CKD Diagnosis and Management

Definition and Diagnosis

The American Diabetes Association and other guideline societies define CKD as the presence of either reduced eGFR or evidence of kidney damage persisting for at least 3 months, with kidney damage including albuminuria, glomerular hematuria, pathological abnormalities on kidney biopsy, radiographic abnormalities, and other urinary sediment abnormalities 1, 2, 3, 4, 5, 6
CKD diagnosis requires either reduced eGFR (<60 mL/min/1.73 m²) or evidence of kidney damage regardless of eGFR level, with evidence of kidney damage including albuminuria (UACR ≥30 mg/g), glomerular hematuria, pathological abnormalities on kidney biopsy, radiographic abnormalities, and other urinary sediment abnormalities 1, 2, 3, 4, 5, 6

Patients with eGFR ≥60 mL/min/1.73 m² are classified as CKD Stage 1 or 2 if they have persistent evidence of kidney damage, with Stage 1 CKD defined as eGFR ≥90 mL/min/1.73 m² PLUS kidney damage, and Stage 2 CKD defined as eGFR 60-89 mL/min/1.73 m² PLUS kidney damage 1, 2

The degree of albuminuria independently predicts CKD progression risk, cardiovascular disease events, and mortality at any eGFR level, with patients with normalized eGFR but persistent albuminuria remaining at elevated cardiovascular and mortality risk compared to those without kidney damage markers 1, 2, 6, 7
Repeat albuminuria testing, review of historical data, assessment for structural damage, and consideration of kidney biopsy findings are necessary to confirm persistent kidney damage and ongoing risk despite eGFR improvement 1, 3, 4

Continue CKD-specific interventions if kidney damage persists despite normal eGFR, including blood pressure control targeting kidney-protective goals, ACEI or ARB therapy for patients with albuminuria, annual monitoring of both eGFR and albuminuria, cardiovascular risk reduction strategies, and avoidance of nephrotoxic medications 1, 2, 3