Chronic Kidney Disease and the DOT Physical

What CDL drivers need to know about kidney disease, CKD staging, dialysis disqualification, and certification requirements.

Kidney disease: If you have kidney disease bring documentation or a letter from your treating physician stating that cause is confirmed, and treatment has been shown to be adequate/effective, safe, and stable. Bring in your most recent labs that include serum creatinine and eGFR (a cystatin C lab result is also acceptable, but not required).

 

What to Bring to Your DOT Physical if You Have Kidney Disease

• A letter from your treating physician stating that:
  • The cause of your kidney disease is confirmed
  • Treatment has been shown to be adequate and effective
  • Your condition is safe and stable
• Your most recent lab results including:
  • Serum creatinine
  • eGFR (estimated Glomerular Filtration Rate)
  • A cystatin C result is also acceptable, but not required

? Dialysis Is an Automatic Disqualifier

A CDL driver cannot operate a commercial motor vehicle (CMV) if they require dialysis for kidney failure. This applies to all forms of dialysis — hemodialysis and peritoneal dialysis. FMCSA strongly recommends that patients undergoing dialysis not be certified as physically qualified to operate commercial motor vehicles for the purposes of interstate commerce.

Kidney Disease vs. Chronic Kidney Disease (CKD)

• Kidney disease means your kidneys are not working properly and are beginning to lose function.
• Chronic kidney disease (CKD) worsens over time — specifically, for at least 3 months — and means the kidneys are damaged and losing their ability to filter your blood.
• In the early stages, most people have no symptoms. As CKD gets worse, waste builds up in the blood and causes illness.
• Kidney disease becomes chronic when function decreases over 3+ months. There is no cure, but damage can be slowed or stopped with treatment.
• Kidney failure can appear without warning — even though problems develop slowly. Once kidneys fail, dialysis or a kidney transplant is required to survive.
  • Kidney failure is also called Kidney Failure with Replacement Therapy (KFRT)

Key CKD Statistics

• Approximately 20 million Americans have CKD
• There are 340,057 patients currently on dialysis, with 106,912 new patients per year
• Better management is paying off — mortality for ESRD fell from 21.7% to 16.4%
• CKD cases rose from 97,300 in 1990 to 315,500 in 2019
  • By 2030, cases are projected to reach 423,300
  • The age-specific CKD incidence rate is projected to increase to 469.04 per 100,000 by 2030

Risk Factors for Chronic Kidney Disease

• High systolic (top number) blood pressure. Hypertension or high blood pressure is the second most common cause of kidney disease.

 

• High fasting blood glucose

 

• Diabetes is the most common cause of kidney disease, and about 1 in 3 adults with diabetes has kidney disease. Diabetes is the leading risk factor for CKD. Persons with diabetes make up the fastest-growing group of kidney dialysis and transplant recipients in the United States.

 

• Diabetes and hypertension together dramatically increase the risk of kidney failure. Diabetes and high blood pressure account for about 75% of new (incident) CKD cases.

 

• High body mass index (BMI)

 

• Body Mass Index (BMI) is a, calculation measuring a person’s weight relative to their height to screen for weight categories—underweight, healthy, overweight, or obese.

 

• Body Mass Index (BMI) Quickly screens for weight categories that might lead to health problems like high blood pressure, heart disease, or diabetes.

 

• Calculate your BMI with CDC’s Adult BMI Calculator

 

• Other causes of CKD include: glomerular diseases (diseases that damage the kidney’s filtering units): glomerulonephritis, IgA nephropathy (IgAN), and HIV nephropathy; inherited conditions: polycystic kidney disease; autoimmune conditions: lupus (lupus nephritis); membranous nephropathy (MN); severe infections: sepsis and hemolytic uremic syndrome (HUS); kidney cancer; kidney stones; frequent untreated and/or long-lasting urinary tract infections (UTIs) and obstructions; hydronephrosis; kidney and urinary tract abnormalities before birth; nephrotic syndrome; exposure to certain chemicals, toxins, contrast dyes, and drugs (including overuse of NSAIDs (nonsteroidal anti-inflammatory drug pain relievers like ibuprofen)); etc.

 

• Lupus nephritis (LN), a major cause of kidney disease, is an inflammation of the kidneys caused by lupus, an autoimmune disease (systemic lupus erythematosus (SLE)). About half of people diagnosed with lupus nephritis didn’t know they had it. The prevalence of LN is 30.9 per 100,000, and it is most common at ages 20 to 40. Lupus nephritis (LN) patients are mostly Black/African American, White, and Hispanic/Latino people, but it affects all races and ethnicities. 9 out of 10 people with lupus are women, but men are more likely to develop lupus nephritis.

