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NICE CKD Calculator

NICE NG203 Chronic kidney disease: assessment and management · with KFRE (4-variable), TA775 dapagliflozin, TA942 empagliflozin, TA877 finerenone, NG28 and NG238

Patient

Kidney function

Progression

Stage and kidney failure risk will appear here.

Blood pressure & bloods

/

Other findings

Current treatment

NICE-recommended plan

Enter age, sex, eGFR and ACR to see the plan.

Decision support only, based on NICE NG203, linked technology appraisals, NG28 and NG238. KFRE uses the 4-variable equation with non-North American calibration. It does not replace clinical judgement, the full guidance, the SPC or local renal referral pathways. Sick-day guidance follows Think Kidneys/NHS practice, as NG203 does not cover it.

Quick reference

Classification & monitoring
GFR / ACRA1 <3A2 3–30A3 >30
G1 ≥900–11≥1
G2 60–890–11≥1
G3a 45–59112
G3b 30–441–22≥2
G4 15–29223
G5 <154≥4≥4

Numbers = minimum eGFR tests per year (NG203 table 2, 1.3.4). Colour = risk of adverse outcomes. CKD = abnormality of kidney structure or function present for more than 3 months; G1–G2 needs another marker (e.g. ACR ≥3). Confirm ACR 3–70 on an early-morning repeat; no repeat needed at ≥70 (1.1.12). Repeat a new eGFR <60 within 2 weeks (1.1.8).

Referral to nephrology (adults)
  • 5-year risk of needing renal replacement therapy >5% (4-variable KFRE)
  • ACR ≥70 mg/mmol, unless known to be caused by diabetes and already appropriately treated
  • ACR >30 mg/mmol with haematuria
  • Sustained eGFR fall ≥25% with a change of category within 12 months, or ≥15 mL/min/1.73m² per year
  • Hypertension uncontrolled despite at least 4 antihypertensive drugs at therapeutic doses
  • Known or suspected rare or genetic cause of CKD
  • Suspected renal artery stenosis

NG203 1.5.5. Outflow obstruction → urology unless urgent (1.5.8). Discussing with a specialist without referral is an option (1.5.7).

Renal ultrasound

Offer if: accelerated progression; visible or persistent invisible haematuria; symptoms of urinary tract obstruction; family history of polycystic kidney disease and aged over 20; GFR <30; or a nephrologist thinks biopsy is needed (1.2.5).

Drug treatment
DrugNICE criteria
ACEi / ARBDiabetes and ACR ≥3; hypertension and ACR >30; any ACR ≥70 – titrate to highest tolerated licensed dose (NG203 1.6, NG28 1.8.16). Don't start if K⁺ >5.0; stop if K⁺ ≥6.0. eGFR fall ≥25% or creatinine rise ≥30%: look for causes, then stop or reduce (1.6.16–1.6.23)
SGLT2i – T2DMOffer if ACR >30, consider if ACR 3–30, within licensed eGFR (NG28 1.8.17–1.8.18)
Dapagliflozin (TA775)eGFR 25–75 and (T2DM or ACR ≥22.6), added to optimised care incl. max tolerated ACEi/ARB
Empagliflozin (TA942)eGFR 20–44, or eGFR 45–90 with ACR ≥22.6 or T2DM, added to optimised care incl. max tolerated ACEi/ARB
Finerenone (TA877)T2DM, CKD stage 3–4 with ACR persistently ≥3, eGFR ≥25, add-on to max tolerated ACEi/ARB and SGLT2i
StatinAtorvastatin 20 mg for primary or secondary prevention (NG238 1.8.1)
AntiplateletFor secondary prevention of CVD, noting bleeding risk (1.6.25)
BP targets, anaemia & bone
  • ACR <70: clinic systolic <140 (aim 120–139) and diastolic <90 (1.6.1)
  • ACR ≥70: clinic systolic <130 (aim 120–129) and diastolic <80 (1.6.2)
  • Hb ≤110 g/L or symptoms: investigate anaemia. eGFR >60 – look for other causes; 30–60 – judgement; <30 – CKD often the cause (1.7.1–1.7.2)
  • GFR <30: measure calcium, phosphate and PTH (1.12.2); consider sodium bicarbonate if bicarbonate <20 mmol/L (1.12.8)
  • Don't offer low-protein diets (1.4.9); give advice on potassium, phosphate, calories and salt as needed (1.4.7)
Who to test for CKD

Offer eGFR and ACR testing to adults with: diabetes; hypertension; previous AKI; cardiovascular disease; structural renal tract disease, recurrent stones or prostatic hypertrophy; multisystem disease with possible kidney involvement (e.g. SLE); gout; family history of end-stage kidney disease or hereditary kidney disease; incidental haematuria or proteinuria (1.1.21). Don't test on age, sex, ethnicity or obesity alone (1.1.24). Monitor at least 3 years after AKI (1.1.25). Check GFR at least annually on calcineurin inhibitors, lithium or long-term NSAIDs (1.1.20).

Lifestyle advice & patient leaflet
  • Stop smoking, exercise, healthy weight (1.4.6)
  • Dietary advice on potassium, phosphate, calories and salt appropriate to severity (1.4.7); no low-protein diets (1.4.9)
  • Use NSAIDs with caution and monitor GFR (1.3.10)
  • Sick-day guidance for ACEi/ARB, diuretics, metformin and SGLT2i (Think Kidneys)