Management of Chronic Kidney Disease (CKD)

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Screening and Diagnosis of Chronic Kidney Disease

GFR table

GFR categories (ml/min/1.73m2)
GFR Description
GFR Range
A1
Normal to mildly increased
<3
A2
Moderately increased
3-30
A3 Severly increased >30
*nephrotic syndrome>220mg/mmol
G1
 Normal and high >90 No CKD in the absence of markers of kidney damage No CKD in the absence of markers of kidney damage

Manage in primary care according to recommendations

Refer to renal unit if the person has:

  • A sustained decrease in GFR of 25% or more and a change in GFR category or sustained decrease in GFR of 15 ml/min or more within 12 months
  • Hypertension that remains poorly controlled despite the use of at least 4 antihypertensive drugs
  • Known or suspected rare or genetic causes of CKD
  • Suspected underlying systemic disease
  • Suspected renal artery stenosis
  • ACR > 70 mg/mmol or more unless known to be caused by diabetes and already appropriately treated
  • ACR > 30 mg/mmol and haematuria
  • Persistently abnormal serum potassium, calcium, phosphate or haemoglobin ( Hb < 110 g/L, potassium > 6.0 mmol/L, calcium < 2.1 mmol/L , phosphate > 1.8 mmol/L

Manage in primary care according to recommendations

Refer to renal unit if the person has any of the criteria in A2, or:

  • ACR 70mg/mmol or more, unless known to be caused by diabetes and already appropriately treated
  • haematuria
G2
 Mild reduction related to normal range for a young adult 60-89
G3a
 Mild- moderate reduction 45-59  
G3b
 Moderate-severe reduction 30-44
G4
 Severe reduction 15-29
Refer for specialist assessment
G5
 Kidney failure <15

Renal Complications

Renal complications

  • Measure serum calcium, phosphate and PTH in people with GFR < 30 ml/min
  • Check haemoglobin in people with GFR < 45ml/min
  • Consider oral bicarbonate supplementation in patients with GFR < 30 and bicarbonate < 20 mmol/L

Frequency for monitoring of GFR

Frequency for monitoring of GFR (number of times per year, by GFR and ACR category) for people with or at risk of CKD

GFR Category

ACR Categories (mg/mmol)

A1 <3 Normal to mildly increased

ACR Categories (mg/mmol)

A2 3-30 Moderately increased

ACR Categories (mg/mmol)

A3 >30 Severely increased

G1 > 90 Normal and High

 ≤ 1 1 ≥ 1
G2 60-89 mild reduction related to normal range for young adult ≤ 1 1 ≥ 1

G3a 45-59 Mild- moderate reduction

 1 1 2

G3b 30-44 Moderate-severe reduction

 ≤ 2 2 ≥ 2

G4 15-29 Severe reduction

 2 2 3

G5 <15 Kidney failure

 4 ≥ 4 ≥ 4

This should be tailored according to:

  • The underlying cause of CKD
  • Past patterns of eGFR and ACR (but be aware CKD progression is often non linear)
  • Co-morbidites especially heart failure
  • Changes to treatment (such as ACEI/ARBs, NSAIDs, diuretics)

Abbreviation

Abbreviation Meaning
DBP Diastolic blood pressure
SBP Systolic blood pressure
ACEI Angiotensin-converting-enzyme inhibitors
ARB Angiotensin II receptor blockers
ACR Albumin-to-creatinine ratio
U&Es Urea and electrolytes
GFR Glomerular filtration rate
MI Myocardial infarction
PTH Parathyroid hormone

Last reviewed: 31 January 2016

Next review: 31 March 2017

Author(s): Renal MDT

Version: 3

Approved By: TAM subgroup of ADTC

Reviewer Name(s): Dr Nicola Joss with Drs Lambie, Peel, McDonald

Document Id: TAM361