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Chronic Kidney Disease (CKD) Staging — KDIGO 2024

Two-axis staging of chronic kidney disease combining glomerular filtration rate (G1–G5) and albuminuria (A1–A3) categories used to estimate risk of progression, cardiovascular events, and need for kidney replacement therapy.

Written by: Saygı Hospital Health Guide Editorial Board
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This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

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What is Chronic Kidney Disease (CKD) Staging — KDIGO 2024?

Chronic kidney disease is defined as abnormalities of kidney structure or function present for more than 3 months with implications for health; staging uses estimated GFR (eGFR) by CKD-EPI 2021 race-free equation and urine albumin-to-creatinine ratio (UACR).

GFR categories range from G1 (eGFR over 90), G2 (60–89), G3a (45–59), G3b (30–44), G4 (15–29), to G5 (under 15 or on dialysis); albuminuria is A1 (under 30 mg/g), A2 (30–300 mg/g), A3 (over 300 mg/g).

The KDIGO heat map combines G and A categories into low, moderately increased, high, and very high risk zones, predicting all-cause and cardiovascular mortality, kidney failure, and acute kidney injury independent of eGFR alone.

Symptoms

Asymptomatic in early stages G1–G3a; detected through screening or incidental laboratory findings
Fatigue, decreased exercise tolerance, anemia symptoms in G3b–G4 due to erythropoietin deficiency
Edema, hypertension that is hard to control, foamy urine indicating proteinuria
Nausea, anorexia, pruritus, restless legs, sleep disturbance in advanced G4–G5
Pericardial rub, encephalopathy, asterixis, uremic frost in stage G5 needing urgent dialysis
Bone pain, fragility fractures from CKD-mineral bone disorder in G4–G5

Risk Factors

Diabetes mellitus type 1 and type 2 — leading cause of CKD and dialysis worldwide
Hypertension, especially uncontrolled or long-standing
Cardiovascular disease, heart failure with preserved or reduced ejection fraction
Family history of polycystic kidney disease, Alport syndrome, IgA nephropathy
Recurrent acute kidney injury, nephrotoxic medication exposure (NSAIDs, aminoglycosides, contrast)
Obesity, metabolic syndrome, smoking, and older age

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • eGFR persistently under 30 mL/min/1.73m² (G4–G5) — referral to nephrology for transplant evaluation and dialysis planning
  • UACR over 300 mg/g (A3) regardless of eGFR — nephrology consultation for cause workup and renoprotection
  • Rapid eGFR decline of more than 5 mL/min/year — urgent nephrology evaluation
  • Hyperkalemia, refractory metabolic acidosis, or volume overload despite treatment — same-day specialist contact
  • Pregnancy in CKD or planning pregnancy in G3a–G5 — multidisciplinary planning before conception

Treatment Methods

01
Strict blood pressure control with ACE inhibitor or ARB in proteinuric CKD; target under 130/80 mmHg in most adults using KDIGO 2024 thresholds
02
SGLT2 inhibitor (dapagliflozin or empagliflozin) for CKD with eGFR 20–60 mL/min and UACR over 200 mg/g, regardless of diabetes status, with documented kidney and cardiovascular benefit
03
Finerenone (non-steroidal mineralocorticoid receptor antagonist) added in diabetic CKD with persistent albuminuria despite ACEi or ARB and SGLT2 inhibitor
04
Anemia management with iron repletion and erythropoiesis-stimulating agents or HIF prolyl hydroxylase inhibitors when hemoglobin under 10 g/dL after correction of deficiencies
05
CKD–mineral bone disorder management including phosphate binders, vitamin D analogs, calcimimetics; preparation of vascular access, transplant referral, and conservative care discussion in G4–G5

Which Department to Visit?

You can visit our Dahiliye (İç Hastalıkları) department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.