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CPE-003 · synthetic case CKD-EX-12

Anemia, acidosis and mineral-bone signals in G4

Hemoglobin 10.2, bicarbonate 17 and persistently high phosphate.

Synthetic · no real patientExtended demonstration caseKidney engine v1.2.0

Purpose: Hemoglobin 10.2, bicarbonate 17 and persistently high phosphate.

Inputs the engine received

Patient

Age: 67 years

Context

Sex for equation: male
CKD confirmed: Yes
G category: G4
Initial anemia cause not explained: Yes
Phosphate persistently elevated: Yes

Laboratory

Hemoglobin: 10.2 g/dL
Bicarbonate: 17 mmol/L

What the engine reports

Detected clinical pattern

CKD Criteria Met — Classification Incomplete

Chronicity is documented, but the A category (UACR) is missing, so risk classification is incomplete.

Chronicity: Chronicity confirmed (≥3 months)
Complication: anemia in ckd context
Complication: low serum bicarbonate in ckd clinically significant
Complication: possible ckd mbd biochemical pattern

Clinical summary

CKD criteria met on documented chronicity (); classification is incomplete without UACR. Physician adjudication required.

Patterns for physician adjudication

Evidence shown, not scored: pattern weights are not clinically validated.

Possible anemia of CKD context

Supporting

Hemoglobin 10.2 g/dL
Confirmed CKD G4

Contradicting or missing

Iron studies and other causes not yet evaluated

Recommended next steps

For physician consideration. Urgent review always comes first.

1Specialist kidney-care referral per triggered criterion: Complex anemia / bone-disease complication.KDIGO 2024 referral criteria.
2Evaluate anemia with CBC, reticulocytes, ferritin and TSAT; a renal cause is not assigned before other causes are excluded.
3Clinician evaluation of persistence, cause and indication for treatment of low bicarbonate.
4Interpret serial phosphate, calcium and PTH together and evaluate modifiable factors and vitamin D status as clinically indicated.

Missing information

UACR (required for the A category and risk assessment).
UACR (required for the A category, risk assessment and a complete classification).

Why it matters

The result is placed in context so the physician can see what is established, what is provisional and what is missing.

Evidence and rule trace · 7 rules

CGA-001Assign G category from selected indexed eGFR

Inputs: G category G4 (documented)

G4 (15–29 mL/min/1.73 m²)

CGA-005Incomplete classification when UACR absent

Inputs: G4 · UACR missing

confirmed_ckd_incomplete_risk_classification

ANEMIA-001Anemia in CKD screening pattern

Inputs: hemoglobin 10.2 g/dL (<13 for male) · confirmed CKD

anemia_in_ckd_context: evaluate with CBC, reticulocytes, ferritin and TSAT; do not assign a renal cause without excluding others

ANEMIA-002Expanded anemia evaluation when initial workup insufficient

Inputs: initial anemia work-up unexplained

Consider smear, haptoglobin, LDH, CRP, B12, folate, liver tests, monoclonal protein evaluation, TSH, PTH and bleeding evaluation as clinically indicated

ACIDOSIS-001Low bicarbonate in CKD context

Inputs: bicarbonate 17 mmol/L

clinically significant acidosis risk

MBD-001Possible CKD-MBD biochemical pattern requires serial assessment

Inputs: persistent phosphate, PTH or calcium abnormality

possible_ckd_mbd_biochemical_pattern: interpret serial phosphate, calcium and PTH together

REF-001Nephrology referral triggers

Inputs: Complex anemia / bone-disease complication

Specialist kidney care referral indicated or to be considered per the triggered criterion

Evidence

R1 · KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Disease: Improving Global Outcomes (KDIGO), 2024.
R5 · KDIGO 2026 Clinical Practice Guideline for the Management of Anemia in CKD - Executive Summary. KDIGO, 2026.
R6 · KDIGO 2017 Clinical Practice Guideline Update for CKD-Mineral and Bone Disorder. KDIGO, 2017.

Physician adjudication required. Clinical decision support for physician review. Criteria-based status is not a probability. Findings require physician adjudication and correlation with the complete clinical context. Validation-only release: not for production clinical use.

Change the values

The same engine, starting from this case. Change any value and watch the pattern and the rule trace react.

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Live eGFR and CGA map

eGFR (mL/min/1.73 m²)

—

enter a creatinine

GFR \ ALB	A1<30	A230–300	A3>300
G1≥90
G260–89
G3a45–59
G3b30–44
G415–29
G5<15

No cell is shown until there are data. Colors follow the KDIGO risk heat map: green low, yellow moderately increased, orange high, red very high.

