Chronic Kidney Disease Comprehensive Staging Reference

Clinical note: This online quick reference summarizes CKD G-stage, ICD-10 coding, presentation, markers, complications, management, therapy, and references in one table for teaching and clinic use.

Stage	GFR (mL/min/1.73 m²)	ICD-10	Diagnosis	Clinical Presentation	Key Labs & Markers	Complications	Management	Therapy	References
G1	≥ 90	N18.1	eGFR ≥ 90 plus markers of kidney damage present ≥ 3 months Markers: albuminuria (ACR ≥ 30 mg/g), hematuria, structural abnormality, history of transplant eGFR alone does NOT qualify as CKD at this stage Use CKD-EPI 2021 creatinine equation; confirm with cystatin C if borderline	Usually asymptomatic Detected via screening in at-risk populations (diabetes, HTN, family history) Foamy urine if significant albuminuria Gross hematuria if glomerulonephritis	eGFR (CKD-EPI 2021, cystatin C) UACR spot urine, confirm with repeat Urinalysis with microscopy BMP, lipid panel at baseline Renal ultrasound if structural cause suspected Monitor eGFR + UACR annually	Increased CV risk if albuminuria present Risk of progression dependent on etiology & albuminuria category	Identify & treat underlying cause (diabetes, GN, obstruction) Risk factor modification: smoking cessation, weight management, exercise Dietary sodium < 2 g/day Avoid nephrotoxins (NSAIDs, aminoglycosides, iodinated contrast without precautions) Annual screening for complications not yet required Patient education on CKD awareness	ACEi/ARB if albuminuria ≥ 30 mg/g (with DM) or ≥ 300 mg/g (without DM); titrate to max tolerated dose BP target < 120 mmHg systolic (standardized measurement) Statin if age ≥ 50 or CV risk factors SGLT2i if T2DM with albuminuria or HF Glycemic control (HbA1c ~7%) if diabetic	1. KDIGO, Kidney Int, 2024 2. Chen, JAMA, 2019 3. Herrington, Lancet, 2026 4. Song, JAMA, 2025 5. Goodbred, Am Fam Physician, 2023
G2	60–89	N18.2	eGFR 60–89 plus markers of kidney damage present ≥ 3 months Same marker requirements as G1 Mildly decreased GFR alone in older adults may not represent CKD Consider age-related GFR decline vs. true CKD	Usually asymptomatic May have foamy urine, nocturia, or gross hematuria depending on etiology Often incidental finding on routine labs	eGFR + UACR Urinalysis with microscopy BMP, lipid panel at baseline Consider cystatin C to confirm eGFR Monitor annually	Mildly increased CV risk Progression risk depends on albuminuria & etiology	Same as G1 Establish CKD cause if not yet determined Consider renal biopsy if unexplained albuminuria or hematuria Medication review for nephrotoxins Immunizations up to date (influenza, pneumococcal, COVID-19)	ACEi/ARB for albuminuria (same criteria as G1) Statin if age ≥ 50 or CV risk factors Glycemic control (HbA1c ~7%) if diabetic SGLT2i if T2DM with albuminuria or HF GLP-1 RA if T2DM with suboptimal glycemic control	1. KDIGO, Kidney Int, 2024 2. Chen, JAMA, 2019 3. Herrington, Lancet, 2026 4. ADA, Diabetes Care, 2026 5. Gunning, JAMA, 2025
G3a	45–59	N18.31	eGFR 45–59; meets CKD criteria on eGFR alone (no markers of damage required) Mildly to moderately decreased kidney function Confirm with repeat eGFR ≥ 3 months apart Calculate KFRE (4-variable) for 2- and 5-year kidney failure risk	Often asymptomatic Fatigue may begin Early nocturia Mild edema in some patients	eGFR + UACR q6–12 months CBC (anemia screening annually) BMP (K⁺, bicarb, Ca²⁺, PO₄) PTH baseline, then as indicated 25(OH)D baseline Lipid panel KFRE calculation	CV disease leading cause of death; risk significantly elevated Early anemia (prevalence ~8–15%) Early CKD-MBD (↑ PTH, ↑ FGF-23) Medication dose adjustments needed AKI vulnerability increased	Dose-adjust renally cleared medications Protein intake ~0.8 g/kg/day Nephrology referral if KFRE 5-year risk ≥ 35% Monitor for anemia, CKD-MBD, acidosis Hepatitis B vaccination Avoid iodinated contrast without hydration protocol	ACEi/ARB (first-line for albuminuria) SGLT2i (dapagliflozin/empagliflozin) eGFR ≥ 20, with or without diabetes Statin (age ≥ 50 or CV risk) Finerenone if T2DM + albuminuria (UACR ≥ 30 mg/g) + eGFR ≥ 25 GLP-1 RA if T2DM with suboptimal glycemic control BP target < 120 mmHg systolic	1. KDIGO, Kidney Int, 2024 2. Herrington, Lancet, 2026 3. Song, JAMA, 2025 4. ADA, Diabetes Care, 2026 5. Moranne, JASN, 2009 6. KDIGO CKD-MBD, 2017