Morbidity and Mortality Risk

• Mortality: CKD is a top-10 leading cause of death globally, claiming nearly 1.5 million lives annually — with rates increasing rather than declining
• Cardiovascular Impact: Kidney dysfunction is responsible for 11.5% of global cardiovascular deaths
  • Kidney disease and heart disease share common risk factors (diabetes, hypertension)
  • Each condition can cause or worsen the other
• Hospitalization: Among Medicare beneficiaries with CKD, 30-day readmission rates reach up to 36.7% for Stage 5
• Progression to ESRD: Roughly 11.3% of community-based CKD patients (Stages 3–5) progress to end-stage renal disease within 3 years — while 37.5% die
• Common Comorbidities (two or more conditions existing simultaneously):
  • Physical: heart failure, COPD, obesity, diabetes, renal insufficiency
  • Mental/Behavioral: depression, anxiety, substance use disorders

The 5 Stages of Chronic Kidney Disease

Staging is determined by blood tests measuring eGFR (estimated Glomerular Filtration Rate) and albuminuria (protein in urine).

Stage 1 — Normal / High Function
eGFR: 90 or higher — with evidence of kidney damage
Evidence of damage (e.g., protein in urine) must be present for 3+ months. eGFR alone in Stage 1 or 2 does not fulfill CKD criteria without evidence of damage.Stage 2 — Mild Reduction*
eGFR: 60–89 — with evidence of kidney damage
*Relative to young adult level. eGFR 60–89 without kidney damage is normal and does not qualify as CKD.Stage 3a — Mild to Moderate Reduction
eGFR: 45–59Stage 3b — Moderate to Severe Reduction
eGFR: 30–44Stage 4 — Severe Reduction
eGFR: 15–29
Significant reduction. High risk of sudden incapacitation. Additional testing required for CMV certification.Stage 5 — Kidney Failure
eGFR: Less than 15
Dialysis or transplant required. DISQUALIFIED from operating a CMV.

DOT Physical Exam Determinations for CKD Drivers

• Summary of CMV driver major physical requirements: The demands of a commercial driver include loading/unloading heavy cargo, tarping trailers, coupling/uncoupling trailers, inspecting brake lines and putting on tire chains and require perceptual skills to monitor a complex driving situation and judgment skills to make quick decisions in addition to the ability to control an oversize steering wheel, shift gears using a manual transmission, maneuver a vehicle in crowded areas, enter and exit the cab frequently, and the ability to climb ladders on the tractor/trailer.

CKD Stages 1 and 2 — Certify / Recertify Every 2 Years2-Year Certificate

• • Certification of individuals with stages 1, 2 or 3 may be considered as physically qualified to drive a commercial motor vehicle. Unless they are restricted for another reason (example: cardiovascular disease, etc.)

   

  • CKD Stages 1 and 2 Evaluate/recertify every two years, unless there are other comorbidities.

   

  • CKD Stage 3 Evaluate/recertify every one year.

   

  • Clinical signs and symptoms of CKD do not usually appear during stage 3.

   

  • Given the lack of evidence that individuals with early CKD are a safety risk, restriction of driving privileges in stage 3 would be inappropriate.

   

  • No evidence (either direct or indirect) suggests stage-1, stage 2, or stage 3 CKD drivers are at an increased risk for a motor vehicle crash

   

  • Stage 3 must be more closely monitored because, kidney function progressively declines in approximately 85% of patients with CKD.

   

  • CKD Stage 4 requires more testing to assess risk

   

  • Normal EKG and a blood pressure less than 140/90 mm Hg: may be certified for a period not to exceed 6 months, whereupon the individual must present for re-certification.

   

  • Normal EKG and blood pressure 140-179 mm Hg (systolic) or 90-109 (diastolic): may be certified for a period not to exceed 3 months, whereupon the individual must present for re-certification.

   

  • An EKG or echogram that reveals left ventricular hypertrophy or a blood pressure that is greater than or equal to 180 mm Hg systolic or greater than or equal to 110 mm Hg diastolic disqualifies one from driving a CMV.

   

  • Primary reason to restrict driving privileges CKD 4 is the high risk for sudden incapacitation or death

   

  • CKD is an independent risk factor for coronary artery disease, left ventricular hypertrophy (LVH) and sudden death, even before dialysis.

