Chronic kidney disease (CKD) is a primary-care staple, but NICE NG203 covers dozens of decisions. Here’s the distilled version clinicians look up most often.
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1) Diagnosing CKD
CKD is diagnosed when either:
- eGFR < 60 for ≥ 3 months, or
- ACR > 3 mg/mmol (A2+) for ≥ 3 months.
Key reminders:
- Use creatinine-based eGFR and confirm new findings with repeat testing.
- Adjust interpretation for extremes of muscle mass and pregnancy.
- Do not diagnose CKD on a single reduced eGFR unless life-threatening pathology is suspected.
2) GFR categories (G1–G5)
- G1: ≥ 90
- G2: 60–89
- G3a: 45–59
- G3b: 30–44
- G4: 15–29
- G5: < 15
Combine GFR category with albuminuria to determine risk and monitoring frequency.
3) Albuminuria categories (A1–A3)
- A1: <3
- A2: 3–30
- A3: >30
Albuminuria often carries more prognostic weight than eGFR alone.
4) Monitoring frequency by risk
| Risk level | ACR | eGFR | Monitoring |
|---|---|---|---|
| Low | A1 | G1–G2 | Annual |
| Moderate | A2 | G3 | 1–2× per year |
| High | A3 | G3b–G4 | 2–4× per year |
5) When to start ACE-I / ARB
Offer ACE-I/ARB to:
- Diabetes with ACR ≥ 3.
- Hypertension with ACR ≥ 30.
- Anyone with ACR ≥ 70, regardless of diabetes or blood pressure.
6) Referral to nephrology
- Declining eGFR (>5 ml/min/yr) or sustained drop ≥25%.
- A3 (>70) albuminuria.
- G4–G5 CKD.
- Suspected rare/genetic/rapidly progressive disease.
- Resistant hypertension.
7) Medication and safety
- Review nephrotoxins (NSAIDs, lithium, contrast).
- Consider SGLT2 inhibitors for diabetes + CKD.
- Adjust DOAC and antibiotic doses by eGFR.
If you need a specialty-specific view (e.g., diabetes, cardiology, or local nephrology thresholds), let us know and we’ll add it.