Five simple steps to help diagnose chronic kidney disease earlier

Chronic kidney disease (CKD) often remains clinically silent with many patients presenting as asymptomatic before progressing to advanced stages.¹

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Nearly 850 million people worldwide are affected to some degree by this condition, and the majority are still undiagnosed.² In fact, nine out of 10 people with CKD don’t even know they have it.³

When you diagnose CKD early, you can make a difference. Identifying patients and intervening early can slow kidney disease progression, reduce the risk of cardiovascular (CV) complications, and potentially prolong life.^4,5 Starting a conversation with your patients is an important step in diagnosing CKD early and improving outcomes.

Ready to talk about CKD with your patients? Visit diagnose-ckd.com and read below for five simple steps to integrate into a routine visit that can help lead to earlier CKD detection.

Explain what the kidneys do and why they are important

As a health care provider, you understand and appreciate the vital role of the kidneys in the body, but a patient might not. Once they know that they act as our body’s filtration system and remove wastes and impurities from the blood, while regulating compounds and nutrients that the body needs, they might be more open to screening and discussing risk factors.⁶

If left undiagnosed and without intervention, CKD can progress to its final stage, end-stage kidney disease, when dialysis or kidney transplantation are required, which are invasive, time consuming and expensive.^7,8 Decreased kidney function causes waste products to build up in the body, making patients feel sick and reducing their quality of life.⁷ When the kidneys stop working, other systems in the body are impacted and CKD is also associated with increased risks of CV events and premature death.⁹

Regardless of etiology, once the loss of nephrons and functional renal mass reaches a certain point, the remaining nephrons begin a process of irreversible decline in glomerular filtration rate (GFR), which makes early detection extremely critical.¹⁰

Talk openly about medical history

Several risk factors are common in people who develop CKD, with the leading causes being diabetes, hypertension, and CV disease. Diabetes and hypertension are responsible for two-thirds of CKD cases.¹¹ Socioeconomic status, ethnicity, and genetics can impact a patient’s risk of developing the disease as well.^12,13

Even if your patient does not have CKD now, they may still be at risk for developing it later in their life based on some of these risk factors. Guidelines recommend routine screenings even if a patient initially tests negative based on individual considerations.¹⁴

Include an estimated GFR (eGFR) screen in regular blood work for patients at higher risk

As kidney disease progresses, the amount of serum creatinine in the blood rises, which may be an indicator of CKD. Guidelines recommend that all patients at risk of CKD should regularly have their eGFR checked, based on serum creatinine levels, as part of a patient's metabolic blood panel. This helps estimate the level of kidney function and supports early diagnosis and ongoing monitoring of renal function.¹⁴

Guidelines define CKD as either kidney damage or a decreased GFR rate of less than 60mL/min/1.73 m2 for at least 3 months.^14,15

Also help detect kidney damage early with a simple urine test

In addition to estimating GFR, it is recommended to perform urine tests that measure levels of albumin relative to creatinine, or urinary albumin creatinine ratio (UACR) for patients at risk of CKD. Elevated UACR levels mean there is an excess amount of protein in the urine, indicating kidney disease due to damaged nephrons.¹⁶

Encourage healthy habits at any age

CKD cannot always be prevented, but in some cases, measures can be taken to reduce a patient's risk. For example, effectively managing or preventing conditions that could lead to CKD, such as diabetes or high blood pressure, can lower a patient's chances of developing CKD.¹⁷

At-risk individuals can also make lifestyle changes such as adopting healthier eating habits, exercising more frequently and quitting smoking to improve their general health and reduce their risk of developing complications that can worsen or lead to CKD, such as obesity or CV disease.¹⁷

You can find more resources to help diagnose CKD by visiting: https://www.diagnose-ckd.com/home/resources.html

References

1. World Kidney Day [Internet]. Chronic Kidney Disease. [cited 2022 Feb 23]. Available from:   https://www.worldkidneyday.org/facts/chronic-kidney-disease/
2. Jager KJ, et al. A single number for advocacy and communication-worldwide more than 850 million individuals have kidney diseases. Nephrol Dial Transplant. 2019;34(11):1803-1805.
3. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases. Kidney Disease Stats [Internet]. [cited 2022 Feb 23]. Available from: https://www.niddk.nih.gov/health-information/health-statistics/kidney-disease
4. National Kidney Foundation [Internet]. CKD Detectors. [cited 2022 Feb 23]. Available from:   https://www.kidney.org/advocacy/ckd
5. Shlipak M, et al. The case for early identification and intervention of chronic kidney disease: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney International, 99;1; 34 - 47
6. National Kidney Foundation [Internet]. How Your Kidneys Work. [cited 2022 Feb 23]. Available from: https://www.kidney.org/kidneydisease/howkidneyswrk .
7. Mayo Clinic [Internet]. End-stage renal disease. [cited 2022 Feb 23]. Available from: https://www.mayoclinic.org/diseases-conditions/end-stage-renal-disease/symptoms-causes/syc-20354532
8. National Kidney Foundation [Internet]. Kidney Disease: The Basics. [cited 2022 Feb 23]. Available from: https://www.kidney.org/news/newsroom/fsindex
9. Belayneh K, et al. Quality of life and its predictors among patients with chronic kidney disease: A hospital-based cross sectional study. PLOS ONE 14(2): e0212184. doi: 10.1371/journal.pone.0212184.  
10. Schnaper HW. Remnant nephron physiology and the progression of chronic kidney disease. Pediatr Nephrol. 2014;29(2):193-202. doi:10.1007/s00467-013-2494-8.
11. National Kidney Foundation [Internet]. Chronic Kidney Disease (CKD) Symptoms and Causes. [cited 2022 Feb 28]. Available from: https://www.kidney.org/atoz/content/about-chronic-kidney-disease
12. Zeng X, et al. Associations between socioeconomic status and chronic kidney disease: a meta-analysis. J Epidemiol Community Health. 2018 Apr;72(4):270-279. doi:10.1136/jech-2017-209815. Epub 2018 Feb 2. PMID: 29437863.
13. Lin BM, et al. Genetics of Chronic Kidney Disease Stages Across Ancestries: The PAGE Study. Front Genet. 2019;10:494.
14. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases [Internet]. Chronic Kidney Disease Tests & Diagnosis. [cited 2022 Feb 23]. Available from: https://www.niddk.nih.gov/health-information/kidney-disease/chronic-kidney-disease-ckd/tests-diagnosis
15. Vaidya SR, et al. Chronic Renal Failure. In: StatPearls [Internet]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK535404/  
16. National Kidney Foundation [Internet]. ACR. [cited 2022 Feb 23]. Available from: https://www.kidney.org/kidneydisease/siemens_hcp_acr
17. National Health Service [Internet]. Prevention: Chronic kidney disease. [cited 2022 Feb 23]. Available from: https://www.nhs.uk/conditions/kidney-disease/prevention/