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The 2024 KDIGO guideline reorganized CKD care around the 'risk-based' framework — with new emphasis on SGLT2 inhibitors in non-diabetic CKD, BP targets, and the G4+ risk categories.
Evidence reviewed & updated: 2026-08 — reflects the latest published trials and guidelines.
The KDIGO 2024 CKD guideline is the first major reorganization of CKD care in over a decade — it reframes staging around a heat-map risk matrix (G1-G5 × A1-A3), recommends SGLT2 inhibitors for non-diabetic CKD (eGFR ≥20), and reaffirms aggressive BP targets. This is the reference for how CKD should be managed today.
KDIGO 2024 kept the G1-G5 eGFR categories and A1-A3 albuminuria categories but formalized them as a heat-map: patients in the lower-right (low GFR, high albuminuria) are highest risk and get the most intensive treatment and monitoring. G4+ (eGFR <30) with A2-A3 is now explicitly 'high risk.'
This reframing matters for clinicians: monitoring frequency, medication intensity, and referral triggers are now tied to the risk cell, not just the eGFR number.
The headline change: SGLT2 inhibitors (dapagliflozin, empagliflozin) are now recommended for ALL CKD patients with eGFR ≥20 and/or UACR ≥200 mg/g — regardless of diabetes status. DAPA-CKD (39% benefit) and EMPA-KIDNEY (28% benefit) both included large non-diabetic populations.
For patients and clinicians: diabetes is no longer a prerequisite for kidney-protective SGLT2 therapy. The drugs are additive to RAS blockade and are continued until dialysis.
Blood pressure: office systolic <120 mmHg is the target for most CKD patients when tolerated — the KDIGO 2021 position carried forward, with home BP monitoring encouraged.
Lipids: statins are recommended for essentially all CKD patients (except on dialysis, where SHARP supports continuing for those already treated). Anticoagulation in AF with CKD: apixaban is the preferred NOAC across stages.
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