G3b	30–44	N18.32	eGFR 30–44; moderately to severely decreased Higher risk of progression to kidney failure KFRE should be calculated; nephrology referral recommended if 5-year risk ≥ 35% Establish cause if not yet determined	Fatigue, mild edema Nocturia, changes in urine output May remain asymptomatic Early pruritus in some patients	eGFR + UACR q3–6 months CBC q6–12 months Ca²⁺, PO₄ q6–12 months PTH baseline, then per trend 25(OH)D Serum albumin Bicarb & K⁺ — monitor closely Iron studies (ferritin, TSAT) if anemia	CV disease — markedly elevated risk Anemia more prevalent CKD-MBD: ↑ PTH, ↑ PO₄ emerging, ↓ vitamin D Metabolic acidosis (bicarb < 22) Hyperkalemia risk increasing Fluid retention Gout exacerbation	Nephrology referral recommended Multidisciplinary CKD care if KFRE 2-year risk ≥ 10% Oral bicarb if HCO₃ < 22 mmol/L Iron repletion for anemia; assess ESA if Hgb < 10 Low-PO₄ diet; phosphate binders if hyperphosphatemia Vitamin D supplementation if deficient K⁺ management (dietary, patiromer/SZC) Review all meds for dose adjustment Reduce metformin to 1000 mg/day if eGFR 30–44	Continue ACEi/ARB, SGLT2i, finerenone (if indicated) Statin (continue or initiate) GLP-1 RA if T2DM BP target < 120 mmHg systolic Avoid dual RAS blockade	1. KDIGO, Kidney Int, 2024 2. Herrington, Lancet, 2026 3. Moranne, JASN, 2009 4. KDIGO CKD-MBD, 2017 5. VA/DoD CKD CPG, 2025 6. ADA, Diabetes Care, 2026
G4	15–29	N18.4	eGFR 15–29; severely decreased kidney function Nephrology co-management essential KFRE: if 2-year risk ≥ 40%, begin KRT planning (access, transplant eval) Inform patient of all treatment options: transplant, dialysis, conservative management	Fatigue, poor appetite, nausea Peripheral edema, dyspnea Pruritus, metallic taste Nocturia, decreased urine output Cognitive changes possible Restless legs	eGFR + UACR q3–5 months CBC q3–6 months Ca²⁺, PO₄ q3–6 months PTH q6–12 months Alk phos annually Bicarb, K⁺, albumin frequent Iron studies (ferritin, TSAT) KFRE for 2- & 5-year risk	CV disease very high risk (MI, HF, stroke, sudden death) Anemia common (~30–41%) CKD-MBD: ↑ PTH (up to 85%), hyperphosphatemia (~30%), vascular calcification Metabolic acidosis (~39%) Hyperkalemia (~42%) Volume overload Uremic symptoms emerging Malnutrition / protein-energy wasting Increased infection risk	Nephrology co-management essential Transplant referral: all CKD G4–G5 patients expected to reach ESKD should be informed & evaluated (refer 6–12 months before anticipated dialysis) Vascular access planning if HD anticipated (AVF creation when eGFR 15–20) ESA if Hgb persistently < 10 g/dL (target 10–11.5) Phosphate binders (sevelamer, Ca-based, lanthanum) Active vitamin D analogs or calcimimetics for hyperparathyroidism Oral bicarb supplementation Hepatitis B vaccination (high-dose series) Discontinue metformin if eGFR < 30 Advance care planning discussions	Continue ACEi/ARB (monitor K⁺ & eGFR closely) SGLT2i continue if eGFR ≥ 20 (may initiate per EMPA-KIDNEY data) Finerenone if T2DM + albuminuria + eGFR ≥ 25 Statin (continue) BP target < 120 mmHg systolic Avoid NSAIDs, nephrotoxins	1. KDIGO, Kidney Int, 2024 2. Chen, JAMA, 2019 3. Herrington, Lancet, 2026 4. Song, JAMA, 2025 5. Moranne, JASN, 2009 6. KDIGO Transplant, 2020 7. Combe, Nat Rev Nephrol, 2026
