Chronic kidney disease for the primary care provider

Chronic kidney disease (CKD) affects approximately 15% of U.S. adults and 9% of the global population, representing a growing public health challenge driven by aging populations and rising rates of diabetes and hypertension. Primary care providers (PCPs) play a pivotal role in CKD identification, risk stratification, and management, given their longitudinal relationships with patients and capacity for early intervention. This review provides a comprehensive framework for CKD management in primary care, synthesizing current evidence on diagnosis, risk prediction, and treatment. Key topics include appropriate use of estimated glomerular filtration rate (eGFR) and albuminuria for diagnosis and staging, risk-based screening in high-risk populations, and evidence-based pharmacotherapy including renin-angiotensin-aldosterone system inhibitors, sodium-glucose cotransporter-2 inhibitors, mineralocorticoid receptor antagonists, and glucagon-like peptide-1 receptor agonists. The review emphasizes risk-based nephrology referral strategies that integrate eGFR decline, albuminuria severity, and kidney failure risk equations to optimize specialist resource use. PCPs are positioned to slow disease progression, reduce cardiovascular morbidity, and coordinate timely specialty referral while managing polypharmacy and supporting shared decision-making about renal replacement therapy. Strengthening CKD care within primary care is essential to mitigating the rising global burden of kidney disease.