From the Guidelines
The recommended monitoring approach for asymptomatic patients at risk of Chronic Kidney Disease (CKD) is not to screen routinely, as the evidence on routine screening for CKD in asymptomatic adults is lacking, and the balance of benefits and harms cannot be determined. According to the US Preventive Services Task Force recommendation statement 1, there is inadequate evidence that routine screening for CKD improves clinical outcomes for asymptomatic adults. However, for individuals with risk factors such as diabetes or hypertension, monitoring for CKD is crucial, as most cases of CKD are associated with these conditions. Some key points to consider in monitoring for CKD include:
- Testing for and monitoring CKD for the purpose of chronic disease management, including monitoring patients with diabetes or hypertension, are not covered by the USPSTF recommendation 1.
- The American Diabetes Association recommends screening for CKD in all patients with diabetes, and several organizations recommend screening patients who are being treated for hypertension 1.
- Monitoring should focus on patients with risk factors, such as older age, diabetes, and hypertension, as they are more likely to have CKD.
- The frequency and components of monitoring may vary depending on the individual's risk factors and clinical presentation. It is essential to weigh the potential benefits and harms of monitoring for CKD in asymptomatic patients and consider the latest evidence and guidelines when making decisions about screening and monitoring.
From the Research
Monitoring Approach for Asymptomatic Patients at Risk of CKD
The recommended monitoring approach for asymptomatic patients at risk of Chronic Kidney Disease (CKD) includes:
- Regular assessment of glomerular filtration rate (GFR) and albuminuria, as these are key indicators of kidney function and damage 2, 3
- Estimation of GFR using prediction equations that take into account serum creatinine concentration, age, gender, race, and body size 4
- Measurement of albuminuria through urinary albumin-to-creatinine ratio, as this is a marker of kidney damage 2, 3
- Monitoring for complications of CKD, such as hyperkalemia, metabolic acidosis, hyperphosphatemia, vitamin D deficiency, secondary hyperparathyroidism, and anemia 2, 5
Risk Assessment and Referral
Patients at high risk of CKD progression, such as those with:
- Estimated GFR <30 mL/min/1.73 m2
- Albuminuria ≥300 mg per 24 hours
- Rapid decline in estimated GFR should be promptly referred to a nephrologist for further evaluation and management 2, 3
Management of CKD
The management of CKD includes:
- Reducing the patient's risk of CKD progression and associated complications, such as cardiovascular disease and anemia 2, 3
- Controlling blood pressure and reducing proteinuria through the use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers 5, 3
- Avoiding potential nephrotoxins, such as nonsteroidal anti-inflammatory drugs, and adjusting drug dosing based on kidney function 2, 3