🔄 Understanding the AKI-CKD Continuum
CKD represents the endpoint of progressive kidney damage, but the relationship with acute injury is bidirectional - CKD increases AKI risk, and AKI accelerates CKD progression.
📋 CKD Definition (KDIGO 2024)
Abnormalities of kidney structure or function present for >3 months, with implications for health
📊 Functional Criteria
- eGFR <60 mL/min/1.73m² for >3 months
- Albuminuria ≥30 mg/g (≥3 mg/mmol)
- Electrolyte abnormalities due to tubular disorders
🔬 Structural Criteria
- Pathologic abnormalities on biopsy
- Imaging abnormalities (polycystic, scarring)
- History of kidney transplantation
🎯 CKD Risk Stratification Matrix
The KDIGO risk matrix combines GFR and albuminuria to predict progression and guide monitoring frequency:
| GFR Category (mL/min/1.73m²) |
Albuminuria Category (mg/g) | |||
|---|---|---|---|---|
| A1 <30 |
A2 30-300 |
A3 300-3000 |
A4 >3000 |
|
| G1 (≥90) | Low Risk* | Moderate Risk | High Risk | 🚨 EXTREME RISK |
| G2 (60-89) | Low Risk* | Moderate Risk | High Risk | 🚨 EXTREME RISK |
| G3a (45-59) | Moderate Risk | High Risk | Very High Risk | 🚨 EXTREME RISK |
| G3b (30-44) | High Risk | Very High Risk | Very High Risk | 🚨 EXTREME RISK |
| G4 (15-29) | Very High Risk | Very High Risk | Very High Risk | 🚨 EXTREME RISK |
| G5 (<15) | Very High Risk | Very High Risk | Very High Risk | 🚨 EXTREME RISK |
Comprehensive CKD Management
🩸 Anemia Management
Evidence-based approach to CKD anemia (2024 updates)
- Iron Deficiency: Absolute vs functional distinction
- Hepcidin Axis: Why oral iron fails in CKD
- IV Iron: Superior to oral in CKD G3b+
- ESA Therapy: Goal is reducing transfusions
- Avoid: Targeting Hgb >11 g/dL (↑ CV risk)
🦴 Mineral Bone Disorder
CKD-MBD management with 2024 evidence updates
- Vitamin D Pathway: 3-step synthesis disruption
- PTH Management: Stage-specific targets
- Evidence Update: PRIMO/OPERA trial impacts
- Severe Hyperparathyroidism: When PTH >300
- Avoid: Routine vitamin D analogs (2017 KDIGO)
⚖️ Metabolic Acidosis
2024 KDIGO threshold update and treatment strategies
- New Threshold: Treat when HCO₃⁻ ≤18 mEq/L
- Evidence Base: UBI study, protein catabolism
- Treatment Options: Sodium bicarbonate vs fruits/vegetables
- CKD Progression: Slows eGFR decline by ~3 mL/min
- Monitor: Trends, not single values
💊 Five Pillars Management
Comprehensive approach to slow CKD progression
- Blood Pressure: Target <130/80 mmHg
- RAAS Inhibition: ACE-I/ARB first-line
- SGLT2 Inhibitors: Renoprotective effects
- Protein Restriction: 2024 evidence challenges
- Diabetes Control: A1C <7% in most patients
🫀 Cardiorenal Disease
CV risk assessment and prevention in CKD
- CV Risk: 2-10× higher than general population
- Risk Factors: Traditional + CKD-specific
- Prevention: Statins, aspirin, lifestyle
- Monitoring: Coronary calcium scoring
- Management: Aggressive risk factor modification
🧮 Interactive Calculators
Clinical decision support tools
- CKD Management: Comprehensive assessment
- Anemia Workup: Iron status evaluation
- PTH Management: Stage-specific recommendations
- Acidosis Treatment: Threshold-based guidance
- Evidence-Based: Latest guideline integration
🚨 CKD Emergency Recognition
Severe Anemia (Hgb <7-8 g/dL)
- Consider urgent transfusion if symptomatic
- Evaluate for bleeding, hemolysis
- Check iron studies, B12, folate
Severe Hyperkalemia (K+ >6.5)
- ECG changes with acidosis
- Calcium gluconate, insulin/dextrose
- Consider emergent dialysis
Severe Acidosis (HCO₃ <12)
- Assess for intercurrent illness
- Consider IV bicarbonate if pH <7.1
- Monitor for respiratory compensation
Uremic Emergency
- Altered mental status, pericarditis
- Bleeding diathesis, uremic frost
- Consider emergent hemodialysis
📊 CKD Management Calculator
Patient Parameters
Management Recommendations
Enter patient parameters to see recommendations
💎 Key Clinical Pearls
🩸 Anemia Management
- IV iron superior to oral in CKD due to hepcidin-mediated poor absorption
- ESA goal is reducing transfusions, not normalizing Hgb
- Check iron studies before starting ESA therapy
🦴 PTH Management
- Address modifiable factors before starting vitamin D analogs
- Modest PTH elevation (2-3× ULN) may be adaptive in CKD
- Consider activated vitamin D analogs when PTH >300 in CKD G3-4
⚖️ Acidosis Management
- 2024 KDIGO moved treatment threshold to ≤18 mEq/L
- Fruits/vegetables equivalent to bicarbonate for CKD progression
- Monitor trends, not single values
🎯 Essential CKD Learning Points
📊 Risk Stratification
- KDIGO matrix combines GFR + albuminuria
- Extreme risk: A4 category (proteinuria >3g)
- Monitor frequency based on risk level
- Early nephrology referral for high risk
🎯 Evidence-Based Management
- 2024 guidelines emphasize individualization
- Avoid routine vitamin D analogs
- New acidosis threshold (≤18 mEq/L)
- IV iron superior in CKD G3b+
🚨 Emergency Recognition
- Severe anemia may require transfusion
- Hyperkalemia with ECG changes
- Uremic emergencies need dialysis
- Severe acidosis evaluation
💡 Clinical Integration
- AKI-CKD continuum concept
- Cardiorenal disease prevention
- Five pillars approach
- Regular monitoring and adjustment