Clinical practice guidelines registry — Chronic kidney disease¶
Last curated: 2026-11-01 (periodic literature sweep). The KDIGO 2027 CKD medications public-review draft PDF was read this session. NICE NG203 last reviewed remains 13 October 2026. Document status below is distinguished from recommendation-level verification. Draft recommendations are not current guidance.
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; last reviewed 13 October 2026 |
| 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 2026-10-11) |
| 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 |
| KDIGO (Annals synopsis) | 2026 | Global | Anaemia in CKD — graded-recommendation synopsis | PMID 42735412 | current companion to PMID 41485807 |
| AHA | 2026 | United States (international reach) | Women's kidney health scientific statement | PMID 42751780 | current statement, not a GRADE guideline |
| Shanghai Medical Doctor Association Nephrologists Branch | 2026 | China | Expert suggestions on telitacicept in IgA nephropathy | PMID 42557084 | regional expert suggestions; not KDIGO |
| International Pediatric Nephrology Association (IPNA) | 2026 | Global (paediatric) | Commentary on the KDIGO 2026 anaemia guideline | PMID 42862204 | current commentary; PubMed record has no abstract, content not summarised |
| KDIGO | 2027 draft | Global | CKD medications focused update | https://kdigo.org/wp-content/uploads/2026/10/KDIGO-2027-CKD-Guideline-Focused-Update-Public-Review-Draft.pdf | public review through 4 November 2026; not final guidance; Rec 1.2.3 suggests finerenone in non-diabetic CKD (2B) |
| KDIGO | 2025 | Global | IgAN/IgAV guideline and executive summary | PMID 40975564; PMID 40975525 | current published topic guideline; replaces the IgAN chapter of 2021 |
| KDIGO | 2026 | Global | Complement inhibitors and B cell-modifying agents in IgAN | PMID 41895685 | commentary accompanying the 2025 guideline; not a full guideline revision |
| KDOQI/NKF | 2026 | United States | Commentary on KDIGO 2025 IgAN/IgAV | PMID 42095796 | implementation commentary |
| ERA Immunonephrology Working Group | 2025 | Europe | Perspective on KDIGO 2025 IgAN update | PMID 41244638 | perspective, not a new KDIGO guideline |
| KDOQI/NKF | 2026 | United States | Commentary on AHA/ACC 2025 blood-pressure guideline | PMID 42907045 | CKD-relevant commentary; BP-target synthesis belongs to hypertension |
| American Society of Onconephrology | 2026 | Global (oncology–nephrology overlap) | Anaemia in patients with cancer and CKD | PMID 42933492 | position statement, not a KDIGO replacement; PubMed abstract retrieved 2026-11-01 |
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: the 2027 medications public-review draft is now readable as a PDF (accessed 2026-11-01). It has not replaced this 2024 document. Draft Rec 1.2.3 suggests finerenone in non-diabetic albuminuric CKD (2B); Rec 1.1.2 suggests SGLT2 inhibition in A1 CKD with eGFR 20–45 (2B); Rec 1.3.2 suggests GLP-1-based therapy in non-diabetic CKD with ASCVD and overweight or obesity (2B).
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.
- Re-read 2026-10-18 (HTTP 200): published and last-updated dates unchanged; last reviewed 13 October 2026. The page's change note: links to relevant NICE technology appraisal guidance were added to the section on renin–angiotensin system antagonists for adults, "to provide easy access to relevant guidance at the right point in the guideline only and is not a change in practice" (NICE — "Chronic kidney disease: assessment and management (NG203)", https://www.nice.org.uk/guidance/ng203, accessed 2026-10-18). The live recommendations were read on 2026-10-25: sections 1.6.9, 1.6.10 and 1.6.22 currently link dapagliflozin TA1075, empagliflozin TA942, finerenone TA877, sodium zirconium cyclosilicate TA1148 and patiromer TA623. This inventory does not establish which links were newly inserted on 13 October (NICE — “Recommendations, NG203”, https://www.nice.org.uk/guidance/ng203/chapter/Recommendations, accessed 2026-10-25).
- 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.
KDIGO 2026 anaemia — Annals synopsis¶
- Hedayati et al. Ann Intern Med. 2026 Sep 15. PMID 42735412.
- Contribution: retrievable text of the eight graded recommendations (IV iron preferred in haemodialysis; ESA first-line over HIF-PHI; ESA maintenance haemoglobin below 11.5 g/dL) plus 49 practice points; evidence reviews through October 2024.
