AHA24 Screening for Kidney Disease to Reduce CVD Risk: uACR and eGFR

CVD is the leading cause of death in patients with established CKD. Kidney-specific practice guidelines recommend that all patients with CKD be evaluated for CVD regardless of the presence or absence of CVD symptoms.8-Introduction Just as screening asymptomatic patients without CKD for CVD can lead to early interventions and improved outcomes, some experts suggest screening asymptomatic patients with CKD can be expected to produce similar benefits. The same atherosclerotic CVD risk calculator is used to assess risk in individuals with or without.8-Use of ASCVD Risk Calculator It is important to diagnose CVD early to intervene early and modify risk factors to improve clinical outcomes.8-Conclusion Undetected CVD in Those With Known CKD CKD risk factors include: † existing hypertension, diabetes or CVD (including HF) or prior acute kidney injury/diseases † residence in geographic areas with high prevalence of CKD associated with environmental factors, high prevalence of APOL1 genetic variants or endemic CKD † genitourinary disorders, multisystem diseases or chronic inflammatory conditions, including systemic lupus erythematosus, vasculitis and HIV † iatrogenic exposures including drug-induced nephrotoxicity and radiation nephritis † family history or known genetic variant associated with CKD † gestational conditions including preterm birth, small gestational size or preeclampsia/eclampsia † occupational exposures including cadmium, lead, mercury, polycyclic hydrocarbons or presticides7-Table5 as well as obesity and age.14-Figure 2 Risk Stratification in CKD Using eGFR and uACR Screening must include both eGFR and uACR measures.7Figure 3 Risk should be stratified using eGFR and uACR. CKD is staged using the KDIGO heat map, which is based on clinical outcomes: † All-cause mortality † Cardiovascular mortality † Myocardial infarction † Stroke † Heart failure † Atrial fibrillation † Peripheral artery disease † Kidney failure with replacement therapy † Acute kidney injury † Hospitalization7-Figure 5 The KDIGO risk class directs the need for treatment and/or specialty consultation.14-Figure 2 14

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