Listings 6.03, 6.04, and 6.05 in 2026: How SSA Evaluates Chronic Kidney Disease, the Dialysis Path, the One-Year Transplant Rule, and the Lab Thresholds That Win at Step 3

By Anthony Albert, Benefits Research Director · Updated June 13, 2026 · 14 min read

Chronic kidney disease is one of the rare claim types where the law gives you three different routes to a Step 3 win. You can meet Listing 6.03 by being on ongoing dialysis. You can meet Listing 6.04 by getting a transplant. Or you can meet Listing 6.05 by combining bad lab numbers with a body complication.

That sounds easy. It isn't. SSA has very specific timing rules, very specific lab thresholds, and a paper trail it wants to see. If you miss a 90-day window or your nephrologist doesn't write the right sentence, your claim can sit in denial limbo for a year even though your kidneys are barely working.

This guide walks you through all three listings under section 6.00 of the Blue Book, the lab cutoffs you have to hit, the body complications that count, and the two worked examples that show how it plays out in real cases.

The three doors into kidney disease approval

Section 6.00 of the SSA Blue Book covers genitourinary disorders. SSA only cares about disorders that result in chronic kidney disease (CKD). That includes chronic glomerulonephritis, hypertensive nephropathy (kidney damage from high blood pressure), diabetic nephropathy (kidney damage from diabetes), chronic obstructive uropathy, hereditary nephropathies, and nephrotic syndrome.

The three listings under 6.00 each take a different angle on the same problem.

You only need to meet one. Most kidney claims clear Step 3 through 6.03 because dialysis itself is the qualifier. The other two paths are for people who haven't started dialysis or who got a transplant.

Listing 6.03: the dialysis path

This is the cleanest listing in the entire Blue Book. The exact text reads:

"Chronic kidney disease, with chronic hemodialysis or peritoneal dialysis."

That's it. There's no lab threshold. No GFR cutoff. No symptom rating. If your nephrologist says you're on ongoing dialysis and it has lasted or is expected to last at least 12 months, you meet 6.03.

What dialysis means here

SSA's 6.00C1 definition covers both forms:

• Hemodialysis. An artificial kidney machine cleans waste products from your blood. Most people do this 3 times a week, about 3 to 5 hours per session, at a dialysis center.
• Peritoneal dialysis. A dialyzing solution is introduced into and removed from the peritoneal cavity (the abdomen) either continuously or intermittently. People do this at home, sometimes overnight.

Either qualifies. SSA doesn't prefer one over the other.

The 12-month rule

The dialysis has to have lasted or be expected to last for a continuous period of at least 12 months. This matches the basic disability standard under 20 CFR 404.1509 and 416.909, which requires any impairment to have lasted or be expected to last at least 12 months (or result in death).

Here's the key: it doesn't have to have already lasted 12 months when you apply. If your doctor expects it to last that long, that's enough. Acute kidney injury from sepsis where you do dialysis for 3 weeks and recover does not qualify. End-stage renal disease where your nephrologist says you'll be on dialysis indefinitely does.

The evidence SSA wants

Per 6.00C1, SSA will accept a report from an acceptable medical source that:

• describes your CKD diagnosis,
• describes your current dialysis treatment, and
• indicates that your dialysis will be ongoing.

That last sentence is the one that gets missed. Your nephrologist has to write the word "ongoing" or words to that effect. If the records just say "starting dialysis" with no projection, the adjudicator can claim 6.03 isn't met even if it's obvious you'll need lifelong treatment. Ask your nephrologist to include a sentence like "patient requires lifelong hemodialysis with no expected return of native kidney function."

Pre-dialysis onset date

Per 6.00C1b, your CKD may have met the definition of disability before dialysis started. If your eGFR was crashing for 18 months before you finally got the fistula placed, the established onset date can be backdated. This matters because retroactive SSDI pays back benefits to 12 months before your application (under 20 CFR 404.621) and your Medicare 24-month wait clock starts from the EOD.

Listing 6.04: the transplant path

If you have received a kidney transplant, SSA will "consider you to be disabled under 6.04 for 1 year from the date of transplant."

The full year is automatic. You don't have to prove anything else for that period. After the year is up, SSA evaluates your residual impairment by looking at:

• your post-transplant kidney function (GFR, creatinine, urine output),
• any rejection episodes you've had,
• complications in other body systems (heart, lungs, infections from immunosuppression),
• adverse effects of ongoing treatment (tacrolimus, cyclosporine, mycophenolate, prednisone side effects).

What happens at the one-year CDR

About 12 months after your transplant, SSA will start a continuing disability review (CDR). They'll send Form SSA-454-BK and request updated records from your transplant clinic. If your transplant is functioning well, your eGFR is above 60, and you're back to work-capable status, your benefits stop using the medical improvement standard under 20 CFR 404.1594 (we covered the CDR rules in detail in our CDR medical improvement deep-dive).

If your transplant has rejected, your eGFR is below 30, or you're back on dialysis, your case is continued and you go back under 6.03 or 6.05.