   

  • The American Heart Association published a statement recommending that patients with chronic kidney disease are in the “highest risk group” for subsequent cardiovascular disease.

   

  • CKD Stage 5 are Disqualified

   

  • Drivers who require renal replacement (Dialysis) therapy with stage 5 CKD cannot be considered fit for duty and should be DISQUALIFIED from operating a commercial motor vehicle.

   

  • Dialysis is an automatic disqualifier. A CDL driver cannot operate a commercial motor vehicle (CMV) that needs dialysis for kidney failure.

   

  • Indirect evidence consistently demonstrates that, on average, individuals with renal failure exhibit cognitive impairments across several domains thought to be associated with decreased driving performance.

   

  • Dialysis patients face increased driving safety risks due to post-session fatigue, dizziness, hypotension (low blood pressure), and, in some cases, hypoglycemia or blurred vision. Studies indicate up to 15-29% of patients on hemodialysis have been involved in at-fault motor vehicle collisions. Safe driving of any kind requires adequate recovery time post-treatment. It is often recommended to avoid driving the day of dialysis treatment. CMV drivers are always held to higher standard of physical fitness requirements.

   

  • Post-Dialysis Fatigue & Weakness: Intense tiredness and muscle weakness after dialysis sessions impair reaction times.

   

  • Dizziness and Hypotension: Rapid fluid removal causes low blood pressure, leading to dizziness or lightheadedness while driving.

   

  • There is a direct association between renal failure, dialysis, and disturbed sleep.

   

  • Hypoglycemia post dialysis is risk in dialysis patients with diabetes. Low blood sugar can occur suddenly causing confusion and dizziness.

   

  • Driving long distances maintaining compliance with dialysis regimens is logistically unsound and unsafe.

   

  • Driving with a portable dialysis machine is logistically unsound and unsafe.

   

  • Neurological complications associated with dialysis include dialysis dementia, disequilibrium syndrome, cerebrovascular accidents, hypertensive encephalopathy, Wernicke’s encephalopathy, hemorrhagic stroke, intracranial hypertension, and aggravation of pre-existing atherosclerosis.

   

  • Small blood vessel disease of the brain is independently associated with the severity of kidney disease and is a common cause of vascular dementia, typically presenting with impairments in attention, executive function, and processing speed, all of which are required for safe driving.

   

  • Functional magnetic resonance imaging (MRI) has demonstrated reduced blood perfusion in the frontal lobe of patients on hemodialysis. This area of the brain is largely responsible for driving-related functions like memory, movement, and executive function.

   

  • Cognitive impairment being remarkably common in chronic kidney disease (CKD). Studies have demonstrated cognitive impairment in both patients on hemodialysis and patients on peritoneal dialysis.

   

  • Another deleterious effect of hemodialysis may arise from its episodic nature (3 times per week typically). Hemodialysis clears uremic toxins only when patients are connected to the dialysis machine. As uremic toxins builds up over the time interval between dialysis treatments, deficits in attention and memory develop, resulting from the accumulation of uremic metabolites.

   

  • Hemodialysis patients may also experience muscle atrophy and related weakness and impaired movement that may impede an individual’s ability to safely operate a CMV.

   

  • Dialysis patients have a higher risk of sudden cardiac death that is associated with left ventricular hypertrophy and cardiovascular disease.

   

  • Dialysis per se causes changes to the heart. Hypotension (low blood pressure), transient myocardial ischemia (angina) and the potential for arrhythmias may accompany dialysis.

   

  • It will be impossible to control the timing of the dialysis treatment and the activity of commercial driving. Many non-commercial drives don’t even feel safe driving themselves to and from dialysis treatments.

   

  • Most individuals feel “wiped out” after a dialysis treatment and dialysis treatments are usually three times per week.

   

  • If dialysis sessions require a new dialysis regimen then that change in regimen protocol can impair driving ability, such as electrolyte imbalances, infection, hypotension, weakness, or ischemic coronary events (angina & heart attacks).

   

  • Dialysis patients are at risk of driving impairment based on self-reported questionnaire responses in a 2021 Australian study. Upwards of 44.8% of dialysis patients felt at risk of driving impairment based on anonymous self-reported questionnaire responses. In the US and Canada around 40% to 50% of dialysis patients per self-reports do not feel safe to drive that day of their dialysis treatment.

