KDIGO 2024 chronic kidney disease guideline: key recommendations

Official guidelineKDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. KDIGO, 2024.
Read the official guideline · Checked for a newer edition on 2026-10-20
We do not reproduce the guideline text — this page is an independent summary.

Who it applies to

Applies to adults and children with or at risk of chronic kidney disease across primary care and nephrology settings, including those with diabetes.

Key recommendations

Diagnose and stage CKD using the combination of eGFR category (G1-G5) and albuminuria category (A1-A3), since both independently predict risk.
Use a validated creatinine-based equation (such as CKD-EPI) for eGFR, and consider cystatin C to confirm the diagnosis when results are borderline or uncertain.
Blood pressure targets should generally aim for a systolic reading below 120 mmHg when tolerated, measured using standardized office technique, in people with CKD not on dialysis.
An ACE inhibitor or ARB is recommended for patients with CKD and significant albuminuria, particularly in those with diabetes or hypertension, titrated to the highest approved tolerated dose.
SGLT2 inhibitors are recommended for patients with CKD and an eGFR at or above approximately 20, regardless of diabetes status, to slow progression and reduce cardiovascular and kidney failure risk.
A nonsteroidal mineralocorticoid receptor antagonist (finerenone) should be considered as add-on therapy in patients with type 2 diabetes, CKD, and residual albuminuria despite maximal ACE inhibitor/ARB and SGLT2 inhibitor therapy.
Lifestyle advice includes a largely plant-based, lower-sodium diet, regular physical activity, smoking cessation, and avoidance of nephrotoxic agents including prolonged NSAID use.
Statin therapy is recommended for most adults with CKD to reduce cardiovascular risk, irrespective of baseline lipid levels in most cases.
Protein intake should be moderated in people with progressive CKD not on dialysis, avoiding high-protein diets and supplements.
Referral to nephrology is advised for low eGFR, rapidly declining kidney function, heavy albuminuria, or difficult-to-control complications such as resistant hypertension or electrolyte disturbance.

What is new in this edition

Stronger emphasis on combination therapy with SGLT2 inhibitors and, where relevant, finerenone alongside ACE inhibitors/ARBs rather than sequential single-agent treatment
Lower recommended systolic blood pressure target using standardized measurement, moving away from less rigorous office readings
Expanded role for cystatin C testing to confirm CKD diagnosis in uncertain cases
Greater focus on lifestyle and dietary pattern (plant-based, lower sodium) rather than isolated nutrient targets

Practice points for students

CKD staging always needs both eGFR and albuminuria (ACR), not eGFR alone, to properly gauge risk of progression and cardiovascular events.
SGLT2 inhibitors are now considered foundational therapy for CKD with albuminuria, not just a diabetes drug.
Watch for an initial dip in eGFR after starting ACE inhibitors/ARBs or SGLT2 inhibitors; this is usually expected and not a reason to stop therapy unless excessive.
Avoid NSAIDs and minimize contrast or other nephrotoxic exposures in CKD patients to protect residual kidney function.
Think of CKD management as a layered strategy: lifestyle plus RAAS blockade plus SGLT2 inhibition plus finerenone in selected diabetic patients, rather than relying on one drug class.

Condition

Chronic kidney disease