Screening and Diagnosis

When and How to Screen

Screen early and often when a patient has type 2 diabetes and/or hypertension

Screen with both uACR and eGFR

Screen when patients have risk factors for CKD: type 2 diabetes, hypertension, age> 60, obesity, family history of kidney disease, history of acute kidney injury (AKI), history of tobacco use, social drivers (i.e.: poverty and/or food insecurity)

CKD can be described as an accelerator of chronic disease7. Identifying CKD in early stages of illness progression is important because the risk renal failure and cardiovascular complications is reduced10. More than 1 in 7 US adults are estimated to have CKD and as many as 9 in 10 do not know they have it yet. CKD does not necessarily cause symptoms or illness at the earliest, preventable stage, so the only way to know a patient has CKD is to test their kidney function11. The American Diabetes Association recommends screening all patients with diabetes for CKD and the National Kidney Foundation recommends screening for CKD in all patients with risk factors including diabetes, hypertension, family history of kidney disease, age 60 or older, Race/U.S. ethnic minority status status (i.e.: AfricanAmericans, Hispanics, Asians/Pacific Islander, Native American). Focusing on screening patients with risk factors annually, or more frequently depending on test results, to identify kidney disease early allows for the best possible prognosis and ability to intervene in the course of this chronic illness.

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Urine Albumin-Creatinine Ratio (uACR)

uACR, the recommended test for albuminuria, gives you the most information and is more sensitive

Urine dipsticks are not recommended for measuring albumin

uACR measures the protein and creatinine in your urine. Rising uACR (≥ 30 mg/g) detection occurs about 10 years before detectable decline in eGFR; uACR can be the best early indicator of kidney disease in patients with diabetes. Protein should be found in our body’s blood, not urine. When protein is spilling into urine, also call albuminuria or proteinuria, it can be an indication that the body’s kidneys are not functioning properly and could be damaged. Albuminuria can also increase risk of cardiovascular disease, so monitoring this regularly is important if you have risk factors.

    Estimated Glomerular Filtration Rate eGFR

    eGFR, a blood test, is the optimal way to measure kidney function and understand how the kidneys are functioning and cleaning toxins from the blood.

    Diagnose CKD

    Use eGFR and uACR to diagnose

    eGFR can be normal where uACR is severely increased

    uACR can be normal where eGFR is severely decreased

    KDIGO Heat Map

    Kidney Disease Improving Global Outcomes (KDIGO) has created a heat map for clinicians to compare eGFR and uACR to diagnose and stage CKD. The heat map helps clinicians to understand patient risk, if referrals are required and help patients understand how CKD is progressing or reversing.

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