   

  • Many CMV drivers are not honest with their treating doctors and even less honest with DOT medical examiners. During a DOT physical, drivers frequently don’t disclose the severity or even the existence of a major medical condition that would shorten their medical certificate length or disqualify them entirely from CMV driving. There is an entire “truck stop culture” that encourages excluding disqualifying conditions and/or medications from their DOT physical exam. It is even more tempting for a CMV driver that needs dialysis to live and CDL driving income to down play or not truthfully disclose dangerous side effects of dialysis that could impair safe driving. Not only does this make evaluating a complex condition like end-stage kidney disease difficult to evaluate, it also creates increased legal liability for both the CMV driver and the medical examiner.

   

  • FMCSA strongly recommends that patients undergoing dialysis not be certified as physically qualified to operate commercial motor vehicles for the purposes of interstate commerce. It would be a massive liability for a Medical Examiner to certify a driver “fit for duty” that requires dialysis of any kind. There is strong evidence of risk for sudden driver incapacitation.

Why Dialysis Disqualifies a CDL Driver

• Post-Dialysis Fatigue & Weakness
  • Intense tiredness and muscle weakness after dialysis sessions impair reaction times
  • Hemodialysis patients may experience muscle atrophy and weakness that impedes ability to safely operate a CMV
• Dizziness and Hypotension
  • Rapid fluid removal causes low blood pressure, leading to dizziness or lightheadedness
  • Hypotension, transient myocardial ischemia, and arrhythmias may accompany dialysis sessions
• Sleep Disturbance
  • There is a direct association between renal failure, dialysis, and disturbed sleep
  • Sleep-disordered breathing is associated with increased crash risk
• Hypoglycemia Risk
  • Dialysis patients with diabetes are at risk of sudden low blood sugar, causing confusion and dizziness
• Cognitive Impairment
  • Indirect evidence consistently demonstrates impaired neurocognition in dialysis patients across multiple domains
  • Functional MRI shows reduced blood flow to the frontal lobe — the area governing memory, movement, and executive function
  • Uremic toxins accumulate between dialysis sessions (typically 3×/week), producing deficits in attention and memory between treatments
• Neurological Complications
  • Associated conditions include: dialysis dementia, disequilibrium syndrome, cerebrovascular accidents, hypertensive encephalopathy, Wernicke’s encephalopathy, hemorrhagic stroke, intracranial hypertension
  • Small blood vessel disease of the brain — associated with kidney disease severity — causes vascular dementia with impairments in attention, executive function, and processing speed
• Cardiac Risk
  • Dialysis patients have a higher risk of sudden cardiac death associated with left ventricular hypertrophy
  • Dialysis per se causes changes to the heart — including hypotension, transient ischemia, and arrhythmias
• Logistical Impossibility
  • It is impossible to coordinate dialysis treatment timing with the demands of commercial driving
  • Driving with a portable dialysis machine is logistically unsound and unsafe
  • Most patients feel “wiped out” after dialysis — treatments are typically 3× per week
• Crash Data
  • Studies indicate 15–29% of hemodialysis patients have been involved in at-fault motor vehicle collisions
  • In the U.S. and Canada, 40–50% of dialysis patients self-report not feeling safe to drive on the day of treatment
  • A 2021 Australian study found 44.8% of dialysis patients felt at risk of driving impairment based on anonymous self-reporting
• Non-Disclosure Risk
  • Many CMV drivers underreport major medical conditions during DOT physicals — especially when their livelihood depends on their CDL
  • A “truck stop culture” exists that encourages hiding disqualifying conditions from examiners
  • Non-disclosure of dialysis creates significant legal liability for both the driver and the Medical Examiner

Albuminuria Categories in CKD

Category	ACR (mg/g)	Description
A1	< 30	Normal to mildly increased
A2	30–300	Moderately increased*
A3	> 300	Severely increased** (including nephrotic syndrome: ACR > 2220 mg/g)

ACR = albumin-to-creatinine ratio. *Relative to young adult level. **Including nephrotic syndrome.

Cystatin C — The Most Accurate Marker to Detect CKD

Cystatin C is a highly accurate blood marker for assessing kidney function. It is particularly useful when creatinine tests are unreliable due to low muscle mass, obesity, or specific diseases. It is a protein produced by all nucleated cells, filtered by the kidneys at a constant rate — high levels indicate reduced kidney function.

