New Guideline for Chronic Kidney Disease 2024, What Primary Care Can Do About It?: A Narrative Review
Keywords:
Chronic Kidney Disease, eGFR, KDIGO, Primary Care
Abstract
Chronic Kidney Disease (CKD) presents an urgent global public health crisis, affecting over 850 million people worldwide, with low-income nations like Indonesia facing a high burden of undiagnosed cases due to limited awareness and a deficient primary care system. This paper serves as a vital, practical response to the novelty of the KDIGO 2024 Clinical Practice Guideline update, which incorporates a decade of new evidence, including the ethical imperative to eliminate the race coefficient from eGFR equations and the introduction of consensus-based "Practice Points." Key findings from this review highlight that CKD diagnosis is not solely reliant on Glomerular Filtration Rate (GFR), but also on persistent markers of kidney damage such as albuminuria and urine sediment abnormalities. The 2024 updates strongly recommend the race-free CKD-EPI 2021 equation for routine screening, the use of estimated GFR based on creatinine and cystatin C (eGFRcr-cys) for superior accuracy, and the strong recommendation for Sodium-Glucose Cotransporter-2 Inhibitors (SGLT2i) in Type 2 Diabetes patients with CKD. Additionally, the guidelines introduce actionable risk prediction thresholds for nephrology referral, alongside practical advice like "sick day rules" for primary care. This review addresses the critical research gap concerning the primary care sector's capacity and capability by synthesizing the KDIGO 2024 updates. It concludes that primary care, as the frontline in health services, must rapidly adopt these standards to enhance early screening, improve patient risk stratification, and facilitate timely, informed referrals to advanced care, thereby mitigating disease progression and improving patient outcomes globally.
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References
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30. Korus J, Szymczak M, Gołębiowski M, Rydzek J, Majcherczyk K, Wilk J, et al. Metabolic Acidosis in Patients with Chronic Kidney Disease: Diagnosis, Pathogenesis, and Treatment—A Narrative Review. Diagnostics. 2025 Jan;15(16):2052.
31. Dhondup T, Qian Q. Electrolyte and Acid-Base Disorders in Chronic Kidney Disease and End-Stage Kidney Failure. Blood Purif. 2017;43(1–3):179–88.
32. Korsa A, Tesfaye W, Sud K, Krass I, Castelino RL. Risk Factor-Based Screening for Early Detection of Chronic Kidney Disease in Primary Care Settings: A Systematic Review. Kidney Med. 2025 Apr 1;7(4):100979.
33. Hundemer GL, Sood MM, Akbari A. Beyond Creatinine: Is Cystatin C the New Global Standard for Estimated Glomerular Filtration Rate Evaluation? Kidney Med. 2024 Apr;6(4):100806.
34. Shi X, Song J, Chen F, Zhang L, Chen Y, Xu W, et al. Association of Differences in Cystatin C‐ and Creatinine‐Based Estimated Glomerular Filtration Rate With Prevalence and Incidence of Stroke. J Am Heart Assoc. 2025 June 3;14(11):e039185.
35. NKF Workgroup for Implementation of Race-Free eGFR-Based Medication-Related Decisions Publishes Consensus on Transition from Cockcroft Gault Creatinine Clearance to Race-free eGFR Equations | National Kidney Foundation [Internet]. [cited 2025 Dec 15]. Available from: https://www.kidney.org/press-room/nkf-workgroup-implementation-race-free-egfr-based-medication-related-decisions-publishes
36. St. Peter WL, Bzowyckyj AS, Anderson-Haag T, Awdishu L, Blackman M, Bland A, et al. Moving forward from Cockcroft-Gault creatinine clearance to race-free estimated glomerular filtration rate to improve medication-related decision-making in adults across healthcare settings: A consensus of the National Kidney Foundation Workgroup for Implementation of Race-Free eGFR-Based Medication-Related Decisions. Am J Health Syst Pharm. 2025 June 11;82(12):644–59.
37. Buchkremer F, Segerer S. Estimating glomerular filtration rate: a systematic comparison of the new European Kidney Function Consortium equation with the Chronic Kidney Disease Epidemiology Collaboration equation. Clin Kidney J. 2021 Jan;14(1):448–50.
38. Nissaisorakarn P, Xiao H, Doshi MD, Singh N, Lentine KL, Rosas SE. Eliminating racial disparities in kidney transplantation. Clin Transplant. 2021 Aug;35(8):e14397.
39. Fu EL, Coresh J, Grams ME, Clase CM, Elinder CG, Paik J, et al. Removing race from the CKD-EPI equation and its impact on prognosis in a predominantly White European population. Nephrol Dial Transplant Off Publ Eur Dial Transpl Assoc - Eur Ren Assoc. 2023 Jan 23;38(1):119–28.
