How to Determine if You Have Chronic Kidney Disease
You can determine if you have chronic kidney disease by getting two simple tests: a blood test to measure serum creatinine (which estimates your kidney filtration rate) and a urine test to check for albumin (protein in urine), with abnormal results confirmed by repeat testing after 3 months. 1
The Two Essential Tests
The most recent KDIGO 2024 guidelines are clear: test using both urine albumin measurement and assessment of glomerular filtration rate (GFR) 1. This dual approach is critical because:
- Blood test (serum creatinine): Your doctor uses this to calculate your estimated GFR (eGFRcr). A GFR below 60 mL/min per 1.73 m² indicates you've lost half or more of normal kidney function 2
- Urine test (albumin-to-creatinine ratio, ACR): An ACR greater than 30 mg/g is abnormal. Sex-specific cutoffs are >17 mg/g in men and >25 mg/g in women 2
Confirming the Diagnosis: The 3-Month Rule
A critical pitfall: never assume you have CKD based on a single abnormal test result 1. The finding could represent acute kidney injury rather than chronic disease. Chronic kidney disease requires either kidney damage OR decreased kidney function persisting for 3 or more months 2.
To establish chronicity, you need 1:
- Review of past GFR measurements
- Review of past urine albumin or protein measurements
- Imaging showing reduced kidney size or cortical thinning
- Medical history of conditions causing CKD (diabetes, hypertension)
- Repeat measurements within and beyond the 3-month timeframe
When to Get Tested
You should be tested if you have any of these risk factors 3, 4:
- Diabetes (highest priority)
- Hypertension (second highest priority)
- Cardiovascular disease
- Age over 60 years
- Obesity
- Family history of kidney disease
- History of acute kidney injury
Refining the Diagnosis When Needed
If your initial creatinine-based eGFR is abnormal but accuracy is questionable (such as in people with very high or low muscle mass), the 2024 KDIGO guidelines recommend adding cystatin C testing 1. The combination of creatinine and cystatin C (eGFRcr-cys) provides the most accurate assessment 1.
Why Early Detection Matters for Your Health
This matters because CKD dramatically increases your risk of cardiovascular death—more than your risk of progressing to kidney failure 2. Early detection allows treatment that:
- Slows progression to kidney failure
- Prevents complications like anemia, bone disease, and malnutrition
- Reduces cardiovascular disease risk
- Improves quality of life 2
Common Pitfalls to Avoid
Do not rely on symptoms—early-stage CKD is asymptomatic 3, 5. By the time symptoms appear, significant kidney damage has occurred.
Do not assume normal aging—while GFR naturally declines with age (approximately 17% of people over 60 have eGFR <60), decreased GFR in elderly patients independently predicts death and cardiovascular disease, requiring the same evaluation and treatment as younger patients 2.
Do not skip the urine test—checking only serum creatinine misses patients with normal GFR but kidney damage (proteinuria), who are still at increased risk for adverse outcomes 2.