• Superior Accuracy — Unlike creatinine, cystatin C is generally unaffected by muscle mass, age, gender, or diet
• Early Detection — Can detect subtle, early declines in renal function faster than creatinine
• Best Use — Used to confirm CKD, particularly when eGFR is in the 45–60 mL/min/1.73m² range; also valuable for patients with low muscle mass (elderly, amputees, chronic illness)
• Limitations
  • More expensive and less widely available than creatinine
  • Levels can be influenced by thyroid issues, high-dose corticosteroids, or smoking

Kidney Failure / End-Stage Kidney Disease (ESKD)

Kidney failure — also called End-Stage Renal Disease (ESRD) or Kidney Failure with Replacement Therapy (KFRT) — means one or both kidneys have completely shut down. This is an irreversible, life-threatening condition.

• Nearly 808,000 people in the U.S. (2 in every 1,000) live with ESKD — 69% on dialysis, 31% with a kidney transplant (2020 data)
• 130,500 people started treatment for ESKD in 2020
• Among men, the incidence of ESKD is 60% higher than among women
• Major causes of ESKD in the U.S. (2020 data):
  • Diabetes: 38%
  • High blood pressure: 27%
  • Together accounting for 65% of all ESKD cases

Identifying the Cause of CKD

The cause of CKD is classified based on the presence or absence of systemic disease and the location of pathologic findings on kidney biopsy or imaging. Determining the cause distinguishes whether the patient has a systemic condition or a localized kidney condition — which directly affects management.

Cause Category	Systemic Diseases Affecting the Kidney	Primary Kidney Diseases (no systemic disease)
Glomerular diseases	Diabetes, systemic autoimmune diseases, systemic infections, drugs, neoplasia (including amyloidosis)	Diffuse, focal or crescentic proliferative glomerulonephritis; focal and segmental glomerulosclerosis; membranous nephropathy; minimal change disease
Tubulointerstitial diseases	Systemic infections, autoimmune, sarcoidosis, drugs, urate, environmental toxins (lead), neoplasia (myeloma)	Urinary tract infections, stones, obstruction
Vascular diseases	Atherosclerosis, hypertension, ischemia, cholesterol emboli, systemic vasculitis, thrombotic microangiopathy, systemic sclerosis	ANCA-associated renal limited vasculitis; fibromuscular dysplasia
Cystic & congenital diseases	Polycystic kidney disease, Alport’s syndrome, Fabry’s disease	Renal dysplasia, medullary cystic disease, podocytopathies

Note: Genetic diseases are not listed separately as many diseases in each category now have recognized genetic determinants.

How Is Kidney Disease Treated?

Early detection is critical — CKD can be slowed or stopped when caught early. Two simple tests can check for CKD:

• Blood test: eGFR (estimated Glomerular Filtration Rate)
• Urine test: uACR (urine albumin-creatinine ratio)

Early treatment includes:

• Diet modifications (see below)
• Exercise and weight management
• Medications; lifestyle changes (stopping smoking)
• Avoiding NSAIDs (ibuprofen, naproxen, etc.)
• Treating underlying risk factors: diabetes and hypertension

Once kidneys fail, there are two treatment options:

Option 1: Dialysis — ? Automatic DOT Disqualifier

Dialysis removes waste and excess fluid from the blood. It comes in two forms:

• Hemodialysis (HD)
  • Performed 3–4 times per week; blood is pumped through a dialysis machine, cleaned, and returned
  • Can be done at a dialysis center (“in-center”) or at home (“home hemodialysis”)
• Peritoneal Dialysis (PD)
  • Blood is cleaned inside the body daily through the lining of the abdomen using a special fluid
  • Can be done at home, at work, at school, or during travel

Dialysis of any kind is an automatic disqualification from the DOT Physical. A CDL driver cannot operate a CMV if they require dialysis for kidney failure.

Option 2: Kidney Transplantation

A kidney transplant uses a healthy kidney from a living or deceased donor. Studies show transplant recipients live longer than those who remain on dialysis.

• Benefits over dialysis: better quality of life, lower risk of death, fewer dietary restrictions, easier travel, lower treatment cost, greater ability to remain employed
• A transplant is a treatment, not a cure — antirejection medications are required ongoing
• More than 27,000 kidney transplants were performed in the U.S. in 2023
• Approximately 90,000 people are on the waiting list; average wait is 2–5 years (up to 10 years)
• 12 people die every day waiting for a kidney transplant

CDL Certification After Kidney Transplant:

• May return to operating a CMV after 90 days post-operatively, provided the transplant physician has cleared the driver as fit-for-duty to operate a commercial motor vehicle
• Must bring:
  • A letter from the treating doctor stating the transplant is stable and the driver is “safe to drive a commercial motor vehicle” — the letter must say “commercial motor vehicle,” not just “drive”
  • Most recent labs with kidney function tests (not older than 6 months)
• Re-certification schedule after clearance:
  • At 3 months, 6 months, and 12 months post-clearance
  • Then annually thereafter
• A stable, well-documented transplant can be certified for up to one year

Chronic Kidney Disease Diet

The Modification of Diet in Renal Disease (MDRD) is a critical management strategy to slow CKD progression by controlling what you eat and drink.