40. Oliver JD, Nee R, Marneweck H, Banaag A, Koyama AK, Pavkov ME, et al. Impact of Race-Free Glomerular Filtration Rate Estimations on CKD Prevalence in the US Military Health System: A Retrospective Cohort Study. Kidney Med. 2024 Aug;6(8):100861.
41. Jeong TD, Hong J, Lee W, Chun S, Min WK. Accuracy of the New Creatinine-based Equations for Estimating Glomerular Filtration Rate in Koreans. Ann Lab Med. 2023 May 1;43(3):244–52.
42. Safdar A, Akram W, Khan MA, Tahir D, Butt MH. Comparison of EKFC, Pakistani CKD-EPI and 2021 Race-Free CKD-EPI creatinine equations in South Asian CKD population: A study from Pakistani CKD community cohort. Verma A, editor. PLOS ONE. 2024 Mar 21;19(3):e0300428.
43. Yang Y, Jiao Y yuan, Zhang Z, Di D xin, Zhang D yang, Jiang S min, et al. Optimal assessment of the glomerular filtration rate in older chinese patients using the equations of the Berlin Initiative Study. Aging Clin Exp Res. 2024 Jan 31;36(1):17.
44. Chen DC, Potok OA, Rifkin D, Estrella MM. Advantages, Limitations, and Clinical Considerations in Using Cystatin C to Estimate GFR. Kidney360. 2022 Oct 27;3(10):1807–14.
45. Farrell DR, Vassalotti JA. Screening, identifying, and treating chronic kidney disease: why, who, when, how, and what? BMC Nephrol. 2024 Jan 25;25(1):34.
46. Pollock C, Moon J young, Ngoc Ha LP, Gojaseni P, Ching CH, Gomez L, et al. Framework of Guidelines for Management of CKD in Asia. Kidney Int Rep. 2023 Dec 22;9(4):752–90.
47. Mallamaci F, Tripepi G. Risk Factors of Chronic Kidney Disease Progression: Between Old and New Concepts. J Clin Med. 2024 Jan;13(3):678.
2. Kidney DIsease Improving Global Outcomes (KDIGO). KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int Suppl; 2012. 5–14 p.
3. GBD Chronic Kidney Disease Collaboration. Global, regional, and national burden of chronic kidney disease, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet Lond Engl. 2020 Feb 29;395(10225):709–33.
4. Hustrini NM, Susalit E, Lydia A, Marbun MBH, Syafiq M, Yassir null, et al. The Etiology of Kidney Failure in Indonesia: A Multicenter Study in Tertiary-Care Centers in Jakarta. Ann Glob Health. 2023;89(1):36.
5. Francis A, Harhay MN, Ong ACM, Tummalapalli SL, Ortiz A, Fogo AB, et al. Chronic kidney disease and the global public health agenda: an international consensus. Nat Rev Nephrol [Internet]. 2024 Apr 3 [cited 2024 Apr 14]; Available from: https://www.nature.com/articles/s41581-024-00820-6
6. Gaitonde DY, Cook DL, Rivera IM. Chronic Kidney Disease: Detection and Evaluation. 2017 [cited 2025 Dec 15]; Available from: https://www.aafp.org/pubs/afp/issues/2017/1215/p776.html
7. Levey AS, Becker C, Inker LA. Glomerular Filtration Rate and Albuminuria for Detection and Staging of Acute and Chronic Kidney Disease in Adults: A Systematic Review. JAMA. 2015 Feb 24;313(8):837–46.
8. Developments in albuminuria testing: A key biomarker for detection, prognosis and surveillance of kidney and cardiovascular disease—A practical update for clinicians - Beernink - 2025 - Diabetes, Obesity and Metabolism - Wiley Online Library [Internet]. [cited 2025 Dec 16]. Available from: https://dom-pubs.onlinelibrary.wiley.com/doi/10.1111/dom.16359
9. Barzilay JI, Farag YMK, Durthaler J. Albuminuria: An Underappreciated Risk Factor for Cardiovascular Disease. J Am Heart Assoc. 2024 Jan 16;13(2):e030131.
10. Claudel SE, Verma A. Albuminuria in Cardiovascular, Kidney, and Metabolic Disorders: A State-of-the-Art Review. Circulation. 2025 Mar 11;151(10):716–32.
11. de Zeeuw D, Remuzzi G, Parving HH, Keane WF, Zhang Z, Shahinfar S, et al. Albuminuria, a therapeutic target for cardiovascular protection in type 2 diabetic patients with nephropathy. Circulation. 2004 Aug 24;110(8):921–7.
12. Smith M, Herrington WG, Weldegiorgis M, Hobbs FR, Bankhead C, Woodward M. Change in Albuminuria and Risk of Renal and Cardiovascular Outcomes: Natural Variation Should Be Taken into Account. Kidney Int Rep. 2018 July;3(4):939–49.
