NICE NG203 2021: Chronic kidney disease assessment and management

Official guidelineChronic kidney disease: assessment and management (NG203). NICE, 2021.
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

Adults, children and young people with or at risk of chronic kidney disease in primary and secondary care.

Key recommendations

Diagnose and classify CKD using the combination of eGFR category (G1-G5) and albuminuria category (A1-A3), since combining both better predicts risk than either alone.
Use a validated creatinine-based eGFR equation (such as the CKD-EPI creatinine equation) for routine estimation of kidney function.
Offer ACE inhibitor or angiotensin receptor blocker therapy to people with diabetes and albuminuria, and to people without diabetes who have hypertension plus a significant degree of albuminuria.
Offer atorvastatin 20 mg for primary or secondary prevention of cardiovascular disease in people with CKD, as part of the broader statin guidance for people at risk of cardiovascular disease.
Consider an SGLT2 inhibitor in addition to an ACE inhibitor or ARB for selected adults with CKD and type 2 diabetes, or with specific levels of albuminuria, based on evidence of kidney and cardiovascular benefit.
Agree an individualised frequency of eGFR and albuminuria monitoring based on CKD category, cause, and risk of progression rather than a fixed schedule for everyone.
Identify people at higher risk of progression or complications using criteria such as a sustained fall in eGFR, or a rapid decline, and refer to nephrology according to specified eGFR, albuminuria, or rate-of-change thresholds.
Advise against routine dietary protein restriction as a strategy to slow progression of CKD.
Address cardiovascular risk holistically in people with CKD, recognising CKD itself as a risk factor, and manage blood pressure to individualised targets that differ depending on presence of diabetes and level of albuminuria.
Avoid offering routine dietary potassium restriction unless the person has or is at risk of hyperkalaemia.

What is new in this edition

Removed the previous 2014 recommendation to use cystatin C based eGFR equations to confirm or exclude CKD in people with eGFR 45-59 ml/min/1.73m2 and no other marker of kidney damage.
Updated advice to include consideration of SGLT2 inhibitors alongside ACE inhibitors or ARBs in appropriate adults with CKD and type 2 diabetes, reflecting newer trial evidence.
Revised recommendations on statin use and cardiovascular risk management in people with CKD.

Practice points for students

CKD staging always needs both an eGFR category and an albuminuria category (ACR-based) to describe risk properly, not eGFR alone.
A urine ACR of 3 mg/mmol or more is generally regarded as clinically important albuminuria in this framework.
ACE inhibitors or ARBs are the renin-angiotensin blockers of choice in proteinuric CKD, but routine combination of an ACE inhibitor with an ARB should be avoided.
Rapid progression is typically defined by a sustained decrease in eGFR of a specified magnitude within a year, which should trigger closer monitoring or referral.
Avoid routine protein or potassium restriction unless there is a specific indication, as blanket dietary restriction is not supported.

Condition

Chronic kidney disease