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Clinical practice guidelines registry — Chronic kidney disease

Last curated: 2026-09-02 (deepening pass). PubMed identifiers were retrieved live from E-utilities in the session that recorded them; the twelve web-only URLs were last re-requested and returned HTTP 200 on 2026-09-02 during the preceding audit and were not re-requested in this pass.

Master table

Body Year Region Scope Citation Status
KDIGO 2024 Global Evaluation and management of CKD PMID 38490803; https://kdigo.org/guidelines/ckd-evaluation-and-management/ current; focused chapter 3 update announced
KDIGO 2022 Global Diabetes management in CKD PMID 36272755 current for diabetes-CKD platform; FLOW post-dates it
KDIGO 2021 Global Blood pressure in CKD PMID 33637203 current
KDIGO 2026 Global Anaemia in CKD PMID 41485807 current; supersedes 2012
KDIGO 2017 Global CKD-MBD update PMID 28646995 current topic update
KDIGO 2013 Global Lipids in CKD PMID 24323134 current topic guideline; aging
KDOQI/NKF 2020 United States Nutrition in CKD PMID 32829751 current
KDOQI/NKF 2015 United States Commentary on KDIGO lipids PMID 25465166 current commentary on older guideline
Canadian Society of Nephrology 2015 Canada Commentary on KDIGO CKD evaluation PMID 25511161 historical commentary
NICE 2021 England/Wales Assessment and management, NG203 https://www.nice.org.uk/guidance/ng203 current; reviewed 2025
UK Kidney Association 2024 United Kingdom eCKD Guide https://www.ukkidney.org/health-professionals/information-resources/uk-eckd-guide current implementation guide
Kidney Health Australia edition year not stated on the official page Australia CKD Management in Primary Care, 5th ed. https://kidney.org.au/health-professionals/ckd-management-handbook/ current (5th edition described as newly available, accessed 2026-09-02)
AHA/ACC/ADA/ASN 2026 United States (international reach) Cardiovascular-kidney-metabolic syndrome: prevention, detection, evaluation, management PMID 42263157 (Circulation); PMID 42265997 (J Am Coll Cardiol) current; declared a "living" document; retires and replaces the 2013 AHA/ACC/TOS obesity guideline
American Diabetes Association 2026 United States Standards of Care §11 — CKD and risk management PMID 41358881 current; revised annually or more often
KDIGO 2013 Global Lipid management in CKD — recommendation summary PMID 24552851 current topic guideline; evidence base >10 years old
European Renal Best Practice (ERA) 2026 Europe Commentary on KDIGO 2026 anaemia guideline PMID 41604211 current commentary
NICE 2021 England/Wales NG203 summary for practitioners PMID 34489303 current summary of NG203

Per-guideline entries

KDIGO 2024 — Evaluation and management

  • Full guideline: Kidney Disease: Improving Global Outcomes CKD Work Group. Kidney Int. 2024;105(4S):S117–S314. PMID 38490803.
  • Executive summary: Levin et al. Kidney Int. 2024;105:684–701. PMID 38519239.
  • Contribution: cause–GFR–albuminuria classification, risk-based care, drug stewardship, complications, referral and research agenda.
  • Status chain: KDIGO 2012 CKD evaluation guideline → superseded by KDIGO 2024.
  • Watch: KDIGO’s official page says a focused Chapter 3 update is underway for newer SGLT2, GLP-1 and non-steroidal MRA evidence outside diabetes.

KDIGO 2022 — Diabetes management in CKD

  • Executive summary: Rossing et al. Kidney Int. 2022;102:990–999. PMID 36272755.
  • Contribution: integrates SGLT2 inhibitors, RAS blockade and non-steroidal MRA into a layered platform.
  • Gap: FLOW semaglutide kidney outcomes were published in 2024 and therefore post-date the evidence cycle (PMID 38785209).

KDIGO 2021 — Blood pressure in CKD

  • Executive summary: Cheung et al. Kidney Int. 2021;99:559–569. PMID 33637203.
  • Contribution: standardized measurement, target and RAS-use recommendations.
  • Border: the hypertension condition owns measurement and target synthesis; CKD owns albuminuria, slope and kidney failure consequences.

