Summary of recommendation statements and practice points relevant to risk assessment in people with CKD in the 2024 KDIGO Guideline and differences from the 2012 KDIGO Guideline.
| 2.1 Overview on monitoring for progression of CKD based upon GFR and ACR categories | |
| Practice point 2.1.1: Assess albuminuria in adults, or albuminuria/proteinuria in children, and GFR at least annually in people with CKD | In agreement with 2012 KDIGO CKD Guideline |
| Practice point 2.1.2: Assess albuminuria and GFR more often for individuals at higher risk of CKD progression when measurement will impact therapeutic decisions. | |
| Practice point 2.1.3: For people with CKD, a change in eGFR of >20% on a subsequent test exceeds the expected variability and warrants evaluation | Introducing cutoffs for eGFR change, in general and in patients initiating haemodynamically active therapies, which should prompt further evaluation |
| Practice point 2.1.4: Among people with CKD who initiate haemodynamically active therapies, GFR reductions of >30% on subsequent testing exceed the expected variability and warrant evaluation | |
| Practice point 2.1.5: For albuminuria monitoring of people with CKD, a doubling of the ACR on a subsequent test exceeds laboratory variability and warrants evaluation | Defining a doubling in albuminuria or more as exceeding the expected variability and warranting evaluation |
| 2.2 Risk prediction in people with CKD | |
| Recommendation 2.2.1: In people with CKD G3–G5, we recommend using an externally validated risk equation to estimate the absolute risk of kidney failure (1A) | Highlights the need and potential benefits on the use of validated risk equations to estimate the absolute risk of outcomes for each individual and enable a personalized care plan for people with CKD |
| Practice point 2.2.1: A 5-year kidney failure risk of 3%–5% can be used to determine need for nephrology referral in addition to criteria based on eGFR or urine ACR, and other clinical considerations | |
| Practice point 2.2.2: A 2-year kidney failure risk of >10% can be used to determine the timing of multidisciplinary care in addition to eGFR-based criteria and other clinical considerations | |
| Practice point 2.2.3: A 2-year kidney failure risk threshold of >40% can be used to determine the modality education, timing of preparation for KRT including vascular access planning or referral for transplantation, in addition to eGFR-based criteria and other clinical considerations | |
| Practice point 2.2.4: Note that risk prediction equations developed for use in people with CKD G3–G5, may not be valid for use in those with CKD G1–G2 | |
| Practice point 2.2.5: Use disease-specific, externally validated prediction equations in people with immunoglobulin A nephropathy and autosomal dominant polycystic kidney disease | |
| Practice point 2.2.6: Consider the use of eGFRcys in some specific circumstances | |
| 2.3 Prediction of cardiovascular risk in people with CKD | |
| Practice point 2.3.1: For cardiovascular risk prediction to guide preventive therapies in people with CKD, use externally validated models that are either developed within CKD populations or that incorporate eGFR and albuminuria | Highlighting the potential benefits of the use of cardiovascular and mortality risk equations in the CKD population |
| Practice point 2.3.2: For mortality risk prediction to guide discussions about goals of care, use externally validated models that predict all-cause mortality specifically developed in the CKD population | |
| 2.1 Overview on monitoring for progression of CKD based upon GFR and ACR categories | |
| Practice point 2.1.1: Assess albuminuria in adults, or albuminuria/proteinuria in children, and GFR at least annually in people with CKD | In agreement with 2012 KDIGO CKD Guideline |
| Practice point 2.1.2: Assess albuminuria and GFR more often for individuals at higher risk of CKD progression when measurement will impact therapeutic decisions. | |
| Practice point 2.1.3: For people with CKD, a change in eGFR of >20% on a subsequent test exceeds the expected variability and warrants evaluation | Introducing cutoffs for eGFR change, in general and in patients initiating haemodynamically active therapies, which should prompt further evaluation |
| Practice point 2.1.4: Among people with CKD who initiate haemodynamically active therapies, GFR reductions of >30% on subsequent testing exceed the expected variability and warrant evaluation | |
| Practice point 2.1.5: For albuminuria monitoring of people with CKD, a doubling of the ACR on a subsequent test exceeds laboratory variability and warrants evaluation | Defining a doubling in albuminuria or more as exceeding the expected variability and warranting evaluation |
