Executive summary
- Diagnosis: eGFR <60 OR ACR ≥3 mg/mmol for >3 months. (Isolated eGFR >60 without proteinuria is NOT CKD).
- Coding: Use 'G' score (eGFR) and 'A' score (ACR) to determine monitoring frequency (Green/Amber/Red table).
- Game Changer: SGLT2 inhibitors are now standard of care for CKD with proteinuria (diabetic or non-diabetic).
Management Priorities
- 1. Blood Pressure:
- Standard target: <140/90.
- If ACR ≥70 (A3): Target <130/80.
- First line: ACEi/ARB. (Stop if K+ >6.0 or Cre rises >30% from baseline).
- 2. SGLT2 Inhibitors (Dapa/Empa 10mg):
- Offer if: CKD + T2DM (ACR >3).
- Offer if: CKD (non-diabetic) + ACR ≥22.6 mg/mmol + eGFR 25-75.
- Benefit: Reduces progression to dialysis and CV death.
- 3. Statins: Atorvastatin 20mg for primary prevention (CKD is an independent risk factor).
When to Refer (Nephrology)
- eGFR < 30 (G4/G5) (unless stable/agreed not to refer).
- ACR ≥ 70 (A3) (unless known diabetic stable).
- ACR ≥ 30 (A2) + Haematuria.
- Rapid Decline: Sustained decrease in eGFR of ≥25% or ≥15ml/min in 12 months.
- Uncontrolled: Refractory hypertension (>4 drugs).
Transparency
This page is an educational, clinician-written summary of publicly available NICE guidance intended for trained healthcare professionals. It uses original wording (not copied text) and should be used alongside the full NICE source, local pathways, and clinical judgement. Doses provided are for general reference; always check the BNF/SPC.