Improving Early Detection of CKD in an Evolving Cardio-Kidney-Metabolic Era

Chronic kidney disease (CKD) remains one of the most common yet underrecognized chronic conditions in the United States. Affecting an estimated 35–36 million individuals, the disease often progresses silently, leaving many patients unaware of their condition until significant kidney damage has occurred.

At a recent clinical forum examining challenges in CKD identification and management, Muthiah Vaduganathan, MD, MPH, codirector of the Center for Cardiometabolic Implementation Science at Brigham and Women’s Hospital, and clinicians across nephrology and cardiovascular medicine discussed the persistent gap between disease prevalence and clinical awareness.

The conversation focused on improving early detection, refining risk stratification, and integrating newer therapies into practice while navigating workforce constraints and evolving care models. Experts emphasized that recent therapeutic advances can only influence outcomes if CKD is identified earlier in its course.

A central theme of the discussion was the striking lack of patient awareness surrounding CKD. Despite affecting tens of millions of Americans, only a small fraction of patients know they have the disease. Because CKD often produces few symptoms in its early stages and screening practices remain inconsistent, many patients are first identified after kidney function has already declined significantly. Disparities in diagnosis and awareness also persist, particularly among younger individuals, women, and certain racial and ethnic populations.

Improving outcomes therefore begins with more consistent detection. Panelists highlighted the underuse of urine albumin-to-creatinine ratio (UACR) testing as a key contributor to missed diagnoses. While estimated glomerular filtration rate (eGFR) is commonly included in routine laboratory panels, albuminuria testing is obtained far less consistently. Yet albuminuria is a critical biomarker of kidney damage and a strong predictor of both CKD progression and cardiovascular risk.

Several experts described efforts to reframe albuminuria testing as an early warning signal for kidney disease. When paired with eGFR, UACR can help clinicians identify patients earlier and better assess their risk of progression. Expanding the routine use of these tests was widely viewed as one of the most practical steps toward improving early CKD detection.

The forum also examined evolving referral patterns to nephrology. Some clinicians reported increased referrals from primary care, particularly from advanced practice providers, though referrals remain inconsistent. In many cases, patients are referred late in the disease course—sometimes only when kidney failure is imminent or dialysis planning is required—limiting opportunities to slow progression.

At the same time, experts acknowledged a practical reality: the nephrology workforce cannot manage every patient with early-stage CKD. With diabetes, hypertension, and cardiovascular disease continuing to rise, the population at risk for kidney disease is expanding rapidly. As a result, more effective triage and risk stratification are needed to ensure nephrology resources are directed toward patients most likely to benefit from specialist care.

Rather than relying solely on eGFR thresholds, panelists emphasized a more nuanced approach to referral decisions. Factors such as albuminuria levels, rate of kidney function decline, structural abnormalities, and underlying disease etiology can help determine which patients require specialist involvement. Many individuals with stable kidney function and minimal albuminuria may be appropriately managed in primary care with careful monitoring and risk factor control.

Strengthening collaboration between primary care clinicians and nephrologists will be essential for making these models work. Education around CKD biomarkers and referral criteria can help clinicians better identify which patients require specialist care and which can be safely managed in the community.

Recent advances in CKD therapeutics have added urgency to improving early detection. Over the past several years, therapies such as sodium-glucose cotransporter 2 inhibitors and nonsteroidal mineralocorticoid receptor antagonists have demonstrated the ability to slow CKD progression while reducing cardiovascular risk. Dapagliflozin and empagliflozin, as assessed in the DAPA-CKD and EMPA-KIDNEY trials, respectively, represent a major shift in CKD care, moving the field closer to disease modification rather than simply managing complications.

However, the benefits of these therapies depend heavily on early identification. If CKD remains undetected until advanced stages, opportunities to meaningfully alter disease trajectory may already be lost.

For clinicians, the message from the forum was clear: the tools to change CKD outcomes now exist, but realizing their full potential will require earlier recognition and a healthcare system capable of moving kidney care further upstream.

References

1. US Centers for Disease Control and Prevention. Chronic Kidney Disease in the United States, 2023. May 15, 2024. Accessed March 12, 2026. https://www.cdc.gov/kidney-disease/php/data-research/index.html

2. American Kidney Fund. Risk factors for kidney disease. Accessed March 12, 2026. https://www.kidneyfund.org/all-about-kidneys/risk-factors

3. Campbell P. Dapagliflozin (Farxiga) Receives Historic FDA Approval for Chronic Kidney Disease. HCPLive. April 30, 2021. Accessed March 12, 2026. https://www.hcplive.com/view/dapagliflozin-farxiga-receives-historic-fda-approval-for-chronic-kidney-disease

4. Campbell P. Empagliflozin (Jardiance) Receives CKD Approval from US FDA. HCPLive. September 22, 2023. Accessed March 12, 2026. https://www.hcplive.com/view/empagliflozin-jardiance-receives-ckd-approval-from-us-fda