Chronic kidney disease screening to reduce cardiovascular risk: a call to action

Chronic kidney disease (CKD) has a high global prevalence, affecting around 1 in 7 adults in the United States; however, most adults with CKD are unaware that they have the condition. Diagnosis and treatment of CKD is essential due to the associated increased morbidity and mortality, including increased risk of cardiovascular disease (CVD) and heart failure. Importantly, people with CKD are more likely to die from CVD than progress to end-stage kidney disease. Dual evaluation of estimated glomerular filtration rate (eGFR) and urinary albumin-to-creatinine ratio (UACR) is essential to determine the level of risk and to guide appropriate treatment. Although abnormalities in both eGFR and UACR can be modifiable risk factors for CKD progression and adverse CV outcomes, there is evidence of underuse of this dual screening for CKD. However, for patients with diagnosed CKD, striking reductions in cardiorenal risk may be achieved by combining appropriate evidence-based therapies. Current approaches to management of CKD involve the use of multiple therapies that target different pathological pathways to reduce cardiorenal risk. Therefore, we raise a call to action to improve the standard of care for early diagnosis and management of CKD, to minimize the risk of disease progression and complications, reduce CV risk, and ultimately improve patient outcomes. Alongside primary care clinicians, cardiologists can also lead the way for preventive efforts and implementation of guideline-directed therapies that can reduce the risk of both CKD progression and adverse CV outcomes.