13. Perazella MA. The urine sediment as a biomarker of kidney disease. Am J Kidney Dis Off J Natl Kidney Found. 2015 Nov;66(5):748–55.
14. Cavanaugh C, Perazella MA. Urine Sediment Examination in the Diagnosis and Management of Kidney Disease: Core Curriculum 2019. Am J Kidney Dis Off J Natl Kidney Found. 2019 Feb;73(2):258–72.
15. Fadel R, Taliercio JJ, Daou R, Layoun H, Bassil E, Fawaz A, et al. Urine Sediment Examination: Comparison Between Laboratory-Performed Versus Nephrologist-Performed Microscopy and Accuracy in Predicting Pathologic Diagnosis in Patients with Acute Kidney Injury. Kidney360. 2023 July 1;4(7):918–23.
16. Um YJ, Chang Y, Kim Y, Kwon MJ, Jung HS, Lee KB, et al. Risk of CKD Following Detection of Microscopic Hematuria: A Retrospective Cohort Study. Am J Kidney Dis Off J Natl Kidney Found. 2023 Apr;81(4):425-433.e1.
17. Orlandi PF, Fujii N, Roy J, Chen HY, Lee Hamm L, Sondheimer JH, et al. Hematuria as a risk factor for progression of chronic kidney disease and death: findings from the Chronic Renal Insufficiency Cohort (CRIC) Study. BMC Nephrol. 2018 June 26;19(1):150.
18. Bullen AL, Fregoso A, Ascher SB, Shlipak MG, Ix JH, Rifkin DE. Markers of Kidney Tubule Dysfunction and Major Adverse Kidney Events. Nephron. 2023 July 31;147(12):713–6.
19. Yuan T, Wang H, Kang T, Wu W, Ou S. Advancements in the non-invasive diagnosis of renal fibrosis. Front Med. 2025 July 30;12:1646412.
20. Aldughiem A. Imaging Diagnosis of Major Kidney and Urinary Tract Disorders in Children. Med Kaunas Lith. 2025 Apr 10;61(4):696.
21. Novel Biomarkers for Rejection in Kidney Transplantation: A Comprehensive Review [Internet]. [cited 2025 Dec 16]. Available from: https://www.mdpi.com/2077-0383/14/15/5489
22. Carlsen RK, Khatir DS, Jensen D, Birn H, Buus NH. Prediction of CKD Progression and Cardiovascular Events Using Albuminuria and Pulse Wave Velocity. Kidney Blood Press Res. 2023;48(1):468–75.
23. Yeo SC, Wang H, Ang YG, Lim CK, Ooi XY. Cost-effectiveness of screening for chronic kidney disease in the general adult population: a systematic review. Clin Kidney J. 2024 Jan;17(1):sfad137.
24. Keshvari-Shad F, Yousefi M, Haj Ebrahimi S, Mahboub-Ahari A, Nemati N, Rezaei S. Chronic kidney disease screening in Iran: a cost-effectiveness analysis of different strategies. Ren Replace Ther. 2025 June 20;11(1):43.
25. Spencer S, Desborough R, Bhandari S. Should Cystatin C eGFR Become Routine Clinical Practice? Biomolecules. 2023 July;13(7):1075.
26. Gaggar P, Raju SB. Diagnostic Utility of Urine Microscopy in Kidney Diseases. Indian J Nephrol. 2024;34(3):213–21.
27. Palsson R, Colona MR, Hoenig MP, Lundquist AL, Novak JE, Perazella MA, et al. Assessment of Interobserver Reliability of Nephrologist Examination of Urine Sediment. JAMA Netw Open. 2020 Aug 21;3(8):e2013959.
28. Lee KS, Jang J, Jang H, Kang H, Rim JH, Lim JB. Better Prediction of Clinical Outcome with Estimated Glomerular Filtration Rate by CKD-EPI 2021. J Appl Lab Med. 2025 Mar 3;10(2):274–85.
29. Kirsztajn GM, Samaan F, Calice-Silva V, Pecoits-Filho R. Critical analysis of the estimated glomerular filtration rate. J Bras Nefrol. 2025;47(4):e20250107.
30. Korus J, Szymczak M, Gołębiowski M, Rydzek J, Majcherczyk K, Wilk J, et al. Metabolic Acidosis in Patients with Chronic Kidney Disease: Diagnosis, Pathogenesis, and Treatment—A Narrative Review. Diagnostics. 2025 Jan;15(16):2052.
31. Dhondup T, Qian Q. Electrolyte and Acid-Base Disorders in Chronic Kidney Disease and End-Stage Kidney Failure. Blood Purif. 2017;43(1–3):179–88.
32. Korsa A, Tesfaye W, Sud K, Krass I, Castelino RL. Risk Factor-Based Screening for Early Detection of Chronic Kidney Disease in Primary Care Settings: A Systematic Review. Kidney Med. 2025 Apr 1;7(4):100979.
