Summary Practice Guidelines
Assess GFR using the CKD-EPI equation. A calculator for estimating GFR can be found at http://www.kidney.org/professionals/kdoqi/gfr.cfm . This is also available as a smartphone app Refer to a nephrologist when GFR <60 ml/min An AV fistula should be fashioned when the GFR <25ml/min Start HD when GFR is 5-10 ml/min or if symptomatic Adequacy targets for HD: Kt/V >1.2 or URR >
Assess GFR using the CKD-EPI equation. A calculator for estimating GFR can be found at http://www.kidney.org/professionals/kdoqi/gfr.cfm. This is also available as a smartphone app
Refer to a nephrologist when GFR <60 ml/min
An AV fistula should be fashioned when the GFR <25ml/min
Start HD when GFR is 5-10 ml/min or if symptomatic
Adequacy targets for HD: Kt/V >1.2 or URR >65%
Target Hb is 10-12 g/dl
IV Fe needed if transferrin saturation <20% or serum ferritin <200ng/ml
Blood pressure target <140/90
Bone disease: maintain phosphate 0.8-1.4 mmo/l and Ca 2.05-2.45 mmol/l
Start CAPD when GFR 5-10 ml/min or if symptomatic
Adequacy targets for CAPD: weekly Kt/V of 1.7 or creatinine clearance 50l/1.73 m2
Click on the image to enlarge.
* Repeat Hb:
Shortly after blood transfusion or hospital admission / As often as weekly if 12.5
**PTH level - additional protocol should apply:
PTH levels above x10 normal range - repeat monthly together with calcium and phosphate levels
***Post-parathyroidectomy repeat calcium tests:
Twice per week if <2.0 / Weekly for the first 4 weeks / Monthly for the first 3 months
****Only for patients with Hepatitis B S-antibodies <5 level
# Can reduce test frequency when online clearance monitoring is used
Paget G, Naicker S, et al. Guideline for the optimal care of patients on chronic dialysis in South Africa. South African Renal Society; 2015.