Patient handout

Chronic Kidney Disease (KDIGO G/A staging + GDMT)

PRODUCTION

1. Your condition

This handout is for chronic kidney disease (kdigo g/a staging + gdmt). Your care team identified this based on: egfr <60 sustained ≥3 months (kdigo 2024).

Other reasons your team may use this plan: uacr ≥30 mg/g sustained ≥3 months (kdigo 2024); existing ckd on problem list — titration visit (kdigo 2024); dm2 with kidney disease — dkd (ada 2026 §11).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
lisinopril	10 mg PO	PO	daily, titrate to 40 mg	KDIGO 2024 proteinuric-CKD foundation. UACR ↓ ~35–40% over wks; expect acute eGFR dip 10–20% then slope flattens. REIN (PMID 9217756): GFR decline 0.53 vs 0.88 mL/min/mo, p=0.03; doubling-Cr/ESRD 18 vs 40 events, p=0.04 (non-diabetic proteinuric CKD)
atorvastatin	20 mg PO	PO	daily	KDIGO 2024 lipid — fixed-dose statin, no LDL target. No eGFR-slope effect; ΔLDL ~−40% in wks. SHARP (PMID 21663949): major atherosclerotic events RR 0.83 (0.74–0.94), p=0.0021 in CKD

Plan: KDIGO G1-G5 stage-driven management (KDIGO 2024)

3. Your action plan

Use these zones to know what to do based on how you feel.

GREEN — Stable — feeling well

If you have:

Eating and drinking normally (KDIGO 2024)
No vomiting / diarrhea / fever (KDIGO 2024)
Home BP at goal SBP <120-130 (KDIGO 2024)
No new medications (KDIGO 2024)

Do this:

Continue all CKD medications as prescribed — RAS, SGLT2i, finerenone, statin (KDIGO 2024)
Stay well hydrated — water; avoid dehydration (KDIGO 2024)
Avoid NSAIDs — ibuprofen, naproxen, diclofenac (KDIGO 2024)
Keep all labs and follow-ups (KDIGO 2024)

YELLOW — Caution — mild illness

If you have:

Vomiting or diarrhea more than 1-2 episodes (KDIGO 2024)
Decreased oral intake or dehydration (KDIGO 2024)
Fever (KDIGO 2024)
Unable to keep down medications (KDIGO 2024)
Home BP much higher or lower than usual (KDIGO 2024)

Do this:

HOLD: ACEi/ARB, SGLT2i, diuretic, NSAIDs, metformin — sick day rules (KDIGO 2024)
Drink small frequent sips of water/electrolyte solution (KDIGO 2024)
Continue blood pressure monitoring (KDIGO 2024)
Call CKD clinic / primary care within 24 hours for guidance (KDIGO 2024)
Resume medications when eating/drinking normally — confirm with provider (KDIGO 2024)

Call your provider if:

Symptoms persist >24 hours (KDIGO 2024)
Unable to drink fluids (KDIGO 2024)
Decreased urination (KDIGO 2024)
New leg swelling or shortness of breath (KDIGO 2024)

RED — Medical alert — severe illness

If you have:

No urine output for ≥6-8 hours (KDIGO 2012)
Severe shortness of breath / chest pain (KDIGO 2012)
Confusion, severe weakness, fainting (KDIGO 2012)
Severe vomiting/diarrhea unable to keep fluids down (KDIGO 2012)
Black/tarry stools or vomiting blood (KDIGO 2012)
Severe leg swelling with shortness of breath — volume overload (KDIGO 2012)

Do this:

Go to ED immediately (KDIGO 2012)
Bring complete medication list (KDIGO 2024)
Tell ED you have CKD and your baseline creatinine (KDIGO 2024)
Do not take any new NSAIDs or contrast-requiring imaging until stable (KDIGO 2024)

Call your provider if:

Any red zone symptom — go to ED now (KDIGO 2012)

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

eGFR <15 OR uremic symptoms — encephalopathy, pericarditis, anorexia, pruritus (KDIGO 2012)
Uremic pericarditis / encephalopathy / bleeding diathesis (KDIGO 2012)(life-threatening)

5. Follow-up

Cadence by KDIGO 2024 stage; vaccinations (flu/pneumo/HBV/COVID); patient education; CKM review (Ndumele Circulation 2023)

6. Sources

Guideline: KDIGO 2024 CKD Guideline (Kidney Int Mar 2024) + KDIGO 2024 Diabetes-in-CKD update + 2025 AHA/ACC HTN Guideline + ADA Standards of Care 2026 + 2022 AHA/ACC/HFSA HF Guideline (cardiorenal protective Rx) + 2023 ACC/AHA/HFSA HF Focused Update (finerenone in HFmrEF/HFpEF) + KDIGO 2013 Lipid + KDIGO 2017 CKD-MBD + KDIGO 2012 Anemia