Chapter 9: Renal Disorders

KIDNEY DISEASE, CHRONIC (CKD)

Population

• – Adults.

Recommendations

USPSTF 2012

• – Insufficient evidence to recommend for or against routine screening.

Source

• – USPSTF. Chronic Kidney Disease (CKD): Screening. 2012.

ACP 2013, AAFP 2014

• – Do not screen adults unless they have symptoms or risk factors.

• – Adults taking an ACE inhibitor or ARB should not be tested for proteinuria, regardless of diabetes status.

Sources

• – AAFP. Clinical Recommendations: Chronic Kidney Disease. 2014.

• – Ann Intern Med. 2013;159(12):835.

NICE 2014

• – Monitor glomerular filtration rate (GFR) at least annually in people who are prescribed drugs known to be nephrotoxic.^a

• – Screen renal function in people at risk for CKD.^b

Source

• – NICE. Early Identification and Management of Chronic Kidney Disease in Adults in Primary and Secondary Care. London (UK): NICE; 2014.

VA/DoD 2019

• – For patients at risk for CKD (DM, HTN, cardiac disease/CHF, or vascular disease), systemic illness such as HIV, urinary tract abnormalities, history of AKI, proteinuria, family history of kidney disease, age >60 y, and ethnicities associated with increased risk (eg, African-Americans, Hispanics, Native Americans), periodically obtain SCr, eGFR, urinalysis, and spot uACR. Periodicity of screening is not defined.

Comments

1. Diagnose CKD if either of the following present for >3 months:

   1. Markers of kidney damage such as albuminuria >30 mg/g, urinary sediment abnormalities, electrolyte abnormalities due to tubular disorders, histologic abnormalities, structural abnormalities by imaging, or kidney transplantation.

   2. GFR <60 mL/min/1.73 m².

Source

• – Kidney Disease Improving Global Outcomes (KDIGO). KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease 2013;3(1).