Stages of Chronic Kidney Disease
The National Kidney Foundation classification of the stages of chronic kidney disease (Table 12;1 adapted from Levey et al2) is primarily based on GFR levels and therefore differs from other systems, in which staging is based primarily on urinary albumin excretion3 Studies have found decreased GFR in the absence of increased urine albumin excretion in a substantial percentage of adults with diabetes4 Serum creatinine should therefore be measured at least annually in all adults with diabetes, regardless of the degree of urine albumin excretion Serum creatinine should be used to estimate GFR and to stage the level of CKD, if present GFR calculators are available at http://www.nkdep.nih.gov/lab-evaluation/gfr-calculators.shtml93References American Diabetes Association. Standards of medical care in diabetes—2013. Diabetes Care 2013;36(suppl 1):S35-S36; Table 12. Levey AS, Coresh J, Balk E, et al for the National Kidney Foundation. National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Ann Intern Med 2003;139:137–147. Kramer H, Molitch ME. Screening for kidney disease in adults with diabetes. Diabetes Care 2005;28:1813-1816. Kramer HJ, Nguyen QD, Curhan G, Hsu CY. Renal insufficiency in the absence of albuminuria and retinopathy among adults with type 2 diabetes mellitus. JAMA 2003;289:3273-3277.