principles of management of stage 3 CKD

Last edited 12/2022 and last reviewed 12/2022

• 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