The 2024 Kidney Disease: Improving Global Outcomes (KDIGO) guidelines for chronic kidney disease (CKD) evaluation and management bring important updates, particularly for European laboratories. These guidelines emphasize the need for harmonization in CKD testing, promoting the use of regional equations. In Europe, the European Kidney Function Consortium (EKFC) equation is particularly suited for European populations, particularly compared to the CKD-EPI 2021 race-free equation. A significant focus is placed on the combined use of creatinine and cystatin C to estimate glomerular filtration rate (eGFRcr-cys), improving diagnostic accuracy. In situations where eGFR may be inaccurate or clinically insufficient, the guidelines encourage the use of measured GFR (mGFR) through exogenous markers like iohexol. These guidelines emphasize the need to standardize creatinine and cystatin C measurements, ensure traceability to international reference materials, and adopt harmonized reporting practices. The recommendations also highlight the importance of incorporating risk prediction models, such as the Kidney Failure Risk Equation (KFRE), into routine clinical practice to better tailor patient care. This article provides a European perspective on how these KDIGO updates should be implemented in clinical laboratories to enhance CKD diagnosis and management, ensuring consistency across the continent.

Clinical Biochemistry Department KAT General Hospital Kifissia Athens Greece

Department of Clinical Chemistry University of Liège CIRM CHU de Liège Liège Belgium

Department of Laboratory Medicine AZ St Jan Hospital Bruges Belgium

Department of Nephrology Dialysis Apheresis Hôpital Universitaire Carémeau Nîmes France

Department of Nephrology Dialysis Transplantation University of Liège CHU de Liège Belgium

Department of Pathology University of Texas Galveston TX USA

Division of Nephrology and Intensive Care Medicine Charité Universitätsmedizin Berlin Berlin Germany

Honorary Professor of Clinical Biochemistry and Clinical Molecular Biology University of Padova Padova Italy

Institute of Medical Biochemistry and Laboratory Diagnostics 1st Faculty of Medicine Charles University and General University Hospital Prague Czech Republic

Siemens Healthineers Diagnostics Newark DE USA

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