When is the right time to start screening for chronic kidney disease?
Andrew S. Narva, MD, FACP, FASN, discusses the challenges of preventing and diagnosing chronic kidney disease (CKD) and how primary care providers can integrate early detection and CKD care into their practice.
Primary care and community settings are often the front lines of CKD testing. Many factors can increase a patient’s risk of developing CKD including ethnicity, family history, and health conditions such as diabetes or high blood pressure. However, competing demands for disease screening and education, challenges interpreting diagnostic tests, and communication about the complexity of CKD are just a few of the issues that interfere with the early identification and diagnosis of CKD. The disease often goes undetected even though two simple tests—glomerular filtration rate (GFR) and urine albumin-to-creatinine ratio (UACR)—can frequently confirm the diagnosis.
Improving the care of CKD patients in the primary care setting has been shown to improve long-term outcomes. Since diabetes is the cause of about half of CKD, providers may be able to leverage the existing diabetes care delivery system to better address kidney complications. The established interdisciplinary approach to diabetes care provides an excellent model for improving CKD outcomes. Engagement of all members of the health care team may improve implementation of evidence-based care and promote patient understanding and self-management.
Early recognition of kidney disease can be part of a systematic approach to management which includes:
- Screen and monitor at-risk patients
- Screen for complications of kidney disease including anemia, malnutrition, and metabolic bone disease
- Treat cardiovascular risk, especially for patients who smoke or have high cholesterol
- Refer to a registered dietitian for nutritional guidance
- Inform patients with CKD that NSAID pain relievers can increase their risk for acute kidney injury
- Educate patients regularly about CKD and treatment
The Kidney Sundays program is a collaborative effort between the NIDDK’s NKDEP and Chi Eta Phi Sorority, Inc. to educate patients about CKD and treatment within the African American community. For the last seven years, this national nursing sorority connected with local churches to conduct CKD education and diabetes and blood pressure screenings. The Kidney Sundays events are held during March, National Kidney Month, to help identify individuals who should be tested for CKD. The NKDEP supports this partnership by providing guidance to Chi Eta Phi members hosting the event, along with health information about the diagnostic tests, diabetes, and CKD. Armed with this knowledge, Chi Eta Phi nurses are better prepared to assess and identify members of their communities at high risk for developing CKD.
Conversations about CKD screening and testing should be part of primary care; GFR and UACR tests should be a regular part of patient care, especially among patients at high risk for the disease. If we increase provider awareness of CKD testing and management and promote collaboration across the health care team, we are far more likely to improve rates of early detection and reduce preventable kidney damage.
How often do you discuss chronic kidney disease prevention and testing with your patients?
About Andrew S. Narva, MD, FACP, FASN
Andrew S. Narva, MD, FACP, FASN, is the Director of NIDDK’s National Kidney Disease Education Program, which works to reduce the burden of chronic kidney disease (CKD) and its complications. He is also the Chief Clinical Consultant for Nephrology for the Indian Health Service and specializes in high-risk populations. He provides direct care at Walter Reed National Military Medical Center and via telemedicine at Zuni Indian Hospital in Zuni, New Mexico.