Chronic kidney disease: what good care looks like

What chronic kidney disease is, in plain language

Your kidneys filter waste and extra fluid out of your blood, help control blood pressure, and produce hormones that support red blood cells and bone health. Chronic kidney disease (CKD) means the kidneys are damaged or filtering less well than normal for three months or longer.

Kidney function is measured by estimated glomerular filtration rate (eGFR), calculated from a blood test, and by how much protein leaks into the urine (albuminuria). CKD is staged from 1 (mildly reduced function) to 5 (kidney failure) based on both numbers together. The two most common causes are diabetes and high blood pressure, and CKD usually causes no symptoms until it is advanced, which is why routine screening in people at risk matters.

What the current guidelines recommend

The main guideline is the KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. A major shift in recent years is that SGLT2 inhibitors and, for diabetic kidney disease, finerenone are now recommended to slow CKD progression regardless of whether the underlying cause is diabetes, based on trial evidence that these medicines protect the kidneys directly.

The treatments, and why each one is recommended

ACE inhibitors or ARBs are first-line for anyone with CKD and significant protein in the urine, or with both CKD and high blood pressure; they lower pressure inside the kidney's filtering units and slow protein leakage.

SGLT2 inhibitors (dapagliflozin, empagliflozin) are now recommended for most people with CKD who have an eGFR and albuminuria in the treatment range, whether or not they have diabetes, because large trials showed they slow the loss of kidney function and reduce the risk of kidney failure and cardiovascular death.

Finerenone, a newer, more kidney-targeted relative of spironolactone, is used for CKD caused by type 2 diabetes to further reduce kidney and cardiovascular events on top of an ACE inhibitor or ARB.

Blood pressure control and a statin for cardiovascular risk are standard parts of care, since cardiovascular disease is the leading cause of death in CKD. Avoiding regular NSAID use (ibuprofen, naproxen) is also important, since these drugs can worsen kidney function.

What guideline-based care looks like at a visit

A good clinician checks eGFR and a urine albumin-to-creatinine ratio (UACR) at least annually if you are at risk, and more often once CKD is diagnosed, since UACR is often the earliest sign of kidney damage and is checked separately from a basic metabolic panel. Blood pressure is treated to the guideline target, medicines are reviewed and adjusted for your kidney function, and you should be referred to a nephrologist when eGFR drops below certain thresholds or protein in the urine is high, rather than only once kidney failure is imminent.

Why choosing a guideline-based clinician matters

Trials of SGLT2 inhibitors in CKD (with and without diabetes) showed roughly a one-third reduction in the risk of kidney failure, dialysis, or death from kidney disease. Because CKD has few symptoms until it is advanced, the medicines and monitoring your clinician offers, not how you feel, are what determine whether it progresses.

Questions to ask your doctor

1. Which guideline do you follow for chronic kidney disease, and what year is it from?
2. Which of the recommended treatments am I on, and if not, why not?
3. What targets are we aiming for, and how will we track them?
4. What should make me call you before my next visit?
5. Do you sell any supplements or compounded medicines? (A guideline-based clinic does not.)

Find a vetted nephrologist near you

Every nephrologist on DoctorDirectory.ai is license-verified, board-certified, and has signed a dated attestation to these guidelines. No patient reviews or star ratings, just facts you can check.