CKD Risk Assessment in Diabetes

Clinical Decision Support (CDS) Tool for CKD Risk Stratification in Diabetes

This Clinical Decision Support (CDS) tool evaluates the risk of Chronic Kidney Disease (CKD) progression, cardiovascular risk, and nephrology referral needs based on estimated Glomerular Filtration Rate (eGFR, calculated using the CKD-EPI Refit Equation) and Urinary Albumin-to-Creatinine Ratio (UACR). The tool is designed for patients with diabetes (T1DM or T2DM) and other CKD risk factors.

Type 1 Diabetes Mellitus (T1DM) for ≥5 years Type 2 Diabetes Mellitus (T2DM) Hypertension Cardiovascular Disease Anemia Hyperparathyroidism Urinary Albumin-to-Creatinine Ratio (UACR) >30 mg/g eGFR <60 mL/min/1.73m²

Diabetes management and risk assessment Chronic Kidney Disease (CKD) screening and monitoring Referral to nephrology based on risk stratification Guidance on SGLT2 inhibitors and CKD-specific treatments

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eGFR_cr = 142 x min(S_cr/κ, 1)^α x max(S_cr/κ, 1)^-1.200 x 0.9938^Age x 1.012 [if female]

where:

S_cr = standardized serum creatinine in mg/dL

κ = 0.7 (females) or 0.9 (males)

α = -0.241 (female) or -0.302 (male)

min(S_cr/κ, 1) is the minimum of S_cr/κ or 1.0

max(S_cr/κ, 1) is the maximum of S_cr/κ or 1.0

Age (years)

 

CKD Risk Stratification Based on eGFR & UACR:

Low Risk (G1-G2, A1) → Annual Monitoring

Moderate Risk (G1-G2, A2 or G3a, A1) → Monitor 1-2 times/year

High Risk (G3a, A2 or G3b, A1) → Monitor 2-3 times/year & Consider Nephrology Referral

Very High Risk (G3b, A2 or G4-G5, A3) → Monitor 4+ times/year & Nephrology Referral

eGFR <30 or UACR >300 → Immediate Nephrology Referra

American Diabetes Association Primary Care Advisory Group. 11. Chronic kidney disease and risk management: Standards of Care in Diabetes—2025 Abridged for Primary Care. Clin Diabetes. Published online ahead of print 1 April 2025 (doi: 10.2337/cd25-a011). ©2025 by the American Diabetes Association.

Börm Bruckmeier Verlag GmbH

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2025-02-27

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