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Definition and classification of CKD Defining CKD. CKD is defined as abnormalities of kidney structure or function, present for a minimum of 3 months, with implications for health (Table 1).1 Classifying CKD. CKD is classified based on Cause, GFR category (G1–G5), and Albuminuria category (A1–A3), abbreviated as CGA.
1 These 3 components of the classification system are each critical in the assessment of people with CKD and help enable determination of severity and risk. Listed below are reference tables describing each component. Note that while the definition of CKD includes many different markers of kidney damage and is not confined to decreased GFR and albumin-to-creatinine ratio (ACR) >30 mg/g [>3 mg/mmol], the classification system is based on the 2 dimensions of GFR and degree of albuminuria (Tables 2 and 3). This nuance is often missed by healthcare providers and students.
It is well established that patient advocates with CKD and healthcare providers prefer the more clinically useful and generally understood assessment of GFR resulting from the use of GFR estimating equations compared with serum creatinine (SCr) alone. Globally, although still not universally available in all countries, SCr is measured routinely and the approach to assessment of GFR is therefore to use SCr and an estimating equation for initial assessment of GFR. The approach to evaluation of GFR using initial and supportive tests is described in greater detail in Chapter 1.
Etiology of CKD should be sought, and there are numerous systems for grouping various etiologies, some of which are evolving with new knowledge and diagnostic tools.
There are congenital and genetic causes of CKD, some associated with systemic diseases, and others that are primary. It is beyond our remit to suggest a specific approach, but we highlight the importance of establishing a cause to individualize management of CKD.

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1.1: DEFINITION OF CKD
1.1.1: CKD is defined as abnormalities of kidney structure or function, present for43 months, with implications for health. (Not Graded)
1.2: STAGING OF CKD
1.2.1: We recommend that CKD is classified based on cause, GFR category, and albuminuria category (CGA). (1B)
1.2.2: Assign cause of CKD based on presence or absence of systemic disease and the location within the kidney of
observed or presumed pathologic-anatomic findings. (Not Graded)
1.2.3: Assign GFR categories as follows (Not Graded):
1.2.4: Assign albuminuria* categories as follows (Not Graded):
*note that where albuminuria measurement is not available, urine reagent strip results can be substituted (Table 7)
1.3: PREDICTING PROGNOSIS OF CKD
1.3.1: In predicting risk for outcome of CKD, identify the following variables: 1) cause of CKD; 2) GFR category;
3) albuminuria category; 4) other risk factors and comorbid conditions. (Not Graded)
Criteria for CKD (either of the following present for 43 months)
Markers of kidney damage (one or more) Albuminuria (AER Z30 mg/24 hours; ACR Z30 mg/g [Z3 mg/mmol])
Urine sediment abnormalities
Electrolyte and other abnormalities due to tubular disorders
Abnormalities detected by histology
Structural abnormalities detected by imaging
History of kidney transplantation
Decreased GFR GFR o60 ml/min/1.73 m2 (GFR categories G3a–G5)
Abbreviations: CKD, chronic kidney disease; GFR, glomerular filtration rate.