CKD · AKI · Electrolytes · Renal Drug Dosing
Staging & Management
Abnormalities of kidney structure or function present for >3 months, with implications for health. Diagnosed by eGFR and/or ACR (albuminuria) — both should be measured at least twice over 90 days before labelling CKD.
The KDIGO heat map combines G + A categories: e.g. G3b A3 = very high risk of progression → nephrology referral.
In CKD with ACR ≥3 mg/mmol or diabetes. Reduces progression by ~30%. Check K+ and creatinine at 1–2 weeks (K+ rise <0.5 mmol/L and creatinine rise <25% acceptable).
Dapagliflozin / empagliflozin: KDIGO 2022 recommends in T2DM + CKD (eGFR 20–75). Reduces CV events and kidney failure by ~39% (DAPA-CKD trial). Do NOT start if eGFR <20.
Target <130/80 mmHg (KDIGO 2021) in all CKD. Systolic target intensification if proteinuria. ACEi/ARB preferred if proteinuria. Avoid thiazides if eGFR <30.
Continue if eGFR >45. Reduce dose if eGFR 30–45. STOP if eGFR <30 (risk of lactic acidosis). Hold at contrast/surgery/illness.
Target Hb 100–120 g/L in CKD. Diagnose cause first — iron deficiency common. IV iron if TSAT <20% + ferritin <100. ESA (EPO) if still low after iron optimisation — refer nephrology.
CKD-MBD: elevated PTH + phosphate, low calcium + vitamin D. Treat: restrict dietary phosphate, phosphate binders, active vitamin D (calcitriol) in G4–5. Avoid prolonged hypercalcaemia.
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