Pre-transplant onset

Same rule as 6.03 applies. Your disability may have started before the transplant date, and SSA determines onset based on the facts in your case record. If you were on dialysis for 2 years before the transplant, your EOD can be backdated to when dialysis began (or earlier if your eGFR was already below 20).

Listing 6.05: the lab + complication path

This is the one that catches everyone who hasn't started dialysis yet but has terrible kidney function. It's a two-prong test. You have to meet both A and B.

Paragraph A: lab thresholds

You need reduced glomerular filtration evidenced by one of these three lab findings, documented on at least two occasions at least 90 days apart during a consecutive 12-month period:

The 90-day rule is what trips people up. If you got one bad lab in January and one bad lab in March, that's only 60 days. SSA will deny 6.05 on procedural grounds even though both labs prove severe disease. You need at least 90 days between the two readings, and both have to fall within the same 12-month window.

For reference, normal eGFR is 90 or above. Mild CKD is 60 to 89. Moderate is 30 to 59. Severe is 15 to 29. Kidney failure is below 15. The 6.05A cutoff of 20 puts you in the late-stage 4 / early stage 5 territory.

Paragraph B: a body complication

Bad labs alone are not enough. You also need one of these four complications:

1. 6.05B1: Renal osteodystrophy with severe bone pain plus imaging studies showing bone abnormalities such as osteitis fibrosa, osteomalacia, or pathologic fractures. Per 6.00C3, "severe bone pain" means frequent or intractable pain that interferes with physical activity or mental functioning.
2. 6.05B2: Peripheral neuropathy from uremia. The toxins build up because the kidneys can't filter them, and nerve tissue gets damaged. You need pain, numbness, tingling, or muscle weakness, plus a finding that the neuropathy is a severe impairment under 404.1520(c) and that it has lasted or is expected to last 12+ months.
3. 6.05B3: Fluid overload syndrome, documented by one of three sub-findings:
   • Diastolic blood pressure of 110 mm Hg or greater despite at least 90 consecutive days of prescribed therapy, documented on at least two measurements 90 days apart within a 12-month window, OR
   • Signs of vascular congestion or anasarca despite at least 90 consecutive days of prescribed therapy, documented on at least two occasions 90 days apart within a 12-month window, OR
   • Anorexia with weight loss showing a BMI of 18.0 or less, calculated on at least two occasions at least 90 days apart within a 12-month window.

The 90-day documentation rule applies to all of these. Two snapshots, 90+ days apart, inside 12 months.

What vascular congestion looks like in a record

Per 6.00C5, the physical exam has to document signs of vascular congestion such as:

• congestive heart failure,
• pleural effusion (excess fluid in the chest),
• ascites (excess fluid in the abdomen),
• hypertension,
• fatigue,
• shortness of breath,
• peripheral edema.

Anasarca is generalized massive edema. Per 6.00C6, SSA wants a description of pretibial (front of the tibia), periorbital (around the eyes), or presacral (front of the sacrum) edema, plus any ascites, pleural effusion, or pericardial effusion.

Worked example 1: California / 6.03 / dialysis path

Worked example 2: Texas / 6.05 / lab + complication path

Other 6.00 listings worth knowing

The 6.09 complications path is the back-door win for people whose labs don't quite hit 6.05A but who keep landing in the hospital. Per 6.00C8, complications can include stroke, congestive heart failure, hypertensive crisis, or acute kidney failure requiring short-course hemodialysis.

What if you don't meet any listing

You go to Steps 4 and 5. Under 20 CFR 404.1545, SSA assesses your residual functional capacity (RFC). For severe CKD that doesn't meet 6.03, 6.04, or 6.05, the RFC restrictions that win cases include:

• frequent unscheduled bathroom breaks (especially on peritoneal dialysis or diuretic regimens),
• 3 absences per month or more (for dialysis days),
• off-task time exceeding 15 percent (for fatigue and uremic brain fog),
• need to recline or lie down during the workday,
• environmental limits on heat exposure (dehydration risk).

A treating nephrologist who completes a Medical Source Statement listing these limits gives you the strongest record at Step 5. We covered the function-by-function rules in our SSR 96-8p RFC assessment article.

How to put a 6.03, 6.04, or 6.05 claim together

1. Get your nephrologist to write a treatment summary that names your diagnosis, your treatment plan, and (if on dialysis) the word "ongoing" or "indefinite."
2. Pull every eGFR, serum creatinine, and creatinine clearance result from the last 18 months. Look for two readings 90+ days apart that both hit the 6.05A cutoffs.
3. Pull every BMI, blood pressure, and physical exam note that documents edema, ascites, pleural effusion, or anorexia. Find two readings 90+ days apart that match 6.05B.
4. If you've had a transplant, secure the operative report and the date of transplant. 6.04 is automatic for one year.
5. If you've had 3+ CKD-related hospitalizations in 12 months each lasting 48+ hours and separated by 30+ days, gather the discharge summaries for 6.09.
6. File the SSDI application online at SSA.gov or by phone at 1-800-772-1213.
7. Don't wait until dialysis starts if your labs already hit 6.05A and you have a 6.05B complication. SSA approves pre-dialysis claims constantly.

Frequently asked questions