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Draft: not yet reviewed by a clinician

Use this page to prepare questions for your care team. It does not replace their advice. Your own targets and doses come from your nephrologist, diabetes team and renal dietitian.

Stage G3a

In short

G3a means your eGFR has been 45–59 for more than 3 months. Most people still feel well (NIDDK). Three things change now. Medicines need checking against your eGFR. New blood tests start for bones and anemia. And lows can become more common, because the kidneys clear less insulin (JBDS–Renal Association; ADA–KDIGO 2022). This is also the time to write a sick-day plan with your team.

Your numbers

Starting points, not your prescription

These numbers are typical starting points from guidelines. Your nephrologist, diabetes team and renal dietitian set your own numbers from your blood tests, urine output and medicines, and change them as your labs change. If your lab report or your team says something different, they win.

Starting numbers at G3a (70 kg adult with type 1 diabetes; the same as the app's "Suggest targets"):

Protein Potassium Phosphorus Sodium Fluid Energy
0.8 g/kg (about 56 g) review ceiling 4,000 mg, only if your blood potassium is high 1,000 mg, used when blood phosphate is high under 2,000 mg no set limit 30 kcal/kg (about 2,100 kcal)

Protein stays at 0.8 g/kg with diabetes: going lower does not help glucose, the heart or kidney function (ADA 2026 §11, recommendation 11.3; KDIGO 2022, recommendation 3.1.1). Full table: Eating well.

Tests to expect

Test How often Typical range (your lab's range wins)
eGFR and UACR 1–4 times a year –
Calcium and phosphate every 6–12 months phosphate 2.5–4.5 mg/dL
PTH and alkaline phosphatase PTH depends on your first result; both start at G3a lab-specific
Hemoglobin at least once a year anemia: under 13 g/dL (men), under 12 g/dL (women)
Potassium and creatinine 2–4 weeks after a new or bigger dose of an ACE inhibitor or ARB potassium about 3.5–5.1 mEq/L
Test How often Typical range (your lab's range wins)
eGFR and UACR 1–4 times a year –
Calcium and phosphate every 6–12 months phosphate 0.81–1.45 mmol/L
PTH and alkaline phosphatase PTH depends on your first result; both start at G3a lab-specific
Hemoglobin at least once a year anemia: under 130 g/L (men), under 120 g/L (women)
Potassium and creatinine 2–4 weeks after a new or bigger dose of an ACE inhibitor or ARB potassium about 3.5–5.1 mmol/L

Sources: eGFR and UACR (ADA 2026 §11, recommendation 11.1b); calcium, phosphate, PTH and alkaline phosphatase (KDIGO 2017, recommendations 3.1.1–3.1.2); phosphate range (NKF); hemoglobin (KDIGO 2026 anemia); potassium range (MedlinePlus); potassium after medicine changes (KDIGO 2024, practice point 3.6.2).

What changes now

Medicines are dosed by eGFR. Many medicines leave the body through the kidneys, so the dose may need to change as eGFR falls (KDIGO 2024, practice point 4.2.1). Tell every doctor, dentist and pharmacist "I have kidney disease, stage 3a, eGFR …". Ask for a full medicine review at each change of care, such as a hospital stay (practice point 4.3.1). Over-the-counter and herbal products need a check too (practice point 4.1.3). Avoid NSAIDs such as ibuprofen and naproxen; NKF says to avoid them especially when eGFR is under 60 (NKF).

New blood tests. Calcium, phosphate, PTH and alkaline phosphatase are checked from G3a, because failing kidneys upset the balance that keeps bones strong and blood vessels soft (KDIGO 2017, recommendation 3.1.1). Hemoglobin is checked for anemia (KDIGO 2026 anemia).

Potassium and phosphorus. Limit them only if your blood levels are high. Then a renal dietitian should help you (KDIGO 2024, practice points 3.11.5.1–3.11.5.2; KDOQI 2020).

Lows become more likely. The kidneys clear insulin and make some glucose. As eGFR falls, insulin needs fall too (JBDS–Renal Association). People with CKD have lows about twice as often as people with normal kidney function, according to the JBDS review. The ADA asks for a check of your awareness of lows at least once a year (ADA 2026 §6, recommendation 6.11). Do not change your insulin yourself: tell your diabetes team about any pattern of lows.

Your risk number. From G3, your team can use the Kidney Failure Risk Equation (KFRE) to estimate your chance of needing dialysis or a transplant (KDIGO 2024, recommendation 2.2.1). A 5-year risk of 3–5 % or more is a reason to see a nephrologist (practice point 2.2.1).

A sick-day plan. When you are ill and not eating or drinking, some medicines may need a pause. KDIGO asks for a clear, written plan that says when to restart (practice point 4.3.2). Insulin is never stopped: see Sick days.

What to do

  • Write your eGFR on your medicine list and show it to every prescriber and pharmacist (Your medicine list).
  • Ask for a medicine review against your eGFR.
  • Clear NSAIDs out of the house, or label them "not for me" (Medicines to avoid).
  • Ask when your calcium, phosphate, PTH and hemoglobin will first be checked.
  • Ask whether you need any potassium or phosphorus limit, based on your last results.
  • Look at your CGM report for lows, especially at night, and bring it to your diabetes visit (CGM metrics).
  • Check your glucagon is in date and someone at home knows how to use it (ADA 2026 §6, recommendation 6.16).
  • Write a sick-day plan with your team, including when to restart each paused medicine.
  • Ask what your KFRE is.
  • Update your stage in the app so the warnings and targets fit (Targets and warnings).

Examples

At the pharmacy. You have a cold and pick up a "multi-symptom" product. Many contain ibuprofen or naproxen. Ask the pharmacist for one without an NSAID, and say your eGFR (NKF).

A new pattern of lows. Your CGM shows glucose under 70 mg/dL (3.9 mmol/L) two mornings a week since your eGFR fell. Treat each low straight away with 15 g of fast carbohydrate, such as 4 glucose tablets, and recheck after 15 minutes (ADA 2026 §6). Then send the report to your diabetes team. They may change your insulin plan. Do not change it yourself.

A blood test after a new medicine. You start an ACE inhibitor in March. Book a blood test for potassium and creatinine in 2–4 weeks (KDIGO 2024, practice point 3.6.2). A small rise in creatinine is expected; a rise of more than 30 % needs review (practice point 3.6.4).

Ask your care team

  1. Which of my medicines need a different dose at my eGFR?
  2. When will you check my calcium, phosphate, PTH and hemoglobin, and what were the results?
  3. Do I need any limit on potassium or phosphorus now?
  4. What is my KFRE? Should I see a nephrologist?
  5. Should my insulin plan change now that my kidneys clear less insulin?
  6. Can we write my sick-day plan today, with restart dates?

Get help now if…

Call 911 (or your local emergency number)

Chest pain, severe breathlessness, fainting or a very slow or irregular pulse (especially with a lab potassium of 6.5 mmol/L or more), a low the person cannot treat themselves (give glucagon, then call), or possible DKA: blood ketones of 3.0 mmol/L or more, or any ketones with vomiting, deep fast breathing or fruity breath (2024 consensus). Full list: Get help now.

Call your care team today

Vomiting, diarrhea or not eating (start your sick-day plan); lows that keep happening or that you no longer feel coming; dizziness on standing after a new blood pressure medicine; a lab potassium of 6.0–6.4 mmol/L: KDIGO advises a repeat test within 24 hours, or checks and treatment in hospital now if you feel unwell (KDIGO 2024, Table 28; 6.5 or more: see Get help now).

Sources

Not yet reviewed by a clinician. Facts and sources last checked 2026-10-06.