Currently, about 37 million adult live with chronic kidney disease (CKD) in the US. The CDC estimates that this is about 15% of all US adults. Yet, by that same estimate, as many as nine in 10 do not know they have it. Often, CKD symptoms do not manifest until the kidneys are badly damaged or disease is advanced. Without screening, patients with CKD may remain under-or improperly diagnosed until their condition has worsened significantly, negatively impacting their treatment and care.
Of the two tests recommended by the National Kidney Foundation to screen for, diagnose, and manage CKD, recent studies show high levels of estimated glomerular filtration rate testing (to evaluate kidney function), but low levels of urine albumin-to-creatinine ratio testing (to evaluate kidney damage), suggesting physicians are inconsistently adhering to guideline recommendations. This is particularly prevalent in patients with diabetes, who are at increased risk for kidney disease or failure.
Additionally, data suggest that many patients at risk are not being screened during early stages, when treatment can slow disease progression and reduce unfavorable outcomes like dialysis and transplant due to kidney failure. Recent reports show that prevention, recognition, and treatment strategies for CKD are greatly underutilized overall. Furthermore, data also show that one in four patients “crash” into dialysis.
Taking steps to improve an at-risk patient’s health before drastic measures like dialysis or transplant are needed are important in providing the best care. What should the medical community do differently to close gaps in screening to diagnose more patients in the early and more easily treatable stages of CKD?
Across the board, many understand the importance of screening and treating early as a tool to both improve outcomes and, ultimately, lower care costs for patients and clinicians. Recent shifts, like the new guidelines introduced by the USPSTF and the American Diabetes Association—which lowered the age to screen for prediabetes and type 2 diabetes to 35—now emphasize the importance of identifying patients sooner.
Indeed, researchers estimate that the new guidelines will increase the proportion of asymptomatic US adults eligible for screening by about 6% to 7%, equating to approximately twice as many individuals. Ultimately, this may increase positive outcomes for patients who will now be able to be treated sooner, before their diabetes progresses to a comorbidity of another condition, which could worsen into serious complications.