KDIGO 2024 CKD Guideline and Staging: Quick Reference
The bottom line of the KDIGO 2024 guideline on chronic kidney disease: how CKD is defined and staged by cause, eGFR and albuminuria, how to estimate GFR, how to judge the risk of kidney failure, and the drugs that slow progression.
At a glance
- CKD means abnormal kidney structure or function for more than 3 months: an eGFR under 60, or markers of damage such as albuminuria.
- Stage every patient by Cause, GFR category (G1 to G5) and Albuminuria category (A1 to A3); both eGFR and albuminuria predict outcomes.
- Estimate GFR with a race-free creatinine equation and add cystatin C when creatinine is unreliable or the decision depends on precision.
- Use a validated risk equation (such as the KFRE) in G3 to G5 to estimate the risk of kidney failure and time referral.
- Foundation therapy for most: a RAS blocker for albuminuria, an SGLT2 inhibitor, a statin, and blood pressure control.
Key recommendations
Definition and staging
Diagnose CKD when eGFR is under 60 mL/min/1.73 m2 or there are markers of kidney damage (for example a urine albumin-to-creatinine ratio of 30 mg/g or more) for more than 3 months.
Classify by cause, by GFR category (G1 at 90 or more, G2 60 to 89, G3a 45 to 59, G3b 30 to 44, G4 15 to 29, G5 under 15) and by albuminuria category (A1 under 30, A2 30 to 300, A3 over 300 mg/g).
Measuring kidney function
Estimate GFR from serum creatinine with a validated equation that does not use race.
Add cystatin C (the combined creatinine-cystatin C equation) when creatinine-based eGFR may be inaccurate, for example with low muscle mass, frailty or liver disease, or when precision matters for decisions such as drug dosing.
Test albuminuria with a urine albumin-to-creatinine ratio, confirming an abnormal result with a first-morning sample when possible.
Risk
In G3 to G5, estimate the 2- and 5-year risk of kidney failure with a validated equation; a 5-year risk of about 3% to 5% can prompt nephrology referral.
Slowing progression
Use an ACE inhibitor or ARB at the highest tolerated dose for CKD with severely increased albuminuria (A3), and for moderately increased albuminuria (A2) in people with diabetes.
Strength: 1BUse an SGLT2 inhibitor for adults with type 2 diabetes and CKD with eGFR of 20 or more, and for adults with eGFR of 20 or more and ACR of 200 mg/g or more, or heart failure, whatever the cause.
Strength: 1AAn SGLT2 inhibitor is also suggested for adults with eGFR 20 to 45 and ACR under 200 mg/g; continue it until dialysis or transplant.
Strength: 2BIn type 2 diabetes with eGFR of 25 or more, normal potassium and albuminuria despite a maximal RAS blocker, add the nonsteroidal MRA finerenone.
In type 2 diabetes with CKD, a GLP-1 receptor agonist with proven benefit is recommended when glucose targets are not met, and it also lowers kidney and cardiovascular risk.
Cardiovascular risk
Treat adults 50 and older with CKD (not on dialysis) with a statin or statin plus ezetimibe.
Blood pressure
Target a systolic pressure under 120 mm Hg, measured in a standardized way, when it is tolerated.
Safety
Give sick-day guidance (pause SGLT2 inhibitors, RAS blockers, diuretics and metformin during dehydrating illness) and review nephrotoxic drugs such as NSAIDs.
How to read the grades KDIGO
Strength: 1 means "we recommend" (most patients should get it); 2 means "we suggest" (the right choice varies). Certainty of evidence: A high, B moderate, C low, D very low. Practice points are expert guidance without a formal grade.
What changed
Compared with the KDIGO 2012 CKD guideline.
Kidney function
- Before
- Creatinine-based equations, some including race.
- Now
- Race-free equations, with wider use of cystatin C.
Risk
- Before
- Staging alone guided referral.
- Now
- A validated kidney failure risk equation in G3 to G5, with referral at about 3% to 5% five-year risk.
Drugs
- Before
- RAS blockers were the main kidney-protective drugs.
- Now
- SGLT2 inhibitors are foundation therapy; finerenone and GLP-1 receptor agonists for type 2 diabetes.
Blood pressure
- Before
- Under 140/90, or 130/80 with albuminuria.
- Now
- Systolic under 120 mm Hg when tolerated, from standardized measurement.
Testing access
- Before
- Laboratory testing.
- Now
- Point-of-care creatinine and urine albumin testing endorsed where laboratory access is limited.
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Questions clinicians ask
What are the CKD stages under KDIGO?
KDIGO stages CKD by cause, by GFR category (G1 to G5) and by albuminuria category (A1 to A3). For example, an eGFR of 40 with a urine albumin-to-creatinine ratio of 150 mg/g is G3b A2. The combination predicts risk better than either measure alone.
When should I use cystatin C?
When a creatinine-based eGFR may be wrong (for example in frailty, low muscle mass, amputation or liver disease) or when an accurate GFR matters for a decision such as drug dosing. The combined creatinine-cystatin C equation is the most accurate.
Does KDIGO recommend SGLT2 inhibitors without diabetes?
Yes. They are recommended for adults with eGFR of 20 or more and an albumin-to-creatinine ratio of 200 mg/g or more, or with heart failure, whether or not they have diabetes, and suggested for those with eGFR 20 to 45 and lower albuminuria.
Sources
- Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2024 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int. 2024;105(4S):S117-S314. doi.org/10.1016/j.kint.2023.10.018
- Awdishu L, Maxson R, Gratt C, et al. KDIGO 2024 clinical practice guideline on evaluation and management of chronic kidney disease: a primer on what pharmacists need to know. Am J Health Syst Pharm. 2025;82(12):660-671. doi.org/10.1093/ajhp/zxaf044
Summarized in our own words by 2 Minute Medicine's physician editors from the source documents listed here. Strength and evidence grades are the guideline authors' own. This is a quick reference, not a substitute for the full guideline or for clinical judgment.
For health care professionals. 2 Minute Medicine is independent and is not affiliated with or endorsed by the societies that write these guidelines.
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