Patient handout

CKD Progression & Management (G1-G5 + ACR stratified)

PRODUCTION

1. Your condition

This handout is for ckd progression & management (g1-g5 + acr stratified). Your care team identified this based on: rising creatinine or declining egfr on annual screening (kdigo 2012 ckd).

Other reasons your team may use this plan: persistent albuminuria a2/a3 (uacr ≥30 mg/g for ≥3 mo) (kdigo 2012 ckd); ckd on problem list (continuation visit); egfr <60 ml/min/1.73 m² for ≥3 mo (kdigo 2012 ckd).

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 daily, titrate to max tolerated (40 mg)	PO	daily	KDIGO 2012 CKD — max-tolerated ACEi/ARB; titrate to BP <120/70 (SPRINT) or <130/80
losartan	50-100 mg PO daily, titrate to max tolerated	PO	daily	KDIGO 2012 CKD — ARB equivalent first-line
empagliflozin	10 mg PO daily	PO	daily	EMPA-KIDNEY 2023 PMID 36331190 — empagliflozin slows CKD progression in broader eGFR + proteinuria spectrum
dapagliflozin	10 mg PO daily	PO	daily	DAPA-CKD Heerspink NEJM 2020 — slows CKD progression in proteinuric CKD
canagliflozin	100 mg PO daily	PO	daily	CREDENCE Perkovic NEJM 2019 — canagliflozin renal primary endpoint in DKD
atorvastatin	40-80 mg PO daily (high-intensity per ACC/AHA Lipid 2026)	PO	daily	ACC/AHA Lipid 2026 — high-intensity statin per ASCVD risk in CKD

Plan: CKD progression 6-tier ladder — Tier 1 RAS + SGLT2i + statin + BP/A1c foundation → Tier 2 finerenone (DKD-albuminuric) → Tier 3 GLP-1 RA → Tier 4 CKD-MBD (binder + vit D + calcimimetic) → Tier 5 anemia (ESA + iron) + acidosis (bicarb) → Tier 6 transplant/RRT/AVF/conservative (KDIGO 2012 CKD; KDIGO 2022; KDIGO CKD-MBD 2017)

3. When to call your provider

Contact your care team if any of the following happen:

Rising Cr >30% on RAS → reduce dose; rule out volume loss + nephrotoxin (KDIGO 2012 CKD)
K+ >5.5 → reduce MRA/finerenone/RAS; binder (patiromer/SZC) if persistent (KDIGO 2024)
Atypical features (rapid Cr rise, hematuria + RBC casts) → biopsy (KDIGO 2012 CKD)
Rapid eGFR decline >5/y → workup for accelerated CKD or NDD (KDIGO 2012 CKD)
eGFR <30 → transplant evaluation + AVF planning + pre-RRT education (KDIGO 2012 CKD)
Symptomatic uremia (anorexia, N/V, pruritus, encephalopathy) → admit for RRT initiation (KDIGO 2012 CKD)

4. When to seek emergency care

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

CKD G4 (eGFR 15-29) — transplant evaluation + RRT planning + AVF placement 6 mo lead time (KDIGO 2012 CKD; KDOQI 2019)
CKD G5 (eGFR <15) — RRT decision + initiation per symptoms; conservative-care option per shared decision (KDIGO 2012 CKD; KDIGO 2015)
CKD G5 with vascular access planning failure — AVF non-maturation / thrombosis / infection; bridge with CVC + revision (KDOQI 2019)
Rapid progressor — eGFR decline ≥5 mL/min/y; intensify tier ladder + biopsy if atypical + transplant evaluation early (KDIGO 2012 CKD)
ESRD palliative-care option — elderly + frail + comorbid; comprehensive conservative care without dialysis; symptom management (KDIGO 2015 conservative care)
AKI-on-CKD acute decompensation — sudden Cr rise + volume/acid-base derangement; hold nephrotoxins, treat AKI cause, resume tier ladder (KDIGO 2012 AKI; KDIGO 2012 CKD)

5. Follow-up

q3-6 mo nephrology; transplant + RRT planning at G4 (eGFR <30); AVF placement 6 mo pre-RRT; pre-RRT immunization + nutrition + psychosocial; conservative-care choice (KDIGO 2012 CKD; KDIGO 2015)

6. Sources

Guideline: KDIGO 2024 CKD + KDIGO 2021 BP in CKD + SGLT2i (DAPA-CKD 2020, EMPA-KIDNEY 2023) + finerenone (FIDELIO-DKD 2020) + SPRINT intensive BP target