KDIGO 2026 — Anaemia in CKD

  • Executive summary: Babitt et al. Kidney Int. 2026;109:44–56. PMID 41485807.
  • Status chain: KDIGO 2012 anaemia guideline → superseded by KDIGO 2026.
  • Contribution: current iron, ESA, HIF-PHI and monitoring framework after the CHOIR/CREATE/TREAT safety era.

KDIGO 2017 — CKD-MBD

  • Executive summary: Ketteler et al. Kidney Int. 2017;92:26–36. PMID 28646995.
  • Status chain: KDIGO 2009 CKD-MBD → updated by KDIGO 2017.
  • Contribution: serial integrated interpretation of phosphate, calcium and PTH; separates biochemical control from proven clinical outcomes.

KDIGO 2013 — Lipids

  • Synopsis: Tonelli et al. Ann Intern Med. 2014;160:182. PMID 24323134.
  • US commentary: Sarnak et al. Am J Kidney Dis. 2015;65:354–366. PMID 25465166.
  • Gap: the document predates the current cardiorenal drug era; its stage distinction remains supported by SHARP versus dialysis statin trials.

KDOQI 2020 — Nutrition

  • Full update: Ikizler et al. Am J Kidney Dis. 2020;76(Suppl 1):S1–S107. PMID 32829751.
  • ISRNM commentary: Kistler et al. J Ren Nutr. 2021;31:116–120.e1. PMID 32737016.
  • Contribution: detailed protein, energy, sodium, potassium and nutrition-assessment guidance.

NICE NG203

  • Official page: https://www.nice.org.uk/guidance/ng203 (accessed 2026-09-02, HTTP 200).
  • Published 25 August 2021; last updated 24 November 2021; last reviewed 19 August 2025 — all three dates read directly from the live page during the audit.
  • Status chain: replaces CG182, NG8, CG157 and ESNM51, as stated on the official page.
  • Contribution: UK case-finding, monitoring, referral, pharmacotherapy and complication pathways.

UK eCKD Guide

  • Official page: https://www.ukkidney.org/health-professionals/information-resources/uk-eckd-guide (accessed 2026-09-02, HTTP 200).
  • The page states the guide "was most recently updated in February 2024" and that the current version was revised in 2024 by Javeria Peracha and Paul Cockwell, incorporating the NICE CKD guideline update; derived from NICE and UKKA guidance.
  • Contribution: operational primary-care staging, KFRE, referral and medication support.

Kidney Health Australia 2024

  • Official page: https://kidney.org.au/health-professionals/ckd-management-handbook/ (accessed 2026-09-02, HTTP 200).
  • The page announces the 5th edition as newly available and free to download, with CPD hours via the Kidney Health Professional Hub. It lists as new in the 5th edition: medication recommendations for slowing CKD progression and reducing cardiovascular risk, and guidance for culturally safe care.
  • Audit correction (2026-09-02): the build recorded a publication year of 2024 and an endorsement "as an accepted clinical resource by Australian professional bodies". Neither is stated on the page; the only endorsement text there is Kidney Health Australia's Deductible Gift Recipient charity status, which is unrelated. Both claims removed.
  • Contribution: locally implementable detection, referral, culturally safe care and medication pathways.

AHA/ACC/ADA/ASN 2026 — Cardiovascular-kidney-metabolic syndrome

  • Scope: the full CKM spectrum — metabolic risk factors including obesity and type 2 diabetes, CKD, and cardiovascular disease — addressed to cardiologists, endocrinologists, nephrologists and primary care clinicians together (PMID 42263157).
  • Method: literature search 29 October 2024 to 14 April 2025 across MEDLINE, EMBASE, Cochrane Library, AHRQ and other databases, for human studies published since 2015.
  • Grading: ACC/AHA Class of Recommendation × Level of Evidence — a different system from the GRADE 1/2 × A–D used by KDIGO, so recommendation strengths are not directly comparable across the two bodies.
  • Structural significance: ASN co-authorship places the nephrology position inside a cardiology-led document, which is the operational answer to the "harmonization across major subspecialty guidelines" need identified in the 2023 CKM presidential advisory (PMID 37807924).
  • Boundary: its evidence window closes in April 2025 and therefore pre-dates CONFIDENCE (PMID 40470996), FINE-ONE (PMID 41780000), FIND-CKD (PMID 42246672) and INFINITY (PMID 42248158).
  • Published in duplicate in Circulation and the Journal of the American College of Cardiology; both records were resolved live on 2026-09-02.

