CKD Identified
eGFR <60 or albuminuria >30mg/g for ≥3 months
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Internal MedicineManagement
Chronic Kidney Disease Management (KDIGO 2024)
Chronic Kidney Disease Management (KDIGO 2024): CKD Identified → Stage CKD (GFR + Albuminuria) → Assess Progression Risk → Lifestyle Interventions (All ...
Pathway Overview
13 steps
Algorithm Steps
13 total
01Start 02Action Stage CKD (GFR + Albuminuria)
Use CGA staging system
- G1: eGFR ≥90 (normal)
- G2: eGFR 60-89 (mild decrease)
- G3a: eGFR 45-59 (mild-moderate)
- G3b: eGFR 30-44 (moderate-severe)
- G4: eGFR 15-29 (severe)
- G5: eGFR <15 (kidney failure)
- A1: UACR <30 | A2: 30-300 | A3: >300
03Decision Assess Progression Risk
Use KFRE calculator for 2/5-year risk
- KFRE: Kidney Failure Risk Equation
- Variables: age, sex, eGFR, UACR
- High risk: >5% at 5 years
- Very high risk: >15% at 5 years
04Action Lifestyle Interventions (All CKD)
Foundation of management
- Smoking cessation
- Exercise: 150 min/week moderate
- Sodium <2g/day
- Protein: 0.8g/kg/day if advanced CKD
- Weight management
- Avoid NSAIDs
05Decision Diabetes Present?
Additional considerations for DKD
06Action Diabetic Kidney Disease
Glycemic + kidney-focused therapy
- A1c target ~7% (individualize)
- Metformin: can use to eGFR 30
- GLP-1 RA: CV/renal benefits
- SGLT2i: always if eligible
- Finerenone: if persistent albuminuria on ACE/ARB
07Action Monitor/Treat CKD Complications
Stage-appropriate screening
- Anemia: check Hgb if eGFR <45
- Mineral bone: PTH, Ca, Phos if eGFR <45
- Acidosis: HCO3 target 22-26
- Hyperkalemia: dietary, diuretics, K-binders
- Volume: loop diuretics for edema
08Action CV Risk Management
CKD = high CV risk
- Statin: all patients ≥50 with CKD
- Aspirin: if established ASCVD
- Smoking cessation critical
09Action Monitoring Frequency
Based on stage and risk
- G1-2, A1: yearly
- G3a, A2: 6-12 monthly
- G3b-4, A3: 3-6 monthly
- G5: 1-3 monthly
- More frequent if rapid progression
10Warning Nephrology Referral
When to refer
- eGFR <30 (plan for RRT)
- UACR >300 persistent
- Rapid progression (eGFR drop >5/year)
- Resistant hypertension
- Unexplained CKD, hematuria
- Hereditary kidney disease
11Action Non-Diabetic CKD
Focus on BP and SGLT2i
- ACE-I/ARB for proteinuria
- SGLT2i if significant proteinuria
- Treat underlying cause (GN, PKD, etc.)
- Avoid nephrotoxins
- Path rejoins step 07Shared downstream outcome
12Action BP Control
Target <120/80 if tolerated
- ACE-I or ARB first-line (especially if albuminuria)
- Target SBP <120 if tolerated, <130 otherwise
- Avoid ACE-I + ARB combination
- Monitor K+ and creatinine after initiation
- Path rejoins step 05Shared downstream outcome
13Action SGLT2 Inhibitor
Strongly recommended if eligible
- Dapagliflozin or empagliflozin
- Indicated: eGFR ≥20, especially if UACR ≥200
- Continue even if eGFR falls initially
- Benefits: kidney protection, CV protection
- Hold for surgery, acute illness
- Path rejoins step 05Shared downstream outcome
Guideline Source
KDIGO 2024 Clinical Practice Guideline for CKD Evaluation and Management
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 address dialysis initiation in detail
- Pediatric CKD not covered
- Transplant evaluation requires specialist input
- Drug dosing not included - refer to protocols
- Does not replace nephrology consultation for advanced CKD
Contraindicated Populations
pediatric
Applicable Regions
USEUGlobal
Global: KDIGO guidelines are internationally recognized
Version 1Next review: 2028-01-01
Next steps
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Related Resources
Frequently Asked Questions
What is the Chronic Kidney Disease Management (KDIGO 2024)?
The Chronic Kidney Disease Management (KDIGO 2024) is a management clinical algorithm for Internal Medicine. It provides a structured decision tree to guide clinical decision-making, based on KDIGO 2024 Clinical Practice Guideline for CKD Evaluation and Management.
What guideline is the Chronic Kidney Disease Management (KDIGO 2024) based on?
This algorithm is based on KDIGO 2024 Clinical Practice Guideline for CKD Evaluation and Management (DOI: 10.1016/j.kint.2023.10.018).
What are the limitations of the Chronic Kidney Disease Management (KDIGO 2024)?
Known limitations include: Does not address dialysis initiation in detail; Pediatric CKD not covered; Transplant evaluation requires specialist input; Drug dosing not included - refer to protocols; Does not replace nephrology consultation for advanced CKD. Individual patient factors may require deviation from these recommendations.
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