Screening and Diagnosis of Chronic Kidney Disease in Primary Care: A Proactive Approach to Initiation of Care

About this course

Chronic Kidney Disease (CKD) is defined as abnormalities of kidney structure or function present for more than three months, with implications for health. It is a major global public health issue, often progressing silently until advanced stages. In primary care, early identification is crucial to prevent complications, delay progression, and reduce cardiovascular risk. Given the high prevalence and often asymptomatic nature of early CKD, especially in populations with diabetes, hypertension, and cardiovascular disease, primary care providers play a critical role in screening and diagnosis.

Challenges in primary care include under-recognition of early CKD, lack of awareness about guideline-based classification, and missed opportunities for early referral or intervention. Early identification and diagnosis of CKD in primary care is vital for improving long-term outcomes. CKD screening in at-risk individuals, awareness of diagnostic thresholds, and CKD classification or CKD staging using KDIGO criteria are essential steps.

CKD screening should be targeted toward high-risk groups rather than the general population. The recommended screening tests are simple and cost-effective: estimation of the glomerular filtration rate (eGFR) using serum creatinine, and detection of albuminuria through a urine albumin-to-creatinine ratio (ACR). Diagnosis of CKD requires the persistence of kidney abnormalities for at least three months. CKD classification or CKD staging of the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines is based on cause, GFR category (G1–G5), and albuminuria category (A1–A3), which helps guide risk stratification and management decisions. Laboratory results should always be interpreted within the clinical context, considering transient causes of reduced kidney function or proteinuria. Integrating decision support tools, such as the Kidney Failure Risk Equation (KFRE), can help identify patients who may need nephrology referral.

This learning activity will equip primary care physicians with knowledge and tools to screen and diagnose CKD early and perform timely specialist referrals, ultimately contributing to reducing the burden of kidney failure and its complications.