A Toolkit for Health Care Professionals Screening for Kidney Disease to Reduce CVD Risk 13 There are currently no general practice guidelines recommending CKD screening for the entire population. However, the KDIGO guidelines recommend screening using uACR and eGFR for people at risk for CKD.7, 10-Who should be screened for CKD? The AHA Cardio-Kidney-Metabolic Initiative includes eGFR and uACR in the recent PREVENT equation, underscoring the role CKD plays in atherosclerotic CVD and heart failure.12-Introduction In practice, uACR and other albuminuria testing are not commonly performed, even in those living with diabetes. Many other individuals at elevated risk for CKD, including those with a family history of kidney disease, hypertension, excess adiposity and other CKD/CVD risk factors, or CVD, too often go unscreened.10-Who should be screened for CKD? A 2014 systematic review of cost-effectiveness analyses of CKD screening strategies concluded that screening high-risk individuals is cost-effective in any scenario. General population screening could be costeffective if medication intervention could be considered highly effective for both kidney and cardiovascular risk reduction.13-Discussion, Conclusion A decade later, SGLT2 inhibitors, GLP-1 receptor agonists, nsMRA (finerenone) and other medication classes are highly effective for both kidney and cardiovascular risk reduction. A cost-effectiveness analysis concluded population-wide screening for albuminuria followed by treatment with SGLT2 inhibitors in addition to ACE inhibitors/ARB treatment may be cost-effective in the general U.S. population aged 35 years and older.10-Discussion, Conclusion The benefits of population-wide screening were published before the confirmation of combined kidney and cardiovascular benefits of GLP-1 receptor agonists and a nsMRA.10-How and When Should CKD Screening Be Performed? It is reasonable to follow a similar path as novel classes of agents are confirmed to benefit kidneys, hearts and lives. The optimal frequency of screening varies by age, reflecting the epidemiology of CKD over the lifetime. For 35- to 45-year-olds, screening every 10 years is costeffective. Because the prevalence of CKD increases with age, screening every five years, starting at age 55 may be reasonable.10-Discussion CKD patients, advocacy groups and others argue strongly in favor of early screening, diagnosis, risk stratification and intervention, particularly for individuals with hypertension, diabetes or CVD. Effective screening and risk stratification must include both eGFR and uACR.14-Introduction, Table 1 Point-of-care (POC) testing is recommended if laboratory access is limited or when POC testing can facilitate clinical intervention.10-Recommendation 1.4.1
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