survive the ravages of PEW and cardiovascular disease, will eventually receive renal replacement therapy in the form of dialysis therapy or kidney transplantation, a new trend is emerging to maintain them longer without dialysis by implementing conservative management of CKD. However, in some with additional comorbidities such as metastatic cancers, palliative measures with supportive care can be considered. Approaches to identification of CKD The lack of awareness of CKD around the world is one of the reasons for late presentation of CKD in both developed and developing economies (20–22). The overall CKD awareness among the general population and even high cardiovascular risk groups across 12 low-income and middle-income countries (LMIC) was less than 10% (22). Given its asymptomatic nature, screening of CKD plays an important role in early detection. Consensus and positional statements have been published by the International Society of Nephrology (ISN) (23), the National Kidney Foundation (24), the Kidney Disease Improving Global Outcomes (25), the NICE Guidelines (26), and the Asian Forum for CKD Initiatives (27). There was a lack of trials to evaluate screening and monitoring of CKD (28). Currently, most will promote a targeted screening approach to early detection of CKD. Some of the major groups at risk for targeted screening include: patients with diabetes, hypertension, those with family history of CKD, individuals receiving potentially nephrotoxic drugs, herbs or substances or taking indigenous medicine, patients with past history of acute kidney injury, and individuals older than 65 years of age (27,29). CKD can be detected with 2 simple tests: a urine test for the detection of proteinuria and a blood test to estimate the GFR (24,27). Given that currently population screening for CKD is not recommended and it was claimed that it might add unintended harm to the general population being screened (28), there is no specialty society or preventive services group that recommends general screening (30). LMIC are ill-equipped to deal with the devastating consequences of CKD, particularly the late stages of the disease. There are suggestions that screening should primarily include high-risk individuals, but also extend to those with suboptimal levels of risk, e.g., prediabetes and prehypertension (31). Cost-effectiveness of early detection programs Universal screening of the general population would be time-consuming, expensive, and has been shown to be not cost-effective. Unless selectively directed towards high-risk groups, such as the case of CKD in disadvantaged populations (32), according to a cost-effectiveness analysis using a Markov decision analytic model, population-based dipstick screening for proteinuria has an unfavorable cost effectiveness ratio (33). A more recent Korean study confirmed that their National Health Screening Program for CKD is more cost-effective for patients with diabetes or hypertension than the general population (34). From an economic perspective, screening CKD by detection of proteinuria was shown to be cost-effective in patients with hypertension or diabetes in a systematic review (35). The incidence of CKD, rate of progression, and effectiveness of drug therapy were major drivers of cost-effectiveness and thus CKD screening may be more cost-effective in populations with higher incidences of CKD, rapid rates of progression, and more effective drug therapy. Braz J Med Biol Res | doi: 10.1590/1414-431X20209614 Prevention of kidney diseases 5/10 A rational approach to CKD early detection The approach towards CKD early detection will include the decision for frequency of screening, who should perform the screening, and intervention after screening (21). Screening frequency for targeted individuals should be yearly if no abnormality is detected on initial evaluation. This is in line with the Kidney Disease Improving Global Outcomes (KDIGO) resolution that the frequency of testing should be according to the target group to be tested and generally needs not be more frequent than once per year (25). Who should perform the screening is always a question especially when the healthcare professional availability is a challenge in lower income countries. Physicians, nurses, paramedical staff, and other trained healthcare professionals are eligible to do the screening tests. Intervention after screening is also important and patients detected with CKD should be referred to primary care and general physicians with experience in management of kidney disease for follow up. A management protocol should be provided to the primary care and general physicians. Further referral to nephrologists for management should be based on well-defined protocols (22,25,27). Integration of CKD prevention into national NCD programs Given the close links between CKD and other NCDs, it is critical that CKD advocacy efforts be aligned with existing initiatives concerning diabetes, hypertension, and cardiovascular disease, particularly in LMIC. Some countries and regions have successfully introduced CKD prevention strategies as part of their NCD programs. As an example, in 2003, a kidney health promotion program was introduced in Taiwan, with its key components including a ban on herbs containing aristolochic acid, public-awareness campaigns, patient education, funding for CKD research, and