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CKD — Detection & the Treatment Pyramid

Kidney Health Check, KDIGO risk bands, ACEi/ARB first

Field: RenalCode: REN-01AUpdated: June 2026Reference: KDIGO 2024 / Kidney Health Australia
Kidney Health Check = eGFR + uACR + BP, every 1–2 years in at-risk patients. Once CKD is confirmed: foundation therapy first (lifestyle + BP), then ACEi/ARB, then an SGLT2 inhibitor — escalate the pyramid whenever a target isn't met.

The CKD treatment pyramid

Escalate when target not met, per KDIGO 2024 and the Kidney Health Australia handbook (5th ed, 2024).

1
Foundation — lifestyle + BP: low salt, no smoking; BP target <130/80 mmHg (KHA/RACGP). Some very high-CVD-risk patients may benefit from a lower, standardised SBP<120 mmHg target per KDIGO — weigh against falls/AKI risk.
2
ACEi or ARB: up-titrate to the maximum tolerated dose; stabilise ≥4 weeks before adding an SGLT2 inhibitor.
3
Add an SGLT2 inhibitor: dapagliflozin or empagliflozin — confirm the current PBS eGFR band at pbs.gov.au; once started, can usually continue below the initiation threshold until dialysis or transplant.
4
Add-on therapies: finerenone, a GLP-1 receptor agonist (if type 2 diabetes), and a statin.
Finerenone needs an SGLT2i on board — PBS-listed for CKD with type 2 diabetes, used together with — not instead of — an SGLT2 inhibitor. Needs eGFR≥25, uACR≥22.6 mg/mmol, and potassium≤5.0 mmol/L to start; starting dose is lower at eGFR 25–<60 than at eGFR≥60. Confirm current PBS criteria at pbs.gov.au.

Kidney Health Check

  • At-risk groups (test every 1–2 years): diabetes, hypertension, CVD, age≥60, smoking, family history, Aboriginal or Torres Strait Islander background, obesity.
  • Three core tests: eGFR + uACR (first-morning sample) + BP — repeat in 3 months if abnormal.
  • Confirm before labelling CKD: 2 abnormal results ≥3 months apart.
  • Stage by KDIGO: eGFR category (G1–G5) × albuminuria category (A1 uACR<3, A2 3–30, A3>30 mg/mmol).

KDIGO risk bands

  • Low (G1–G2 + A1): routine GP review.
  • Moderate (G1–G2+A2, or G3a+A1): annual eGFR + uACR.
  • High (G3a+A2, G3b+A1, or G1–G2+A3): start an SGLT2 inhibitor; consider a nephrology opinion.
  • Very high (G3b+A2/A3, or any G4–G5): SGLT2 inhibitor + nephrology referral; monitor 3-monthly.

Full KDIGO heat-map

This summarises the KDIGO eGFR × albuminuria heat-map by risk band. For the full colour-coded grid and exact monitoring intervals per cell, see the current KDIGO CKD guideline or the Kidney Health Australia CKD handbook at kidney.org.au.

Safety

  • Don't start finerenone if potassium >5.0 mmol/L; recheck potassium and eGFR 4 weeks after starting or up-titrating any RAS blocker, SGLT2 inhibitor or finerenone.
  • NSAIDs significantly worsen CKD — avoid at eGFR<60, absolutely avoid below eGFR 30.
  • Discuss alternatives to IV contrast where possible if eGFR<30.

Red flags / refer

  • eGFR<30 (Stage 4–5) → nephrology referral, all patients.
  • Albuminuria uACR≥30 mg/mmol (Stage A3) → nephrology referral.
  • Rapid decline — eGFR fall ≥15 mL/min/1.73m²/year, or ≥25% within 12 months → nephrology referral.

REN-01A v1.0 · Reviewed Jun 2026 · Review Jun 2027

For health-professional use. Framework: KDIGO 2024 CKD Guideline; Kidney Health Australia CKD Management in Primary Care (5th ed, 2024). Companion sheet: REN-01B CKD — Practical Care, Dosing & Referral.