Draft: not yet reviewed by a clinician
Use this page to prepare questions for your care team. It does not replace their advice. Your own targets and doses come from your nephrologist, diabetes team and renal dietitian.
About this handbook¶
Please read this first¶
This handbook and the kidney-health app support your care team; they never replace it. The nephrologist, the diabetes team and the renal dietitian set the real targets for potassium, phosphorus, sodium, protein, fluid and blood glucose from your own blood tests, urine output, medicines and insulin plan, and they change them as your labs change. Every guideline cited here says this; KDIGO 2024 asks clinicians to "use renal dietitians or accredited nutrition providers" to tailor sodium, phosphorus, potassium and protein "to their individual needs" (KDIGO 2024, practice point 3.3.2). The numbers in the handbook are starting points that your care team should overwrite in the app. Nothing here changes an insulin or medicine dose. It is education, not medical advice, and not a medical device.
Editorial policy¶
- Sources. Every clinical statement cites a source from the bibliography, and every medical page lists at least three. Guidelines (KDIGO, KDOQI, ADA, ISPD) come first, then government and charity patient pages, then studies.
- Numbers. Every number has a unit and a source. Lab ranges come with "your lab's range wins". Food values come from USDA FoodData Central through the app's food list; menus, grocery lists and target tables are generated from the same data the app uses, so the handbook and the app agree.
- No doses. The handbook never gives an insulin or medicine dose or a dose change, and never tells anyone to stop a medicine. It says "ask your team whether to pause X when you are ill, and get it in writing". A build check rejects dose-like text on the diabetes and medicine pages.
- Lows first. Treating low blood glucose is never delayed or warned against.
- Specialist care. Pregnancy and children are referred to specialists.
- Plain words. Pages aim for a US grade 8 reading level and are checked for understandability and actionability with AHRQ's PEMAT (PEMAT) and the CDC Clear Communication Index (CCI). KDIGO terms are used ("kidney failure", "kidney replacement therapy"); "ESRD" appears only as Medicare's legal name.
- Copyright. We paraphrase; we do not copy text, tables or recipes from NKF, AKF, DaVita or the ADA, or adapt KDIGO tables and figures (KDIGO guidelines are CC BY-NC-ND). We quote at most one sentence, with attribution. NIDDK material is mostly in the public domain (NIDDK).
Clinical review¶
Every page shows a draft banner until a named reviewer signs it off in the page's front matter
(status: reviewed, reviewed_by, reviewed_on).
| Section | Reviewer |
|---|---|
| Eating well | renal dietitian (RDN, ideally board-certified in renal nutrition) |
| Stages, lab results, medicines, preparing for treatment, get help now | nephrologist or nephrology nurse practitioner or physician assistant |
| Type 1 diabetes | diabetes specialist or CDCES |
| Living well | nephrologist or nephrology nurse practitioner or physician assistant; ideally a kidney social worker for work, costs and benefits |
| Using the app | the project maintainer, plus a renal dietitian for targets and warnings |
| Self-hosting | the project maintainer |
| Every patient page | one patient or caregiver, for clarity |
Pages are reviewed every 12 months; each December after the new ADA Standards and any new KDIGO guideline; within 30 days of an FDA approval or safety notice that touches a page; and each November for Medicare amounts.
Review log¶
| Date | Pages | Reviewer | Notes |
|---|---|---|---|
| 2026-10-05 | all | – | First draft; structure and the eating pages migrated from the original diet guide. Not yet clinically reviewed. |
| 2026-10-06 | Start here, Get help now, Wallet cards, Questions to ask, Understanding CKD (3 pages), Glossary, Units, Licences | – | Written and fact-checked against primary sources (KDIGO 2024 and 2022, ADA 2026, the 2024 hyperglycemic crises consensus, the Kerendia label and FINE-ONE, NIDDK, CDC, NHS). Not yet clinically reviewed. |
| 2026-10-06 | Stages, lab results, eating well, type 1 diabetes, medicines, using the app, self-hosting | – | Fact-checked section by section against primary sources. Preparing for treatment and Living well have not yet had an independent fact-check. Not yet clinically reviewed. |
| 2026-10-06 | all | – | Consistency pass: the same numbers and terms on every page, US spelling, every abbreviation in the glossary, cross-links, layout fixes for phones. Not yet clinically reviewed. |
Questions for clinical reviewers¶
Points where sources differ or where the handbook made a judgment call. Reviewers, please confirm or correct them first.
| Page | Point | What the handbook says now |
|---|---|---|
| Get help now | Blood ketones 1.6–2.9 mmol/L: the NHS says speak to your diabetes team; the ADA says seek emergency care | Call the diabetes team now; go to the emergency department if they cannot be reached quickly or if vomiting |
| Get help now | Fever after a transplant: the spec put "fever with chills" in the 911 tier; NIDDK says call the transplant center for a fever over 100 °F | 911 for signs of sepsis (fever or shivering with confusion, fast heartbeat, breathlessness); transplant center the same day for fever over 100 °F |
| Get help now | Fistula or graft bleeding | 911 if heavy or spurting, or not stopped after 10–15 minutes of firm pressure (AKF) |
| Get help now | Peritonitis: "keep the bag" | Taken from the content plan's reading of the ISPD 2022 guideline; its full text was not open to re-check |
| Using the app | The potassium_additive warning (ARCHITECTURE.md v0.3 item 9) |
A medium warning, "contains a potassium additive; potassium not listed", when potassium is unknown |
Suggest a correction¶
Open an issue at https://github.com/ksullivan86/kidney-health/issues with the page, the sentence, and the source that shows the correct fact. Clinicians are especially welcome. Never post your own health information in an issue.
Licence¶
The handbook text is licensed CC BY-NC-SA 4.0 (Creative Commons): you may copy, print and adapt it for non-commercial use with credit, and share adaptations under the same licence. The app's code is licensed PolyForm Noncommercial 1.0.0. Third-party material keeps its own licence; see Licences and the licence column of the sources.
Sources¶
- KDIGO 2024 CKD guideline: practice point 3.3.2.
- AHRQ: PEMAT; CDC Clear Communication Index.
- NIDDK: copyright.
- CC BY-NC-SA 4.0.
Not yet reviewed by a clinician. Facts and sources last checked 2026-10-06.