Chronic Kidney Disease (CKD)
CKD requires staging by kidney function and albuminuria, then management based on cause, progression risk, and complications. Staging and initial risk-based management are recommended using the KDIGO framework [1].
Staging and Risk Stratification
CKD severity is defined by estimated glomerular filtration rate (eGFR) and albuminuria category. [1]
- eGFR categories
- G1: ≥90 mL/min/1.73 m² with evidence of kidney damage
- G2: 60–89 mL/min/1.73 m²
- G3a: 45–59 mL/min/1.73 m²
- G3b: 30–44 mL/min/1.73 m²
- G4: 15–29 mL/min/1.73 m²
-
G5: <15 mL/min/1.73 m² or kidney failure [1]
-
Albuminuria categories
- A1: <30 mg/g
- A2: 30–300 mg/g
- A3: >300 mg/g [1]
Core Disease-Modifying Measures
Renin-angiotensin system blockade is recommended for proteinuric CKD to reduce progression risk. [1]
- Indication typically includes
- CKD with albuminuria, especially in the setting of diabetes or higher-risk albuminuria categories [1]
Kidney Function Monitoring and Follow-Up
Monitoring frequency should be based on CKD stage and albuminuria risk. [1]
- Monitoring commonly includes
- Serum creatinine/eGFR
- Urine albumin
- Serum potassium and bicarbonate (to guide medication safety and metabolic management) [1]
Treatment of CKD Complications
CKD care should address complications in a risk-stratified manner. [1]
- Examples of complication domains
- Anemia
- Bone-mineral disorders
- Metabolic acidosis
- Electrolyte abnormalities [1]
Referral Thresholds
Nephrology referral is recommended when CKD severity or progression risk is high or complications are difficult to manage. [1]
Information Needed to Provide a Specific Clinical Plan
CKD guidance can differ substantially by presentation. Please specify the intended use case:
- Whether the question is about CKD staging, CKD progression prevention, blood pressure targets/therapy, diabetes + CKD, anemia of CKD, CKD-MBD, or electrolyte/metabolic acidosis management.
- The available data:
- Latest eGFR
- Urine albumin-to-creatinine ratio (or protein-to-creatinine ratio)
- Etiology (if known)
- Comorbidities (diabetes, cardiovascular disease)
- Current medications (especially ACE inhibitor/ARB, SGLT2 inhibitor, diuretics)
Next Step
A targeted CKD management algorithm can be provided once the specific CKD problem domain is identified. [1]