AHA 2026 — Women's kidney health¶
- Gohar et al. Circulation. 2026 Sep 17. PMID 42751780.
- Contribution: scientific statement on sex differences in CKD prevalence versus kidney-failure incidence, trial under-representation, pregnancy risk, and menopause.
KDIGO 2027 CKD medications — public-review draft¶
- PDF: https://kdigo.org/wp-content/uploads/2026/10/KDIGO-2027-CKD-Guideline-Focused-Update-Public-Review-Draft.pdf (accessed 2026-11-01).
- Status: public review through 4 November 2026; the document states it is not current guidance and will change after feedback. Evidence reviews closed April 2026.
- Contribution of the draft: Rec 1.1.1 SGLT2 1A/1B by diabetes/HF/albuminuria/eGFR strata; Rec 1.1.2 SGLT2 in A1 with eGFR 20–45 (2B); Rec 1.2.1 nsMRA in T2D (1A); Rec 1.2.2 nsMRA in T1D (2C); Rec 1.2.3 finerenone without diabetes (2B); Rec 1.3.1 GLP-1 in T2D CKD (1A); Rec 1.3.2 GLP-1 without diabetes plus ASCVD and overweight/obesity (2B).
- FIND-CKD uptake is 2B, not 1A. Rec 1.2.3 excludes polycystic kidney disease, lupus nephritis and ANCA vasculitis.
American Society of Onconephrology 2026 — anaemia in cancer and CKD¶
- Costa E Silva et al. Kidney Int. 2026. PMID 42933492.
- Contribution: position statement on overlapping erythropoietin deficiency, inflammation-driven iron restriction, myelosuppression and transfusion thresholds when CKD and malignancy coexist. Not a replacement for KDIGO 2026 anaemia. Abstract retrieved; full text not retrieved.
Telitacicept in IgA nephropathy — 2026 Chinese expert suggestions¶
- Zhonghua Nei Ke Za Zhi. 2026;65:791–799. PMID 42557084.
- Contribution: regional practice suggestions after Chinese approval of telitacicept for IgA nephropathy; not a KDIGO document.
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) | Published guidelines pre-date FLOW; the 2027 public-review draft suggests GLP-1-based therapy in non-diabetic CKD with ASCVD and overweight/obesity (Rec 1.3.2, 2B) | Implementation lag; draft is not current guidance |
| MRA outside diabetes | Finerenone outcomes established in T2D CKD; FIND-CKD (PMID 42246672) and INFINITY (PMID 42248158) cover non-diabetic CKD | Published guidelines still restrict nsMRA to diabetic CKD. The 2027 public-review draft suggests finerenone in non-diabetic albuminuric CKD (Rec 1.2.3, 2B) while retaining T2D as 1A | Draft uptake, not a published replacement for KDIGO 2024 |
| 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 | 2027 medications public-review draft read 2026-11-01; Rec 1.2.3 (finerenone without diabetes, 2B), Rec 1.1.2 (SGLT2 in A1 eGFR 20–45, 2B), Rec 1.3.2 (GLP-1 without diabetes + ASCVD + overweight, 2B). Comments close 4 November 2026; not current guidance | Draft PDF; 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 | Trial signal closed (PMID 42246672). Draft Rec 1.2.3 is 2B, not 1A; published KDIGO 2024 unchanged | Final 2027 medications guideline |
| 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 | Reviewed 13 October 2026: technology-appraisal links added to the RAS-antagonist section, stated not to be a change in practice | NICE NG203 page and 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 | EASi-KIDNEY ACTIVE_NOT_RECRUITING, actual enrolment 8,371 (planned 11,000), estimated primary completion 2026-12-31 (registry 2026-10-18); baxdrostat still recruiting (n=5,000); lorundrostat phase 2 CKD signal (PMID 42778148); balcinrenone phase 2 (PMID 41218621) and phase 3 NCT07624305 | NCT06531824; NCT06742723; NCT07624305 |
| IgA nephropathy guideline revision | 2025 guideline and 2026 KDIGO commentary located and catalogued; monitor future updates after the newly indexed final phase 3 reports | KDIGO IgAN page; PMID 40975564; PMID 41895685 |
| ZEUS (ziltivekimab) outcome paper | Registry COMPLETED 2026-09-28, n=6,385, no posted results | NCT05021835 |
| KDIGO anaemia graded numbers | Annals synopsis now retrievable (PMID 42735412) | Annals; KDIGO anaemia 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.