Kidney Health Health-Care Provider Information

Building blocks

Stages of Chronic Kidney Disease (CKD)

  • CKD is defined as abnormalities of kidney imaging, urinalysis, or function (eGFR <60 mls/min/1.73m2) for greater than 3 months.  
  • Based on eGFR and urine albumin-creatinine ratio.  
  • Both must be done in order to help guide diagnosis, management and predict risk of progression.  Imaging and kidney biopsy may also be required for diagnosis, management, and prognosis.  
  • Please refer to the heat map at: Chronic Kidney Disease Stages.
  • The higher the ACR, the greater the chance of progression of the chronic kidney disease.

eGFR

  • Best calculated by the CKD-EPI equation.  Can use qxmd.com
  • If reported <60 mls/min/1.73m2, should be repeated within 1 to 2 weeks to ensure it is not declining rapidly and if not, repeated again after 3 months to determine if persistent.
  • Interpret with caution in the very elderly, those with morbid obesity, those with low body mass index, patients who have amputations and in pregnancy.
  • Requires a correction factor for African American ethnicity – multiple eGFR by 1.21 for correct value.
  • Drugs that inhibit the tubular secretion of creatinine (such as trimethoprim, gemfibrozil, cimetidine) can affect eGFR accuracy.
  • Do not use eGFR in acute kidney injury.

    Urine albumin-creatinine ratio (ACR)

    • Spot urine collection, early morning specimen is best but any time of day is okay.
    • 2 of 3 tests must be greater than 2 mg/mmol if diabetic or greater than 3 mg/mmol if not diabetic.
    • Do NOT do a urine for ACR when:
      • Blood sugars are very high – i.e. Diabetes is poorly controlled.
      • Hypertension is poorly controlled.
      • The patient has an infectious illness.
      • Congestive heart failure is not controlled.
      • The patient has her menses.
      • The patient has been vigorously exercising in the past 48 hours.

    Kidney Failure Risk Equation (KFRE)

    • This tool identifies patients who are at increased risk of progression to end-stage kidney disease, especially when the eGFR is 30 to 60 mls/min. The equation requires age, sex, eGFR and ACR.
    • The results of this calculation stratify patients into no current risk, low risk, intermediate risk, and high risk for progression.
    • The KFRE can be accessed at: kidneyfailurerisk.com or at qxmd.com.

    Treatment Tips for People with Diabetes and CKD

    • All of these treatments are an attempt to decrease the urine ACR in order to decrease progression of kidney disease.
    • Control BP: Target BP is <130/80 mmHg for most people.  Multiple comorbidities and the frail elderly will have a target BP of 140/90 mmHg. 
    • Control Blood sugar: Target A1c is 7% or less for most people.  Multiple comorbidities and the frail elderly will have a target A1c of 7.5 to 8%.
    • Salt restriction: 1500 mg/day.
    • Protein restriction: 1 gm/kg/day.
    • Smoking cessation.
    • Control weight and/or modest weight loss.
    • Assess for sleep apnea.

    When to Refer to Nephrology

    • Acute kidney failure
    • eGFR <60 mls/min/1.73m2 with proteinuria and/or microscopic hematuria
    • Progressive decline in eGFR
    • Persistent proteinuria (2 of 3 urine samples)
    • Unexplained hematuria
    • Hereditary or unknown cause of CKD
    • Inability to achieve treatment targets or other difficulties in management of the CKD patient.
    • If in doubt, call LINK Nephrology through System Flow Coordination Centre. 

    Useful Resources