conditions, Slowing progression, CVD risk reduction
2	Kidney Damage with Mild ↓ GFR	60–89	Estimating progression
3	Moderate ↓ GFR	30–59	Evaluating and treating complications
4	Severe ↓ GFR	15–29	Preparation for kidney replacement therapy
5	Kidney Failure	<15 (or dialysis)	Replacement (if uremia is present)

Chronic Kidney Disease is defined as either kidney damage or GFR <60 mL/min/1.73 m² for ≥ 3 months. Kidney damage is defined as pathologic abnormalities or markers of damage, including abnormalities in blood or urine tests or imaging studies.


Patients with CKD should be evaluated to determine:

• Diagnosis (type of kidney disease)
• Comorbid conditions
• Severity, assessed by level of kidney function
• Complications, related to level of kidney function
• Risk for loss of kidney function
• Risk for cardiovascular disease

Treatment of CKD should include:

• Specific therapy, based on diagnosis
• Evaluation and management of comorbid conditions
• Slowing the loss of kidney function
• Prevention and treatment of cardiovascular disease
• Prevention and treatment of complications of decreased kidney function
• Preparation for kidney failure and kidney replacement therapy
• Replacement of kidney function by dialysis and transplantation if signs and symptoms of uremia are present

A clinical action plan should be developed for each patient, based on the stage of disease as defined by the K/DOQI CKD classification.

Review of medications should be performed at all visits for the following:

• Dosage adjustment based on level of kidney function
• Detection of potentially adverse effects on kidney function or complications of CKD
• Detection of drug interactions
• Therapeutic drug monitoring, if possible

Self-management behaviors should be incorporated into the treatment plan at all stages of CKD.

Patients with CKD should be referred to a Nephrologist for consultation and co-management if the clinical action plan cannot be prepared, the prescribed evaluation of the patient cannot be carried out, or the recommended treatment cannot be carried out. In general, patients with GFR <60 mL/min/1.73 m² should be referred to a Nephrologist.