20 Key Takeaways CKD is emerging as a key and almost universally unrecognized risk factor for CVD. The prevalence of CKD may be as high as 15% of all adults in the United States7-Fast Facts and up to 16% of the global population,5-Review affecting about 35.5 million people in the U.S. and 1.3 billion individuals around the world. Even in its earliest stages, CKD can lead to hypertension and potentiate CVD. Impaired kidney function is an independent risk factor for the development of CVD and may increase CVD risk more than traditional risk factors such as diabetes mellitus or hypertension. Impaired kidney function alone can increase the risk of CVD two- to fourfold.1-Results CKD develops and progresses silently and unpredictably with symptoms that may not appear until the late stages.1-Results As many as 90% of all individuals with CKD are unaware they have impaired kidney function and about 33% with severe CKD do not know it.6-Fast Facts, 28 All individuals, children and adults at risk should be screened for CKD using a combination of two standard laboratory tests widely available in primary and specialty care, eGFR and uACR. Because CKD has few, if any, symptoms in the early stages, broad-based screening is the only viable approach to early detection and management of CKD and the associated CVD risk.4-Evidence supporting CKM-related screening If CKD is identified, clinicians have an expanding toolkit of therapeutic approaches to prevent or mitigate metabolic risk factors, to delay the progression of kidney disease, and to reduce the associated CVD risk. Multiple therapeutic agents, including ACEi/ ARB, SGLT2 inhibitors, a nsMRA (finerenone), GLP1-RAs and other incretin analogues,3Figure 3 offer beneficial metabolic effects, kidney effects, cardiovascular effects or all three to improve CVD and kidney health.4-introduction These agents are effective only if they are used. We know how to prevent or delay the onset and progression of kidney disease; we have clear clinical practice guidelines for CKD and CVD. Adherence to evidence-based GDMT is suboptimal.20-Gaps Between Knowledge and Implementation in Kidney Care The time is now to implement broad-based screening of children and adults at high risk for CKD using eGFR and uACR to diagnose asymptomatic and unrecognized CKD. The time is now to implement appropriate heart protective and kidney protective treatments and new agents as they become available. 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 1 2 3 4 5 6 7 8 9 10
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