33. Hundemer GL, Sood MM, Akbari A. Beyond Creatinine: Is Cystatin C the New Global Standard for Estimated Glomerular Filtration Rate Evaluation? Kidney Med. 2024 Apr;6(4):100806.
34. Shi X, Song J, Chen F, Zhang L, Chen Y, Xu W, et al. Association of Differences in Cystatin C‐ and Creatinine‐Based Estimated Glomerular Filtration Rate With Prevalence and Incidence of Stroke. J Am Heart Assoc. 2025 June 3;14(11):e039185.
35. NKF Workgroup for Implementation of Race-Free eGFR-Based Medication-Related Decisions Publishes Consensus on Transition from Cockcroft Gault Creatinine Clearance to Race-free eGFR Equations | National Kidney Foundation [Internet]. [cited 2025 Dec 15]. Available from: https://www.kidney.org/press-room/nkf-workgroup-implementation-race-free-egfr-based-medication-related-decisions-publishes
36. St. Peter WL, Bzowyckyj AS, Anderson-Haag T, Awdishu L, Blackman M, Bland A, et al. Moving forward from Cockcroft-Gault creatinine clearance to race-free estimated glomerular filtration rate to improve medication-related decision-making in adults across healthcare settings: A consensus of the National Kidney Foundation Workgroup for Implementation of Race-Free eGFR-Based Medication-Related Decisions. Am J Health Syst Pharm. 2025 June 11;82(12):644–59.
37. Buchkremer F, Segerer S. Estimating glomerular filtration rate: a systematic comparison of the new European Kidney Function Consortium equation with the Chronic Kidney Disease Epidemiology Collaboration equation. Clin Kidney J. 2021 Jan;14(1):448–50.
38. Nissaisorakarn P, Xiao H, Doshi MD, Singh N, Lentine KL, Rosas SE. Eliminating racial disparities in kidney transplantation. Clin Transplant. 2021 Aug;35(8):e14397.
39. Fu EL, Coresh J, Grams ME, Clase CM, Elinder CG, Paik J, et al. Removing race from the CKD-EPI equation and its impact on prognosis in a predominantly White European population. Nephrol Dial Transplant Off Publ Eur Dial Transpl Assoc - Eur Ren Assoc. 2023 Jan 23;38(1):119–28.
40. Oliver JD, Nee R, Marneweck H, Banaag A, Koyama AK, Pavkov ME, et al. Impact of Race-Free Glomerular Filtration Rate Estimations on CKD Prevalence in the US Military Health System: A Retrospective Cohort Study. Kidney Med. 2024 Aug;6(8):100861.
41. Jeong TD, Hong J, Lee W, Chun S, Min WK. Accuracy of the New Creatinine-based Equations for Estimating Glomerular Filtration Rate in Koreans. Ann Lab Med. 2023 May 1;43(3):244–52.
42. Safdar A, Akram W, Khan MA, Tahir D, Butt MH. Comparison of EKFC, Pakistani CKD-EPI and 2021 Race-Free CKD-EPI creatinine equations in South Asian CKD population: A study from Pakistani CKD community cohort. Verma A, editor. PLOS ONE. 2024 Mar 21;19(3):e0300428.
43. Yang Y, Jiao Y yuan, Zhang Z, Di D xin, Zhang D yang, Jiang S min, et al. Optimal assessment of the glomerular filtration rate in older chinese patients using the equations of the Berlin Initiative Study. Aging Clin Exp Res. 2024 Jan 31;36(1):17.
44. Chen DC, Potok OA, Rifkin D, Estrella MM. Advantages, Limitations, and Clinical Considerations in Using Cystatin C to Estimate GFR. Kidney360. 2022 Oct 27;3(10):1807–14.
45. Farrell DR, Vassalotti JA. Screening, identifying, and treating chronic kidney disease: why, who, when, how, and what? BMC Nephrol. 2024 Jan 25;25(1):34.
46. Pollock C, Moon J young, Ngoc Ha LP, Gojaseni P, Ching CH, Gomez L, et al. Framework of Guidelines for Management of CKD in Asia. Kidney Int Rep. 2023 Dec 22;9(4):752–90.
47. Mallamaci F, Tripepi G. Risk Factors of Chronic Kidney Disease Progression: Between Old and New Concepts. J Clin Med. 2024 Jan;13(3):678.
Published
2026-04-24
How to Cite
1.
Simanjuntak A, Heryadi S, Sembiring L. New Guideline for Chronic Kidney Disease 2024, What Primary Care Can Do About It?: A Narrative Review. inakidney [Internet]. 24Apr.2026 [cited 24Apr.2026];3(1):189-01. Available from: https://inakidneyhypertension.co.id/index.php/inakidney/article/view/232
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