Trial Files Guidelines Edition: KDIGO 2024 Evaluation and Management of CKD

Sep 22, 2025

These guidelines were published in 2024 and span nearly 200 pages.

Risk-based care is central. Use eGFR and albuminuria for staging CKD— this combination predicts outcomes better than either alone. This dual approach enables more precise prognostication and tailoring of care, while also guiding decisions around the intensity of follow-up and therapy.
Cystatin C adds accuracy and can help confirm kidney function. This is particularly in situations where creatinine-based estimates may be unreliable (e.g., cachexia, malnourished, amputation) or for borderline eGFR (e.g., eGFR 45 to 59).
SGLT2 inhibitors are standard of care for patients with CKD. The benefits extend beyond diabetes, reducing kidney disease progression and CV events. Therapy should be continued until dialysis or transplant, unless contraindications arise.

Expanded role for SGLT2 inhibitors: Now recommended broadly across CKD etiologies, not just diabetes-related CKD.
GLP-1 have renal and cardiovascular benefits for patients with CKD from T2DM: While published before the FLOW results, the guidelines highlighted the emerging benefits of semaglutide for patients with CKD from T2DM.
Updated risk-based approach: Guidelines now stratify care intensity and referral based on both eGFR and albuminuria rather than eGFR alone.

Check urine ACR regularly, not just creatinine: It’s a simple, inexpensive test that reclassifies risk in many patients.
If available, order cystatin C before labeling CKD: Avoids overdiagnosis in older adults with low muscle mass.
Start SGLT2 inhibitors early: Don’t wait for diabetes or advanced proteinuria; even modest albuminuria benefits from treatment.