Chronic kidney disease: evaluation, staging, and management
What the major U.S. guidelines recommend, with a link to verify each at the source. A quick-reference summary for clinicians, not medical advice.
Stage by cause, eGFR (G1 >=90, G2 60-89, G3a 45-59, G3b 30-44, G4 15-29, G5 <15) and albuminuria ACR (A1 <30, A2 30-300, A3 >300 mg/g). Use creatinine plus cystatin C eGFR to confirm when decisions hinge on it. Target SBP <120 mm Hg by standardized office measurement.
Verify at KDIGO →SGLT2 inhibitor (1A) for adults with CKD and eGFR >=20 with ACR >=200 mg/g, for T2D plus CKD with eGFR >=20, or with heart failure regardless of albuminuria; suggested (2B) for eGFR 20-45 with ACR <200. Continue if eGFR later falls below 20; expected initial eGFR dip is not a reason to stop.
Verify at KDIGO →ACEi or ARB at highest approved, tolerated dose for CKD with moderate to severe albuminuria (ACR >=300, or 30-300 with diabetes). Recheck BP, SCr, and potassium within 2-4 weeks of start or dose increase. Continue when eGFR falls below 30 if tolerated. Do not combine ACEi, ARB, and direct renin inhibitor.
Verify at KDIGO →