NICE guideline [NG203]: Chronic kidney disease — assessment and management
The updated NICE chronic kidney disease guideline (NG203) shifts to a risk-based referral approach using the Kidney Failure Risk Equation and recommends adding an SGLT2 inhibitor to ACE-inhibitor or ARB therapy for eligible patients with type 2 diabetes and significant albuminuria.
Background
Chronic kidney disease is a common, largely asymptomatic condition that carries a substantially increased risk of cardiovascular disease and progression to kidney failure. NICE classifies CKD by estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (ACR), which together identify the patients at greatest risk of adverse outcomes. The guideline emphasizes screening people at risk of CKD using both eGFR and ACR.
Key recommendations
The updated guidance recommends no longer adjusting the eGFR estimate for people of African-Caribbean or African family background. It advises using the four-variable Kidney Failure Risk Equation rather than an eGFR threshold to guide specialist referral, with referral suggested for adults whose five-year risk of needing renal replacement therapy exceeds 5%. The guideline also recommends offering an SGLT2 inhibitor, in addition to an optimised dose of an ACE inhibitor or ARB, to people with type 2 diabetes and an ACR of 30 mg/mmol or greater who meet the marketing-authorisation criteria.
Clinical implications
Adopting risk-based stratification with the Kidney Failure Risk Equation is intended to better target specialist referral than eGFR thresholds alone, and integrating SGLT2 inhibitors into standard therapy reflects accumulating evidence for slowing CKD progression and reducing cardiovascular risk. Early identification through combined eGFR and ACR testing remains central to initiating treatment before complications develop.
Category
Guidelines
Source
NICE
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