Date



Date ___ /___ / ___

Dear _________________________,

I was pleased to see your patient, ______________________, in my office on ___ /___ / ___ for evaluation of chronic kidney disease (CKD). Your patient has diabetic/non-diabetic CKD, Stage 4/5 (eGFR __mL/min/1.73m²), associated with ____ ______(glomerular, vascular, tubulo-interstitial, or cystic disease - e.g. with biopsy-proven diabetic glomerulosclerosis). The major issues and goals to be addressed at this stage are: establishing the cause of the CKD; optimizing BP, lipid, and diabetes management; evaluation and treatment of anemia, calcium, phosphorus, and metabolic derangements; avoidance of nephrotoxic agents; attention to nutrition; ongoing review of medications/doses that may need adjustment in advanced CKD; education about renal replacement therapy options; and referral for vascular access when appropriate.

I recommend the following: monitor and treat diabetes with goal A1C ................
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