What is the approach to evaluating Chronic Kidney Disease (CKD)?

From the Guidelines

The approach to evaluating Chronic Kidney Disease (CKD) involves a comprehensive workup to establish the cause of CKD, using clinical context, personal and family history, social and environmental factors, medications, physical examination, laboratory measures, imaging, and genetic and pathologic diagnosis.

Key Components of Evaluation

• Establishing the cause of CKD: This is crucial as the etiology impacts prognosis, risk, and choice of therapies 1.
• Clinical context and history: Utilizing an individual’s clinical history, behavioral exposures, social determinants of health, environmental exposures, and physical findings to guide the evaluation 1.
• Laboratory measures: Including tests to estimate GFR and urine albumin-to-creatinine ratio (ACR) to accurately stage CKD 1.
• Imaging and genetic testing: May be used to further evaluate the cause of CKD, especially when the etiology is unclear 1.
• Kidney biopsy: May be considered as a diagnostic test to evaluate the cause and guide treatment decisions when clinically appropriate 1.

Considerations for Evaluation

• High-risk populations: CKD is often silent and patients may be asymptomatic at early stages, emphasizing the importance of detecting CKD in high-risk populations 1.
• Individualized approach: An individualized approach based on the clinical context seems prudent, especially for retesting efforts and determining the optimal CKD screening interval 1.
• Comprehensive workup: Pursuing a comprehensive workup to establish the cause of CKD and guide treatment decisions 1.

From the Research

Approach to Evaluating Chronic Kidney Disease (CKD)

The approach to evaluating CKD involves several key components, including:

• Definition and staging of CKD based on measures of kidney function, such as estimated glomerular filtration rate (eGFR) and degree of proteinuria 2, 3, 4
• Identification of patients at high risk of CKD, including those with diabetes, hypertension, cardiovascular disease, and family history of kidney failure 4, 5
• Regular measurement of eGFR, urine albumin-creatinine ratio, and blood pressure in patients at high risk of CKD 5
• Use of classification systems, such as the CGA system, which takes into account the cause, GFR category, and albuminuria category 2
• Consideration of lifestyle changes and management of underlying conditions, such as hypertension and diabetes, to slow disease progression 4, 5

Diagnostic Criteria

The diagnostic criteria for CKD include:

• eGFR less than 60 mL/min/1.73 m2 or persistent evidence of kidney damage on imaging, biopsy, or urinalysis that persists for longer than 3 months 2, 4
• Presence of albuminuria, defined as urinary excretion of albumin >30 mg/day 2
• Reduction in kidney function defined as a decrease in eGFR <60 mL/min/1.73 m2 for a period longer than three months, in the presence of kidney tissue damage verified by imaging or histologic methods 2

Role of Primary Care Practitioners

Primary care practitioners play a crucial role in the early identification and management of CKD, including:

• Regular monitoring of renal function and management of modifiable risk factors, such as blood pressure and proteinuria 3, 5
• Implementation of evidence-based clinical practice guidelines for lifestyle modification and guideline-directed medical therapy 5
• Coordination of care and communication with specialist nephrologists as needed 3, 5