Identification and risk stratification of chronic kidney disease in primary care

Chronic kidney disease (CKD), defined as a reduced estimated glomerular filtration rate and/or increased albuminuria, is a common disease in primary care. CKD is more common in individuals with diabetes and hypertension, as well as older adults and those from minoritized racial-ethnic groups. Although CKD can be diagnosed through blood and urine tests, screening is under-utilized, in part, because there are no clear screening frequency guidelines outside of diabetic kidney disease. Many individuals with diabetes do not receive annual guideline-recommended CKD screening, particularly yearly urine albumin-to-creatinine ratio. In primary care, physicians may miss the opportunity to identify, treat, and risk stratify patients with CKD. Early CKD identification and treatment are important because new therapeutics can delay CKD progression to end-stage kidney disease and reduce cardiovascular morbidity and mortality. Identifying patients at high risk of CKD progression and complications can guide patient and clinician action. Equations such as the Pooled Cohort Equation, the PREVENT equation, and QRISK® risk score have been validated in predicting the risk of a cardiovascular event in patients with CKD. Furthermore, the Kidney Failure Risk Equation and the Kaiser Permanente Northwest equation have also been validated tools in being able to predict risk of end-stage kidney disease in patients with CKD. Although there have been no validated equations to predict death in patients with CKD, the REIN, and Charlson Comorbidity Indices have been used to predict mortality in patients starting on dialysis to help frame prognostication with patients and their families. These risk equations help to quantify risks for CKD-related outcomes for physicians and patients to aid in deciding therapeutics, understanding prognosis, and instituting timely referral to nephrology.