| 2.2 Risk prediction in people with CKD | |
| Recommendation 2.2.1: In people with CKD G3–G5, we recommend using an externally validated risk equation to estimate the absolute risk of kidney failure (1A) | Highlights the need and potential benefits on the use of validated risk equations to estimate the absolute risk of outcomes for each individual and enable a personalized care plan for people with CKD |
| Practice point 2.2.1: A 5-year kidney failure risk of 3%–5% can be used to determine need for nephrology referral in addition to criteria based on eGFR or urine ACR, and other clinical considerations | |
| Practice point 2.2.2: A 2-year kidney failure risk of >10% can be used to determine the timing of multidisciplinary care in addition to eGFR-based criteria and other clinical considerations | |
| Practice point 2.2.3: A 2-year kidney failure risk threshold of >40% can be used to determine the modality education, timing of preparation for KRT including vascular access planning or referral for transplantation, in addition to eGFR-based criteria and other clinical considerations | |
| Practice point 2.2.4: Note that risk prediction equations developed for use in people with CKD G3–G5, may not be valid for use in those with CKD G1–G2 | |
| Practice point 2.2.5: Use disease-specific, externally validated prediction equations in people with immunoglobulin A nephropathy and autosomal dominant polycystic kidney disease | |
| Practice point 2.2.6: Consider the use of eGFRcys in some specific circumstances | |
| 2.3 Prediction of cardiovascular risk in people with CKD | |
| Practice point 2.3.1: For cardiovascular risk prediction to guide preventive therapies in people with CKD, use externally validated models that are either developed within CKD populations or that incorporate eGFR and albuminuria | Highlighting the potential benefits of the use of cardiovascular and mortality risk equations in the CKD population |
| Practice point 2.3.2: For mortality risk prediction to guide discussions about goals of care, use externally validated models that predict all-cause mortality specifically developed in the CKD population | |
Summary of recommendation statements and practice points relevant to risk assessment in people with CKD in the 2024 KDIGO Guideline and differences from the 2012 KDIGO Guideline.
| 2.1 Overview on monitoring for progression of CKD based upon GFR and ACR categories | |
| Practice point 2.1.1: Assess albuminuria in adults, or albuminuria/proteinuria in children, and GFR at least annually in people with CKD | In agreement with 2012 KDIGO CKD Guideline |
| Practice point 2.1.2: Assess albuminuria and GFR more often for individuals at higher risk of CKD progression when measurement will impact therapeutic decisions. | |
| Practice point 2.1.3: For people with CKD, a change in eGFR of >20% on a subsequent test exceeds the expected variability and warrants evaluation | Introducing cutoffs for eGFR change, in general and in patients initiating haemodynamically active therapies, which should prompt further evaluation |
| Practice point 2.1.4: Among people with CKD who initiate haemodynamically active therapies, GFR reductions of >30% on subsequent testing exceed the expected variability and warrant evaluation | |
| Practice point 2.1.5: For albuminuria monitoring of people with CKD, a doubling of the ACR on a subsequent test exceeds laboratory variability and warrants evaluation | Defining a doubling in albuminuria or more as exceeding the expected variability and warranting evaluation |
| 2.2 Risk prediction in people with CKD | |
| Recommendation 2.2.1: In people with CKD G3–G5, we recommend using an externally validated risk equation to estimate the absolute risk of kidney failure (1A) | Highlights the need and potential benefits on the use of validated risk equations to estimate the absolute risk of outcomes for each individual and enable a personalized care plan for people with CKD |
| Practice point 2.2.1: A 5-year kidney failure risk of 3%–5% can be used to determine need for nephrology referral in addition to criteria based on eGFR or urine ACR, and other clinical considerations | |
| Practice point 2.2.2: A 2-year kidney failure risk of >10% can be used to determine the timing of multidisciplinary care in addition to eGFR-based criteria and other clinical considerations | |