Kidney functionAdd a prior result with dates to test chronicity

Age(years)

Sex for the equation

FemaleMale

Serum creatinine (current)(mg/dL)

Collection date

Serum creatinine (prior)(mg/dL)

Prior collection date

Cystatin C (optional)(mg/L)

Switches the engine to the combined eGFRcr-cys equation.

Albuminuria

UACR (current)(mg/g)

Collection date

UACR (prior)(mg/g)

Prior collection date

Specimen type

UPCR (optional)(mg/g)

Chemistry

Potassium(mmol/L)

Specimen hemolysis

Bicarbonate(mmol/L)

Hemoglobin(g/dL)

Creatinine rise within 4 weeks of ACEi/ARB(%)

Kidney findings and red flags

Context

Transient albuminuria confounders

Creatinine may be unreliable

Complications (persistent)

Therapy

Documented history and special populations

This case also carries values that have no field here: G_category, initial_anemia_cause_not_explained. They are included in the calculation until you clear the form.

Live result · computed in your browser

Detected clinical pattern

CKD Criteria Met — Classification Incomplete

Chronicity is documented, but the A category (UACR) is missing, so risk classification is incomplete.

Chronicity: Chronicity confirmed (≥3 months)
Complication: anemia in ckd context
Complication: low serum bicarbonate in ckd clinically significant
Complication: possible ckd mbd biochemical pattern

Clinical summary

CKD criteria met on documented chronicity (); classification is incomplete without UACR. Physician adjudication required.

Patterns for physician adjudication

Evidence shown, not scored: pattern weights are not clinically validated.

Possible anemia of CKD context

Supporting

Hemoglobin 10.2 g/dL
Confirmed CKD G4

Contradicting or missing

Iron studies and other causes not yet evaluated

Recommended next steps

For physician consideration. Urgent review always comes first.

1Specialist kidney-care referral per triggered criterion: Complex anemia / bone-disease complication.KDIGO 2024 referral criteria.
2Evaluate anemia with CBC, reticulocytes, ferritin and TSAT; a renal cause is not assigned before other causes are excluded.
3Clinician evaluation of persistence, cause and indication for treatment of low bicarbonate.
4Interpret serial phosphate, calcium and PTH together and evaluate modifiable factors and vitamin D status as clinically indicated.

Missing information

UACR (required for the A category and risk assessment).
UACR (required for the A category, risk assessment and a complete classification).

Why it matters

The result is placed in context so the physician can see what is established, what is provisional and what is missing.

Evidence and rule trace · 7 rules

CGA-001Assign G category from selected indexed eGFR

Inputs: G category G4 (documented)

G4 (15–29 mL/min/1.73 m²)

CGA-005Incomplete classification when UACR absent

Inputs: G4 · UACR missing

confirmed_ckd_incomplete_risk_classification

ANEMIA-001Anemia in CKD screening pattern

Inputs: hemoglobin 10.2 g/dL (<13 for male) · confirmed CKD

anemia_in_ckd_context: evaluate with CBC, reticulocytes, ferritin and TSAT; do not assign a renal cause without excluding others

ANEMIA-002Expanded anemia evaluation when initial workup insufficient

Inputs: initial anemia work-up unexplained

Consider smear, haptoglobin, LDH, CRP, B12, folate, liver tests, monoclonal protein evaluation, TSH, PTH and bleeding evaluation as clinically indicated

ACIDOSIS-001Low bicarbonate in CKD context

Inputs: bicarbonate 17 mmol/L

clinically significant acidosis risk

MBD-001Possible CKD-MBD biochemical pattern requires serial assessment

Inputs: persistent phosphate, PTH or calcium abnormality

possible_ckd_mbd_biochemical_pattern: interpret serial phosphate, calcium and PTH together

REF-001Nephrology referral triggers

Inputs: Complex anemia / bone-disease complication

Specialist kidney care referral indicated or to be considered per the triggered criterion

Evidence

R1 · KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Disease: Improving Global Outcomes (KDIGO), 2024.
R5 · KDIGO 2026 Clinical Practice Guideline for the Management of Anemia in CKD - Executive Summary. KDIGO, 2026.
R6 · KDIGO 2017 Clinical Practice Guideline Update for CKD-Mineral and Bone Disorder. KDIGO, 2017.

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