G5	< 15	N18.5	eGFR < 15; kidney failure Dialysis initiation based on symptoms, signs, QoL, preferences — NOT eGFR alone Often initiated when eGFR 5–10 (IDEAL trial: no benefit to early start) Urgent indications: uremic encephalopathy, pericarditis, pleuritis, refractory hyperkalemia/acidosis/volume overload	Uremic symptoms: nausea, vomiting, anorexia, weight loss Severe fatigue, pruritus Dyspnea, orthopnea Peripheral neuropathy Mental status changes, encephalopathy Pericarditis (emergent) Bleeding diathesis Asterixis	eGFR + UACR q1–3 months CBC q1–3 months Ca²⁺, PO₄ q1–3 months PTH q3–6 months Alk phos q12 months Full metabolic panel frequent Iron studies, albumin, prealbumin BUN — uremic marker Coagulation studies if bleeding	All complications of G4, more severe Uremia — multi-organ toxicity Severe anemia Refractory hyperkalemia, acidosis Severe CKD-MBD with vascular calcification Pericarditis, pleuritis Immune dysfunction & infections Malnutrition Peripheral & autonomic neuropathy	Nephrology-led care Shared decision-making: dialysis vs. transplant vs. conservative kidney management Preemptive transplant preferred when feasible (superior survival) Dialysis modality education (in-center HD, home HD, PD) Conservative management pathway if aligned with patient goals (symptom-focused care) Aggressive anemia management (ESA + IV iron; HIF-PHI as alternative) Phosphate binders, calcimimetics, active vitamin D Dietary management (protein, K⁺, PO₄, Na⁺, fluid restriction) Symptom management (antiemetics, antipruritics, pain) Advance care planning	Continue cardiorenal protective agents as tolerated SGLT2i may be continued below eGFR 20 once initiated Symptom-directed pharmacotherapy Initiate KRT when clinically indicated	1. KDIGO, Kidney Int, 2024 2. Chen, JAMA, 2019 3. Herrington, Lancet, 2026 4. Combe, Nat Rev Nephrol, 2026 5. Flythe, JAMA, 2024 6. Wouk, Am Fam Physician, 2021
ESRD	< 15 + RRT	N18.6	eGFR < 15 AND receiving kidney replacement therapy (HD, PD, or transplant) Distinct from G5 (which is pre-dialysis kidney failure) Medicare ESRD benefit eligibility in the US Transplant recipients coded N18.6 regardless of post-transplant eGFR	On hemodialysis, peritoneal dialysis, or kidney transplant Symptoms depend on dialysis adequacy Fatigue, cramping, hypotension (intradialytic) Access-related complications (infection, thrombosis) Post-transplant: immunosuppression side effects	Dialysis adequacy (Kt/V ≥ 1.4 HD; ≥ 1.7 PD weekly) Monthly: CBC, BMP, Ca²⁺, PO₄, albumin PTH q3–6 months Iron studies monthly (HD patients) Hepatitis B/C serologies Transplant: drug levels (tacrolimus, cyclosporine), DSA monitoring, BK virus, CMV	All CKD complications persist CV disease remains #1 cause of death Access complications (AVF/AVG stenosis, catheter infections) Dialysis-related amyloidosis (long-term) Transplant: rejection, infection, malignancy risk (PTLD, skin cancer) Psychosocial burden, depression Mortality ~15–20% per year on dialysis	Kidney transplant — preferred RRT when feasible (superior survival & QoL) Hemodialysis — in-center 3×/week or home HD (more frequent; better outcomes) Peritoneal dialysis — CAPD or APD; preserves residual function Conservative management — for patients declining dialysis Maintain access patency; monitor adequacy Anemia, CKD-MBD, BP, volume management Cardioprotection: statin, antiplatelet as indicated Vaccination per ESRD schedule Multidisciplinary support (dietitian, social work, mental health)	Immunosuppression (transplant): tacrolimus, MMF, prednisone, induction ESA + iron, HIF-PHI Phosphate binders, calcimimetics, active vitamin D Anti-hypertensives, statin Treat dialysis-specific issues (cramps, hypotension, access)	1. KDIGO, Kidney Int, 2024 2. KDIGO Transplant, 2020 3. USRDS Annual Report, 2024 4. Combe, Nat Rev Nephrol, 2026 5. Flythe, JAMA, 2024

For clinical reference only. Verify dosing and recommendations against current local guidelines and primary literature before applying to patient care.