CV risk: if you aren't testing ACR, you aren't seeing the full picture

Chronic kidney disease (CKD) remains a hidden epidemic, under-recognized and under-diagnosed, despite widespread recognition of the benefits of systematic screening of at-risk individuals and early diagnosis. CKD is an important driver of cardiovascular risk, even in the early stages before a diagnosis has been made. An elevated albumin-to-creatinine ratio is an independent cardiovascular (CV) risk factor, and importantly, it is modifiable. Inclusion of urinary albumin-to-creatine ratio testing enables detection of CV risk and CKD before estimated glomerular filtration rate declines and allows for implementation of guideline‑directed therapy at the earliest point where it is clinically indicated. Inclusion of urinary albumin-to-creatinine ratio as part of routine testing of at-risk individuals in standard practice would enable early intervention with guideline-directed medical therapies to optimize outcomes and alter disease progression. Individuals at risk of CKD include, but are not limited to, those with type 2 diabetes, CV disease, or hypertension, all conditions that can cause early, often silent, kidney damage. In these populations, measuring the urine albumin-to-creatinine ratio enables early detection of CKD and CV risk, allowing timely initiation of guideline-directed therapies to prevent disease progression. Although this podcast presents expert opinion, rather than original research, all recommendations are guideline-driven and evidence-based, rather than opinion-based.