Chronic kidney disease (CKD) affects around 10% of the adult population and it is responsible for high morbidity1 and premature mortality.2 Risk factors include diabetes, hypertension, cardiovascular disease, obesity, and older age, all of which are increasing in prevalence globally.3 Mortality risk is closely correlated with reductions in kidney function (estimated glomerular filtration rate [eGFR]) and rising albuminuria.4 It is predicted that CKD will be the fifth leading cause of death worldwide by 2040.5 Here we lay out some difficult challenges faced by primary care in CKD diagnosis and management, recent advances in available treatments, and practical recommendations for improving care.
Albuminuria testing
CKD is typically asymptomatic, particularly in the early stages. Albuminuria testing in the form of urine albumin-creatinine ratio (uACR) is key in the detection, risk stratification, and monitoring of CKD.6 There is no evidence-based guidance for frequency of albuminuria testing and there is a lack of consistency across some disease-specific guidelines. The National Institute for Health and Care Excellence (NICE) guidelines suggest that uACR should be measured at least annually (regardless of eGFR) in individuals with diabetes (type 1 and type 2) and/ or hypertension, in those prescribed nephrotoxic medications such as non-steroidal anti-inflammatory drugs (NSAIDs) and in those with an eGFR <60 ml/ min/ 1.73 m2 or uACR >3 mg/ mmol. Individuals with cardiovascular disease, multisystem diseases with the potential for kidney involvement, or family history of kidney disease/ failure should also be screened for CKD with uACR and eGFR testing.6 However, despite these recommendations, albuminuria testing has historically been suboptimal in primary care in the UK …