| Practice point 2.2.3: A 2-year kidney failure risk threshold of >40% can be used to determine the modality education, timing of preparation for KRT including vascular access planning or referral for transplantation, in addition to eGFR-based criteria and other clinical considerations | |
| Practice point 2.2.4: Note that risk prediction equations developed for use in people with CKD G3–G5, may not be valid for use in those with CKD G1–G2 | |
| Practice point 2.2.5: Use disease-specific, externally validated prediction equations in people with immunoglobulin A nephropathy and autosomal dominant polycystic kidney disease | |
| Practice point 2.2.6: Consider the use of eGFRcys in some specific circumstances | |
| 2.3 Prediction of cardiovascular risk in people with CKD | |
| Practice point 2.3.1: For cardiovascular risk prediction to guide preventive therapies in people with CKD, use externally validated models that are either developed within CKD populations or that incorporate eGFR and albuminuria | Highlighting the potential benefits of the use of cardiovascular and mortality risk equations in the CKD population |
| Practice point 2.3.2: For mortality risk prediction to guide discussions about goals of care, use externally validated models that predict all-cause mortality specifically developed in the CKD population | |
| 2.1 Overview on monitoring for progression of CKD based upon GFR and ACR categories | |
| Practice point 2.1.1: Assess albuminuria in adults, or albuminuria/proteinuria in children, and GFR at least annually in people with CKD | In agreement with 2012 KDIGO CKD Guideline |
| Practice point 2.1.2: Assess albuminuria and GFR more often for individuals at higher risk of CKD progression when measurement will impact therapeutic decisions. | |
| Practice point 2.1.3: For people with CKD, a change in eGFR of >20% on a subsequent test exceeds the expected variability and warrants evaluation | Introducing cutoffs for eGFR change, in general and in patients initiating haemodynamically active therapies, which should prompt further evaluation |
| Practice point 2.1.4: Among people with CKD who initiate haemodynamically active therapies, GFR reductions of >30% on subsequent testing exceed the expected variability and warrant evaluation | |
| Practice point 2.1.5: For albuminuria monitoring of people with CKD, a doubling of the ACR on a subsequent test exceeds laboratory variability and warrants evaluation | Defining a doubling in albuminuria or more as exceeding the expected variability and warranting evaluation |
| 2.2 Risk prediction in people with CKD | |
| Recommendation 2.2.1: In people with CKD G3–G5, we recommend using an externally validated risk equation to estimate the absolute risk of kidney failure (1A) | Highlights the need and potential benefits on the use of validated risk equations to estimate the absolute risk of outcomes for each individual and enable a personalized care plan for people with CKD |
| Practice point 2.2.1: A 5-year kidney failure risk of 3%–5% can be used to determine need for nephrology referral in addition to criteria based on eGFR or urine ACR, and other clinical considerations | |
| Practice point 2.2.2: A 2-year kidney failure risk of >10% can be used to determine the timing of multidisciplinary care in addition to eGFR-based criteria and other clinical considerations | |
| Practice point 2.2.3: A 2-year kidney failure risk threshold of >40% can be used to determine the modality education, timing of preparation for KRT including vascular access planning or referral for transplantation, in addition to eGFR-based criteria and other clinical considerations | |
| Practice point 2.2.4: Note that risk prediction equations developed for use in people with CKD G3–G5, may not be valid for use in those with CKD G1–G2 | |
| Practice point 2.2.5: Use disease-specific, externally validated prediction equations in people with immunoglobulin A nephropathy and autosomal dominant polycystic kidney disease | |
| Practice point 2.2.6: Consider the use of eGFRcys in some specific circumstances | |
| 2.3 Prediction of cardiovascular risk in people with CKD | |
| Practice point 2.3.1: For cardiovascular risk prediction to guide preventive therapies in people with CKD, use externally validated models that are either developed within CKD populations or that incorporate eGFR and albuminuria | Highlighting the potential benefits of the use of cardiovascular and mortality risk equations in the CKD population |
| Practice point 2.3.2: For mortality risk prediction to guide discussions about goals of care, use externally validated models that predict all-cause mortality specifically developed in the CKD population | |
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