American Diabetes Association 2026 — Standards of Care, Section 11

  • Scope: chronic kidney disease and risk management within diabetes care (PMID 41358881).
  • Grading: ADA A/B/C/E evidence-grading system, described in the Standards' Introduction and Methodology section.
  • Distinguishing feature: annual (or more frequent) revision by the ADA Professional Practice Committee. This is the shortest revision cycle of any document in this registry and is the reason ADA guidance typically incorporates new kidney-outcome trials one to three years ahead of multi-year guideline cycles.

KDIGO 2013 — Lipid management in CKD

  • Thirteen recommendations structured as assessment in all, treatment in many, follow-up measurement in few (PMID 24552851).
  • Key recommendation: statin or statin/ezetimibe in adults aged ≥50 with eGFR <60 not on chronic dialysis and not transplanted.
  • Dialysis position: the Work Group noted that the relative risk reduction appears substantially smaller than at earlier CKD stages and did not recommend initiating statins in most prevalent haemodialysis patients — consistent with the SHARP/AURORA discontinuity (PMIDs: 21663949, 19332456).
  • Notable removal: LDL-cholesterol targets were abandoned because higher statin doses have not been shown safe in CKD and because LDL level does not itself indicate a need for dose escalation; follow-up lipid measurement is therefore not recommended.
  • Status: more than a decade old and unrevised; the registry watch list tracks this.

European Renal Best Practice 2026 — commentary on KDIGO anaemia

  • Records where a second expert body would place emphasis differently on the same evidence (PMID 41604211).
  • Notes that the 2026 KDIGO update introduces more proactive intravenous iron thresholds, especially in haemodialysis, and retains erythropoiesis-stimulating agents as preferred first-line therapy because of persisting cardiovascular safety concerns and methodological limitations of available HIF-PHI trials.
  • Identifies gaps the guideline does not address: pregnancy, sex-specific considerations, and interactions with SGLT2 inhibitors or with inflammation.
  • Records regional regulatory divergence between European and US approvals for HIF-PHIs — the same evidence base yielding different licensed availability.

