Screening for Chronic Kidney Disease

By Harold Szerlip, MD MS(ED), FACP, FCCP, FASN, FNKF, CCRP and Bernard V. Fischbach, MD, CCRP

Chronic kidney disease (CKD) is a general term for diverse disorders affecting kidney structure and function with a variable clinical presentation. The Centers for Disease Control (CDC) estimates that more than 20 million adults, in the U.S., may have CKD. Unfortunately, many of these individuals are unaware of their disease. Risk factors for CKD include hypertension, diabetes, obesity, and underlying cardiovascular disease. Screening for CKD is relatively simple, and requires only a urine and blood test. Although the routine screening of asymptomatic adults remains a topic of debate, the Kidney Disease Improving Global Outcomes (KDIGO) guidelines recommend annual testing for those individuals at high risk.

Albuminuria is not only a marker of CKD, it appears to be directly nephrotoxic. A mainstay of any treatment regimen includes minimizing albuminuria with ACE inhibition or angiotensin receptor blockers (ARB’s). In addition, the aggressive control of blood pressure, lipids, hyperglycemia, and avoidance of nephrotoxic medications have all been shown to slow the progression of CKD.

CKD has been recognized as an independent risk factor for cardiovascular disease, infection, and impaired physical function. These complications are associated with higher morbidity, mortality, and healthcare costs. If CKD is detected and treated early, the associated complications and progression to end stage renal disease can be delayed or even prevented.