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Principles of management of stage 3 CKD

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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  • if patient has stage 3 CKD should undergo
    • requires annual measurement of haemoglobin, potassium, calcium and phosphate
    • treatment of anaemia with intravenous iron ± erythropoiesis stimulating agents (ESAs), after exclusion of other causes of anaemia
      • threshold Hb concentration for initiation of an ESA should be 11 g/dL, and treatment adjusted to maintain Hb between 11 and 12 g/dL
      • patient’s functional needs and level of desired physical activity should be taken into account when deciding what level of Hb to aim for
      • lower levels of Hb should be accepted if the Hb fails to rise despite adequate iron replacement and a weekly dose of ESA equivalent to 300 iu/kg/week of epoietin alfa or beta
    • masurement of parathyroid hormone (PTH) concentration when stage 3 CKD is first diagnosed
    • treatment of disorders of calcium, phosphate, or PTH concentrations according to the guidance set out below
    • renal ultrasonography in patients with lower urinary tract symptoms or refractory hypertension or unexplained progressive fall in GFR
    • immunisation against influenza and pneumococcus
    • regular review of all prescribed medication, to ensure appropriate dose adjustments and the avoidance, wherever possible, of nephrotoxic drugs, including NSAIDs

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