Praxis Medical Insights

Est. 2024 • Clinical Guidelines Distilled

Made possible by volunteer editors from the University of Calgary & University of Alberta

Last Updated: 10/6/2025

CKD Staging and Management

CKD Staging Classification

  • The American College of Physicians recommends that an eGFR of 60-89 mL/min/1.73 m² be classified as Stage G2, indicating mildly decreased kidney function 1, 3
  • The National Kidney Foundation suggests that an ACR of >300 mg/g be classified as Stage A3, indicating severely increased albuminuria 1, 4

Combined Risk Assessment

  • The Kidney Disease: Improving Global Outcomes (KDIGO) guideline recommends that patients with a combination of G2A3 be placed in a high-risk category for adverse outcomes, with a recommended monitoring frequency of 3-4 times per year 1, 2
  • The KDIGO guideline also states that at any GFR level, ACR >300 mg/g is associated with markedly elevated risks for death, cardiovascular disease, and end-stage renal disease 1

Blood Pressure Control

  • The American Heart Association recommends a target blood pressure of ≤130/80 mmHg for patients with CKD and severely increased albuminuria 2, 5
  • The American College of Cardiology suggests that for patients >65 years, a target systolic blood pressure of 130-139 mmHg is appropriate, avoiding <120 mmHg 6

RAAS Blockade

  • The KDIGO guideline strongly recommends initiating ACE inhibitor or ARB therapy immediately for patients with ACR >300 mg/g, regardless of diabetes status, with a Grade 1B recommendation 2, 5
  • The American Diabetes Association suggests that ACE inhibitor or ARB therapy reduces proteinuria and slows CKD progression in both diabetic and non-diabetic nephropathy 2, 5

Monitoring Frequency

  • The KDIGO guideline recommends monitoring eGFR and ACR 3-4 times per year for patients with G2A3 category 1, 2
  • The National Kidney Foundation suggests that more frequent monitoring (every 3 months) is warranted given the severely elevated albuminuria 6

Additional Management Priorities

Nephrology Referral Considerations

  • The American Society of Nephrology recommends referral for ACR ≥300 mg/g to coordinate care and optimize management 6

Cardiovascular Risk Reduction

  • The American College of Cardiology recommends lifestyle modifications, including sodium restriction <2 g/day, smoking cessation, and exercise 30 minutes 5 times weekly 5

Nephrotoxin Avoidance

  • The National Kidney Foundation suggests minimizing exposure to iodinated contrast 7
  • The American Society of Nephrology recommends reviewing all medications for appropriate dosing adjustments 7

Diabetes Management

  • The American Diabetes Association recommends targeting HbA1c ≤7.0%, though higher targets (≤8.0%) may be appropriate given age 80 and risk of hypoglycemia 6
  • The American College of Cardiology suggests considering SGLT2 inhibitor if diabetic, as these reduce CKD progression and cardiovascular events 6

REFERENCES

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