• • Protein Restriction: Reducing protein intake (e.g.,0.58 to 0.75 g/kg/day) reduces the workload on the kidneys and minimizes waste product accumulation.

  • ·        Phosphorus Management: Restricting high-phosphorus foods
    (dairy, cola, processed foods) prevents weak bones and mineral imbalances.

    ·       
    Potassium Control: Limiting high-potassium foods
    (bananas, potatoes, tomatoes) is necessary when kidney function declines to
    prevent dangerous blood levels.

    ·       
    Fluid Management: Limiting fluids is often necessary,
    especially in advanced stages or if swelling occurs.

    ·       
    Energy Intake: Maintaining an adequate calorie
    intake is crucial to prevent muscle breakdown. 

    ·       
    The seminal MDRD study: demonstrated that while reducing
    protein intake to very low levels (0.28 g/kg/day) did not significantly slow
    the progression to end-stage renal disease compared to a moderate low-protein
    diet (0.58 g/kg/day), it did highlight that protein restriction, alongside
    blood pressure control, is essential in managing kidney health.

    ·       
    Individual Needs and Expert Advice: Dietary needs vary
    significantly based on the stage of CKD and whether the patient is on dialysis.
    A renal dietitian is essential for tailoring a meal plan

The DASH Diet

The DASH diet (Dietary Approaches to Stop Hypertension) is a healthy-eating plan designed to treat or prevent high blood pressure — one of the top CKD risk factors.

• DASH diet emphasizes:
  • Vegetables, fruits, and whole grains
  • Fat-free or low-fat dairy products
  • Fish and poultry (low in saturated fats)
  • Beans and nuts
• DASH diet limits:
  • Fatty meats (beef, pork, lamb)
  • Full-fat dairy products
  • Tropical oils (coconut and palm)
  • Sweets and sugar-sweetened drinks

Learn more about the DASH Diet at the National Kidney Foundation ?

Dietary needs vary significantly based on CKD stage and whether the patient is on dialysis. A renal dietitian is essential for a personalized meal plan.

Essential Lifestyle Changes for Managing CKD

• Exercise — Aim for 30 minutes of moderate activity (walking, swimming) most days of the week
• Weight Management — Maintain a healthy weight to reduce strain on the kidneys
  • Calculate your BMI with the CDC Adult BMI Calculator
• Quit Smoking — Smoking accelerates kidney damage and significantly increases cardiovascular risk
• Limit Alcohol — Reduce or eliminate alcohol intake
• Hydration — Drink appropriate amounts of water as directed by your doctor

Which CDL Drivers Should Be Screened for CKD?

Many drivers are unaware they have CKD. Research shows:

• Nearly 24% of CKD patients are unaware of their condition (NHANES study)
• 70% with Stage 2, 78% with Stage 3, and 55% with Stage 4 were unaware of their CKD
• 92% of individuals with Stage 3 and 75% with Stage 4 were unaware (Hsu study)

CDL drivers who should be screened (eGFR from serum creatinine):

• Drivers with a known history of CKD
• Drivers with a family history of CKD
• Drivers over 65 years of age
• Drivers with diabetes
• Drivers with hypertension
• Drivers with proteinuria (protein in the urine)

Ideally, all CDL drivers should have a serum creatinine test and calculated eGFR. At minimum, all drivers with any of the above risk factors should be tested.

? Final Reminder: Dialysis Is an Automatic Disqualifier

A CDL driver cannot operate a commercial motor vehicle (CMV) if they require dialysis for kidney failure. FMCSA strongly recommends that patients undergoing dialysis not be certified as physically qualified to operate commercial motor vehicles for interstate commerce. There is strong evidence of risk for sudden driver incapacitation.

About This Page

This page is for informational purposes only. FMCSA and DOT regulations and guidelines are constantly being updated. Please go to www.fmcsa.dot.gov for the most current and complete information.