Imagine a hypothetical pilot. He was sharp, dependable, and had never failed a medical exam, though—truth be told—he also hadn’t seen his doctor for routine preventive health care in several years. One afternoon, crossing over the Rockies at 16,500 feet, he noticed something was off. His hands were swelling, his vision was slightly blurred, and the fatigue was hitting harder than usual. As the fight progressed, he missed several frequency changes as he transitioned between controlling agencies, struggled with arrival procedures at his home airport, and missed several routine checklist steps during the landing and shutdown portions of his flight.

Why Chronic Kidney Disease Is on the FAA’s Radar

Like many chronic diseases like high blood pressure, diabetes, or heart disease, the symptoms of Chronic Kidney Disease (CKD)—elevated blood pressure, persistent fatigue, and intermittent muscle cramps—often develop gradually [1].  

For pilots, these aren’t just health concerns—they’re aviation safety risks. Imagine trying to fly a precision approach with blurred vision, swollen hands, or mental fog from a high potassium level. 

On the other hand, when diagnosed early and appropriately managed, CKD may not go on to produce symptoms or impair aviation performance whatsoever. That’s why the FAA lists CKD as a certifiable—but closely watched—condition under its Conditions AME’s Can Issue (CACI) program [2]. 

What the FAA’s CACI Program Means for Pilots

The CACI program allows AMEs to issue a certificate on the spot for certain chronic conditions, including CKD, provided that the pilot meets all the requirements outlined in the FAA’s CACI CKD worksheet [3].

Under CACI, you don’t need a Special Issuance, and your AME doesn’t need to call or defer to the FAA—if your documentation is complete and your condition is stable. This streamlined process can save weeks or even months of waiting, but it only works when pilots arrive prepared.

What You Must Show Your AME

To qualify for CACI certification with CKD, the FAA requires that you present your AME with:

• A detailed clinical progress note from your treating provider (dated within 90 days) concerning your diagnosis of CKD. It must document that:
  • Your condition is asymptomatic and stable; 
  • You have not developed any new conditions or complications that would affect renal function;
  • You have have two functioning kidneys; 
  • Any underlying conditions (such as diabetes, HTN, glomerulonephritis, PKD, or chronic obstruction) are well controlled; and 
  • Dialysis or transplant is not recommended or anticipated at this time  
• Recent lab results showing:
  • Your eGFR was 35 or higher within six months of your AME exam;
  • Your albumin on urine dipstick is trace or negative OR albumin creatinine ratio (ACR) is 29 or less; and
  • Your hemoglobin is at least 10 gm/dL AND hematocrit is at least 30%

With those criteria met, your AME can be issued your medical certificate at the time of the exam—no waiting; no FAA review [3].

When CKD Doesn’t Qualify for CACI

Not all pilots with CKD will qualify for issuance under the CACI protocol. If you’ve ever required dialysis, had recent changes in medication due to worsening function, or experienced symptoms like fluid retention or anemia requiring treatment, your AME is obligated to defer your exam to the FAA’s Aeromedical Certification Division [4].

This doesn’t mean your flying career is over—it simply means the FAA will need more information. If you’re in this category, it’s especially important to have a complete packet of records, including nephrology consult notes, imaging, labs, and a narrative summary from your treating doctor. These cases benefit greatly from support by medical certification experts, and Wingman Med provides tailored consultations to help with deferred cases.

Why CACI-Qualified Pilots Still Get Deferred

Even with CACI available, many pilots with CKD get deferred simply because they didn’t bring the right documents. The CACI program doesn’t provide a free pass [5]—it’s a tool. If your AME doesn’t have everything they need to check the boxes on the FAA’s worksheet, they must defer your application, even if your condition is under control.

Some pilots also assume they can “talk through” the issue during the exam, but your AME needs to see evidence of quality medical care from your doctor in writing. Treat your AME visit like a checkride. Come in fully prepared. Don’t expect the AME to interpret vague notes, chase down labs, or guess about your treatment plan. If you’re not sure whether your documentation is complete, a pre-visit review with a specialist—like those offered by Wingman Med—can make all the difference.

MedXPress and Medical Honesty

The process starts by accurately completing your MedXPress application. Be transparent about your CKD diagnosis, medications, and any history of complications or hospitalizations. Your AME will see these entries before your exam begins and will use them to frame the review. Don’t leave anything out. Inconsistencies between what’s written and what’s documented can lead to avoidable delays.

If you’re unsure how to describe your CKD on MedXPress, seek guidance on how to phrase medical conditions accurately without triggering unnecessary concern. If you’re safe to fly, a well prepared application will reflect that and help minimize delays. Omissions and half-truths will only confuse the issue and complicate your application. 

How to Make CACI Work for You

CACI is about trust and documentation. The FAA trusts AMEs to issue under CACI only when the medical facts clearly meet the standard. If you have stable CKD and show up with current labs, a detailed doctor’s note, and a clear history, you’re likely to walk out of your AME’s office with your certificate in hand.

But if you’re missing a lab result, have a vague clinical note, or your status has recently changed, your AME can’t verify the information the FAA requires. They have no choice but to defer your application, even if they believe you’re likely to be approved later.

Preparation isn’t just smart—it’s the foundation of a safe, uninterrupted flying career.

References

[1] National Kidney Foundation, “Chronic Kidney Disease (CKD),” Kidney.org. [Online]. Available: https://www.kidney.org/atoz/content/about-chronic-kidney-disease

[2] Federal Aviation Administration, “Guide for Aviation Medical Examiners—Conditions AMEs Can Issue (CACI),” FAA AME Guide, 2025. [Online]. Available: https://www.faa.gov/ame_guide/certification_ws

[3] Federal Aviation Administration, “CACI Chronic Kidney Disease Worksheet,” AME Guide Media. [Online]. Available: https://www.faa.gov/ame_guide/media/C-CACIChronicKidneyDisease.pdf

[4] Federal Aviation Administration, “Item 41 – Kidneys,” FAA AME Guide. [Online]. Available: https://www.faa.gov/ame_guide/app_process/exam_tech/item41/amd/gd

[2] D. J. Monlux, “CACIs – Help the FAA Help You,” Wingman Med Blog, Sep. 22, 2024. [Online]. Available: https://wingmanmed.com/cacis-help-the-faa-help-you/