Disagreements and gaps

Issue Position A Position B / gap Why it matters
Screening Risk-based case finding is conventional Population screening may be cost-effective only under favourable assumptions (PMID 38213490) Testing strategy determines who reaches treatment
Cystatin C KDIGO/NKF-ASN support confirmatory use Access and reimbursement remain uneven (PMID 34563581) Equity and dosing consequences
Albuminuria Central to risk and therapy selection uACR remains less often measured than creatinine Disease can be staged incompletely
SGLT2 low albuminuria EMPA-KIDNEY slope supports benefit (PMID 38061371) Hard-event precision is lower in slow progressors Absolute benefit and threshold decisions
GLP-1 kidney outcomes FLOW supports semaglutide in T2D CKD (PMID 38785209); a pooled SELECT/FLOW/SOUL analysis of 30,787 participants extends the kidney signal to people without diabetes (HR 0.84, 0.77–0.91; PMID 42567173) Every guideline in this registry pre-dates FLOW Implementation lag
MRA outside diabetes Finerenone outcomes established in T2D CKD Resolved since every guideline here was written: FIND-CKD (PMID 42246672) and the INFINITY pooled analysis (PMID 42248158) now cover non-diabetic CKD; no registry document reflects them Current guidance restricting non-steroidal MRA to diabetic CKD reflects its evidence cycle, not the trial base
Anaemia Avoid haemoglobin normalization after TREAT/CHOIR HIF-PHI positioning differs by regulator and setting Safety and access
CKD-MBD Treat serial biochemical patterns Patient-important trial evidence remains thin (PMID 35232774) Surrogate uncertainty
Nutrition Detailed KDOQI targets Plant-forward/potassium liberalisation evidence is evolving Malnutrition versus hyperkalaemia balance
Dialysis start Symptoms/complications rather than eGFR alone (PMID 20581422) Service pathways still use threshold-driven preparation Crisis starts and patient choice
Grading systems KDIGO GRADE 1/2 × A–D plus ungraded practice points ACC/AHA Class of Recommendation × Level of Evidence (PMID 42263157) A KDIGO 1A and an ACC/AHA Class 1 Level A are not the same claim, and the two systems place different content in their ungraded categories
Revision cadence Multi-year, topic-by-topic (KDIGO) Annual (ADA §11, PMID 41358881); "living" (CKM 2026, PMID 42263157) Every recommendation should be read with both a publication date and an evidence-search closing date; the gap is the minimum lag
Lipid targets Abandoned by KDIGO 2013 because higher statin doses are unproven for safety in CKD (PMID 24552851) Target-based strategies persist in some national documents Follow-up lipid measurement is either necessary or unnecessary depending on which document is followed
Which risk number to quote KFRE for kidney failure (PMID 26757465) PREVENT for total cardiovascular risk, now multinationally validated (PMIDs: 37947085, 42086979) For most people with CKD the cardiovascular number is much larger; no guideline specifies an order of presentation
Age-adapted CKD definition KDIGO retains a fixed eGFR threshold of 60 at every age (PMID 38490803) Age-adapted criteria remove a large low-risk older group whose death risk exceeds kidney-failure risk 69–935-fold (PMID 34459844) and under-diagnose young adults (PMID 38411155) Determines who is labelled, tested, referred and treated; no trial has randomized a diagnostic threshold
ESA versus HIF-PHI first line KDIGO 2026 retains ESAs first line (via PMID 41604211) Pooled long-term data show no MACE difference (PMID 39186635); regulatory availability differs by continent The stated reason is methodological limitation of the HIF-PHI trials rather than observed harm

Watch list

Document or issue Signal Source to watch
KDIGO CKD Chapter 3 focused update Officially announced KDIGO CKD guideline page
KDIGO lipid guideline revision 2013 evidence base is old KDIGO guidelines index
Post-FLOW diabetes/CKD integration Dedicated kidney outcome published 2024 KDIGO Diabetes and CKD page
Non-diabetic finerenone Signal closed: FIND-CKD primary results published (PMID 42246672); glomerular-disease subgroup (PMID 42246414); INFINITY pooling (PMID 42248158) Watch instead for guideline uptake — KDIGO CKD Chapter 3 focused update
Combination therapy CONFIDENCE reported a 180-day albuminuria advantage for finerenone plus empagliflozin (PMID 40470996); no outcome-powered combination trial yet ClinicalTrials.gov NCT05254002; KDIGO Diabetes and CKD page
Finerenone in type 1 diabetes FINE-ONE reported a six-month albuminuria effect in 242 participants (PMID 41780000) ClinicalTrials.gov NCT05901831
CKD screening implementation Large pragmatic studies active NCT06330480; NCT06906640
NICE NG203 update Official page lists ongoing surveillance NICE history page
UKKA eCKD Guide Web guide can change between journal cycles UKKA eCKD Guide history
KDIGO uptake of the 2026 CKM joint guideline ASN co-authored an ACC/AHA-graded document covering CKD (PMID 42263157) KDIGO CKD guideline page; ACC/AHA guideline index
ADA Standards annual cycle Fastest-updating document here; check §11 each January Diabetes Care Supplement 1
Aldosterone synthase inhibitor outcome trials Two trials, ~16,000 participants, both on background SGLT2 inhibition NCT06531824 (EASi-KIDNEY); NCT06742723
IgA nephropathy guideline revision Iptacopan converted proteinuria to an eGFR slope and kidney-failure benefit (PMID 41910396); five further agents in phase 3 KDIGO Glomerular Diseases guideline page
CKD adaptive platform trial First platform architecture in nephrology, eGFR-slope primary NCT06058585

Registry scope is documents, not a duplicate recommendations synthesis. See guidelines.md.