Module 1: Understanding Chronic Kidney Disease (ckd)

Tips for MNT: diabetic kidney disease

• Slide 71 of 80

• Assess eGFR and UACR, obtain 2nd referral if CKD is identified (change in medical condition, diagnosis).
• Intensive glucose control to near normal glucose levels early in the course of diabetes may prevent or delay the onset of CKD.
• A1C < 8% may be appropriate for advanced CKD.
• A1C may measure lower in CKD due to increased erythrocyte turnover (shorter lifespan).
• Blood pressure control slows CKD progression.
• Review sodium intake.
• Certain blood pressure medications increase risk for hyperkalemia.

Follow trends in eGFR

• Slide 72 of 80

Follow trends in UACR

• Slide 73 of 80

• Note differences in timeframes

NKDEP tools to share with other providers

• Slide 74 of 80

• Explaining Your Kidney Test Results: A Tear-Off pad for clinical use
• https://www.niddk.nih.gov/health-information/professionals/clinical-tools-patient-education-outreach/explain-kidney-test-results
• Quick Reference on GFR and UACR in Evaluating Patients with Diabetes for Kidney Disease
• https://www.niddk.nih.gov/health-information/health-communication-programs/nkdep/a-z/quick-reference-uacr-gfr/Documents/quick-reference-uacr-gfr-508.pdf
• Making Sense of CKD – A concise guide for managing chronic kidney disease in the primary care setting (Guide)
• https://www.niddk.nih.gov/health-information/health-communication-programs/nkdep/a-z/Documents/ckd-primary-care-guide-508.pdf

References

• Slide 75 of 80

• Alicic RZ, Rooney MT, Tuttle KR. Diabetic kidney disease: challenges, progress, and possibilities. Clinical Journal of the American Society of Nephrology. May 2017.doi: https://doi.org/10.2215/CJN.11491116
• Bolignano D, Zoccali C. Effects of weight loss on renal function in obese CKD patients: a systematic review. Nephrology Dialysis Transplantation. 2013;28(Suppl 4):iv82-iv98.
• Centers for Disease Control and Prevention. National Chronic Kidney Disease Fact Sheet: general information and national estimates on chronic kidney disease in the United States, 2017. Atlanta, GA: US Department of Health and Human Services. Centers for Disease Control and Prevention website.
• https://www.cdc.gov/diabetes/pubs/pdf/kidney_factsheet.pdf
• Accessed June 21, 2017.
• Centers for Disease Control and Prevention. International Classification of Diseases, tenth revision (ICD-10-CM). Centers for Disease Control and Prevention website. https://www.cdc.gov/nchs/icd/icd10cm.htm Accessed August 18, 2017