Chronic Kidney Disease (CKD)

🔍 When to Suspect

Often asymptomatic; consider in patients with diabetes, hypertension, CVD, or family history of kidney disease; late symptoms include uraemia or urinary obstruction

From the full topic in The Ocean Library: Chronic Kidney Disease (CKD)

🧭 When to suspect

Chronic kidney disease (CKD) is abnormality of kidney function or structure present for more than 3 months.

In practice this means any of the following that persists beyond 3 months:

• A confirmed eGFR < 60 mL/min/1.73 m².

• An albumin:creatinine ratio (ACR) ≥ 3 mg/mmol.

• Another marker of kidney damage, such as haematuria or structural disease.

Most early CKD is entirely asymptomatic and is picked up on bloods or urine testing requested for another reason – symptoms of uraemia (nausea, anorexia, fatigue, pruritus) or of outflow obstruction tend to appear only in the later stages.

A single low eGFR is not CKD. A newly found eGFR < 60 must be repeated within 2 weeks to exclude acute kidney injury, and chronicity confirmed over ≥ 3 months before the label is applied.

The two core clinical skills in primary care are to:

• stage accurately by eGFR and ACR (the two axes that drive every decision)

• slow progression with renoprotective therapy and risk-factor control.

Offer eGFR and ACR testing to anyone with a risk factor:

• diabetes

• hypertension

• cardiovascular disease

• previous acute kidney injury (AKI)

• structural renal-tract disease, stones or prostatic hypertrophy

• gout

• multisystem disease (e.g. systemic lupus erythematosus [SLE])

• a family history of kidney failure or hereditary kidney disease

• nephrotoxic medication (long-term NSAIDs, lithium, calcineurin inhibitors)

Age, sex and ethnicity alone are not indications to test.

GFR stage	eGFR (mL/min/1.73 m²)	Kidney function
G1	≥ 90	Normal or high – CKD only if other markers of damage
G2	60–89	Mild reduction – CKD only if other markers of damage
G3a	45–59	Mild to moderate reduction
G3b	30–44	Moderate to severe reduction
G4	15–29	Severe reduction
G5	< 15	Kidney failure (end-stage)

ACR category	ACR (mg/mmol)	Albuminuria
A1	< 3	Normal to mildly increased
A2	3–30	Moderately increased
A3	> 30	Severely increased

Higher ACR and lower eGFR each independently raise the risk of progression, cardiovascular events and death, and multiply that risk in combination – which is why both numbers are needed to stage and to set management.

Source: NICE NG203 · UK Kidney Association

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