Suspected or Confirmed CKD
Patient with reduced eGFR or markers of kidney damage
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NephrologyManagement
Chronic Kidney Disease (CKD) Evaluation & Management (KDIGO 2024)
Chronic Kidney Disease (CKD) Evaluation & Management (KDIGO 2024): Suspected or Confirmed CKD → Confirm CKD Diagnosis → Stage CKD (GFR + Albuminuria) → ...
Pathway Overview
13 steps
Algorithm Steps
13 total
01Start 02Action Confirm CKD Diagnosis
Requires abnormality for >3 months
- eGFR <60 mL/min/1.73m² on 2+ occasions ≥90 days apart, OR
- Markers of kidney damage present ≥3 months:
- - Albuminuria (ACR ≥30 mg/g)
- - Urine sediment abnormalities
- - Structural abnormalities on imaging
- - History of kidney transplant
03Action Stage CKD (GFR + Albuminuria)
Use CKD-EPI 2021 equation (race-free)
- G1: eGFR ≥90 (with kidney damage markers)
- G2: eGFR 60-89 (with kidney damage markers)
- G3a: eGFR 45-59
- G3b: eGFR 30-44
- G4: eGFR 15-29
- G5: eGFR <15
- ---
- A1: ACR <30 mg/g (normal-mild)
- A2: ACR 30-300 mg/g (moderate)
- A3: ACR >300 mg/g (severe)
04Action Determine Cause of CKD
Identify underlying etiology
- Most common: Diabetes, hypertension
- Consider: Glomerulonephritis, PKD, obstruction
- Workup: Urinalysis, renal US, consider biopsy if unclear
- Document cause for prognosis and treatment planning
05Decision Assess Progression Risk
Use KDIGO heat map (GFR × Albuminuria)
- Green (Low): G1-2/A1, G3a/A1
- Yellow (Moderate): G1-2/A2, G3a/A2, G3b/A1
- Orange (High): G1-2/A3, G3a/A3, G3b/A2, G4/A1
- Red (Very High): G3b/A3, G4/A2-3, G5 all
06Action Low-Moderate Risk
Primary care management, annual monitoring
- Annual eGFR and uACR
- BP target <130/80 mmHg
- Cardiovascular risk management
- SGLT2i if diabetic or high CV risk
07Action Kidney-Protective Therapies
Evidence-based interventions to slow progression
- ACEi or ARB: First-line for proteinuria (max tolerated dose)
- SGLT2i: Add for eGFR ≥20 (dapagliflozin, empagliflozin)
- Finerenone: Add for T2DM with albuminuria despite ACEi/ARB
- GLP-1 RA: Consider for T2DM with CKD
- Avoid NSAIDs
08Action Manage CKD Complications
Address metabolic consequences
- Anemia: Target Hgb 10-11.5 g/dL (ESA + iron)
- MBD: Monitor Ca, PO4, PTH; phosphate binders if needed
- Acidosis: Sodium bicarbonate if HCO3 <22 mEq/L
- Hyperkalemia: Dietary, K+ binders if needed
- Volume: Diuretics for edema
09Decision Nephrology Referral Indicated?
KDIGO 2024 referral criteria
- eGFR <30 (G4-5)
- Persistent ACR >300 despite treatment
- Rapid progression (eGFR decline >5/year)
- Unexplained hematuria
- Resistant hypertension
- Hereditary kidney disease
10Outcome Continue Primary Care
Ongoing monitoring per risk category
11Action Nephrology Referral
Co-management with specialist
- RRT planning (dialysis, transplant) for G4-5
- Vascular access planning 6-12 months before RRT
- Living donor evaluation
- Conservative care discussion if appropriate
12Outcome RRT Planning
Prepare for dialysis or transplant as needed
13Action High-Very High Risk
Intensive management, nephrology referral
- eGFR + uACR every 3-6 months
- BP target <130/80 with RAAS blockade
- SGLT2i (first-line for high risk)
- MRA (finerenone) if diabetic with albuminuria
- Nephrology referral
- Path rejoins step 07Shared downstream outcome
Guideline Source
KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease
Clinical Safety Information
Clinical Decision Support — Not a Substitute for Clinical Judgment
Individual patient factors may require deviation from these recommendations.
Known Limitations
- Does not replace nephrology consultation for complex cases
- eGFR equations may be inaccurate in extremes of muscle mass
- Albuminuria testing methods may vary between labs
- Simplified medication guidance - refer to full guideline for details
Contraindicated Populations
neonates
Applicable Regions
EUUSglobal
US: Race-free eGFR equations now standard per KDIGO 2024
global: KDIGO 2024 represents international consensus on CKD management
Version 1Next review: 2028-01-01
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eGFR (CKD-EPI 2021)
Estimated glomerular filtration rate using CKD-EPI 2021 equation (race-free)
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Related Resources
Frequently Asked Questions
What is the Chronic Kidney Disease (CKD) Evaluation & Management (KDIGO 2024)?
The Chronic Kidney Disease (CKD) Evaluation & Management (KDIGO 2024) is a management clinical algorithm for Nephrology. It provides a structured decision tree to guide clinical decision-making, based on KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease.
What guideline is the Chronic Kidney Disease (CKD) Evaluation & Management (KDIGO 2024) based on?
This algorithm is based on KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease (DOI: 10.1016/j.kint.2023.10.018).
What are the limitations of the Chronic Kidney Disease (CKD) Evaluation & Management (KDIGO 2024)?
Known limitations include: Does not replace nephrology consultation for complex cases; eGFR equations may be inaccurate in extremes of muscle mass; Albuminuria testing methods may vary between labs; Simplified medication guidance - refer to full guideline for details. Individual patient factors may require deviation from these recommendations.
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