Early stages of kidney disease often go unrecognized as many people do not present with symptoms. Completing the recommended screenings and tests provides opportunities for early detection, further supporting effective treatment to prevent or delay the progression of CKD. Fewer than half of people with diabetes get both the recommended estimated glomerular filtration rate (eGFR) and urinary albumin-to-creatinine ratio (uACR) screenings.¹ Both of these tests are required to accurately screen for kidney disease and understand a patient’s overall kidney health.
‍
More than 1 in 7 adults, or about 35.5 million people, have chronic kidney disease and as many as 9 in 10 adults do not know they have CKD². About 1 in 3 adults with severe CKD do not know they have CKD². Progress has been made in reducing the mortality and morbidity due to noncommunicable diseases, with the global age-standardized mortality rates between 2007 and 2017 for ischemic heart disease, stroke, and chronic obstructive pulmonary disease coming down by 9.7%, 13.6%, and 13.6%, respectively³. However, the mortality rate due to CKD went up by 1.5% during the same period³. According to the CDC, in 2019 CKD cost more than $87 Billion in Medicare costs alone².
‍
Diabetes is a major cause of chronic kidney disease (CKD) in the United States, and of the approximately 32.6 million patients with type 2 diabetes (T2D), up to 40% have evidence of CKD. Despite this high prevalence, approximately 90 percent of patients with diabetes and CKD are unaware of their kidney disease.² Almost 1 in 2 people with chronic kidney disease are undiagnosed, research found. Many are therefore not receiving guideline-directed medical therapy that is indicated to slow the progression of CKD. For instance, antihypertensive medications lower blood pressure which may reduce the risk of kidney disease getting worse as well as other conditions such as heart failure.
‍
One in two adults have high blood pressure, the second leading cause of chronic kidney disease with nearly thirty percent of patients showing evidence of CKD. Acknowledging that there are a number of risk factors associated with developing CKD, data supports the importance of early detection of CKD within patients who are diabetic and hypertensive and educational opportunities supporting individuals with risk factors associated with developing CKD.

The Objective

The objective of this toolkit is to encourage primary care practices to adhere to standards of care in screening for CKD, understand diagnosis of CKD, manage and treat CKD in their practice, and refer to nephrology when necessary. There are limited nephrology resources within health systems and treating people in primary care settings can increase the health care capacity, slow disease progression, and improve outcomes in CKD. This toolkit is a practical, usable tool for quick referencing and following standards of care. The final workflows met the latest evidence-based, updated clinical guidelines and care models from professional medical societies and associations for screening for and treatment of CKD.

Intended Audience

This toolkit is intended for adult populations in primary care settings. Providers, residents, fellows, and administrators who review this toolkit should examine how best to adapt their practice and polices to meet the needs of this patient population and adhere to established screening standards for CKD. The intention is not to print off the toolkit in its entirety but to use it as a provider reference tool to help guide screening, diagnosis, and treatment of CKD.



‍