19 A Toolkit for Health Care Professionals Screening for Kidney Disease to Reduce CVD Risk KDIGO heat map detailing the prognosis of CKD based upon GFR and albuminuria category [7]. Abbreviations: Kidney Disease: Improving Global Outcomes (KDIGO); GFR-glomerular filtration rate. This traditional approach may not fully address patients’ elevated early CVD risk, particularly the risk for HF, as it can result in treatment delays. Following some current guidelines could delay full treatment >18 months. And spacing multiple medication adjustments and additions over many months substantially increases the risk for therapeutic inertia and further delay.21 The rapid sequence approach used in HF, acute myocardial infarction and HIV is a viable alternative. Rather than adjusting medications in a slow, stepwise fashion, introduce them simultaneously or within a very short period based on GDMT. This rapid approach reduces therapeutic inertia and increases potential benefits.21 It is also appropriate to use an externally validated risk equation to assess the absolute risk of kidney failure and adjust GDMT by risk stratification. The KDIGO heat map and Kidney Failure Risk Equation are the most commonly used risk assessments in practice21 and other equations are in various stages of development and validation.23, 25, 26, 27 Act Now New and continuing therapeutic advances offer genuine hope that many people with CKD can survive without progression to kidney failure and death. The time is now to implement broad-based screening using eGFR and uACR, both common and readily accessible in primary and specialty care. The time is now to spur the adoption of GDMT to ensure that all who might benefit from CKD treatment can receive it and do receive it. Healthy hearts and healthy kidneys will become a reality only when we narrow the gap between what we know about protecting CKM health and what we do to protect it. 20-Call to action Persistent Albuminuria Categories Description and Range GFR categories (ml/min/1.73 m2) Description and range A1 G1 ≥90 G2 60–89 G3a 45–59 G3b 30–44 G4 15–29 G5 <15 Kidney failure Severely decreased Moderately to severely decreased Mildly to moderately decreased Mildly decreased Normal or high A2 A3 Normal to mildly increased Moderately increased Severely increased <30 mg/g <3 mg/mmol 30–300 mg/g 3–30 mg/mmol >300 mg/g >30 mg/mmol KDIGO: Prognosis of CKD by GFR and Albuminuria Categories Green: low risk (if no other markers of kidney disease, no CKD);Yellow: moderately increased risk; Orange: high risk; Red: very high risk.
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