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Early identification and intervention can slow or prevent CKD progression. CKD may have no symptoms in most stages, so many people are unaware of their CKD status until late-stage disease. In addition, limited provider awareness of CKD risk factors and surveillance guidelines can contribute to low patient awareness. Improving identification allows earlier treatment of CKD, which may reduce the number of people who progress to later-stage CKD, require transplant or dialysis or experience secondary consequences. Identification of CKD typically includes screening at-risk individuals, determining the stage of disease and communicating results and next steps to patients. There are multiple challenges to improving disparities in identification of CKD: • Clinical care teams and people at risk need to understand more about CKD, including its causes, stages and consequences. • Primary care practice teams need protocols for detecting CKD. Most guidelines agree that people with diabetes or hypertension should be screened. Research shows that older individuals, non-Hispanic blacks, Native Americans and Hispanics should also be considered for CKD screening. • Screening for CKD may be conducted by community-based organizations that are not coordinated with primary care teams. Addressing these challenges can improve identification of CKD in vulnerable populations, which has the potential to slow or prevent the progression of disease. Improving Identification of CKD: Suggested Steps Approaches to Identifying Chronic Kidney Disease Page 11 of 19 April 2021 Improving Identification of CKD: Suggested Steps Resources Develop and implement a CKD detection protocol that defines the population at risk Informational Materials Practical Tools Training Materials Leverage health information systems to identify and track at-risk patients and prompt the clinical care team of the need for CKD detection Develop scripts for the care team to explain the risks of CKD and how it is detected Practical Tools Promote CKD detection at every opportunity Include CKD detection during preventive or well-care visits Integrate CKD detection into care management programs (e.g., diabetes, hypertension, heart disease) Coordinate with community-based CKD screening activities that outreach to racial and ethnic minorities and low-income populations Informational Materials Practical Tools Use two tests to detect CKD over a 3-month period Spot urine for albumin-to-creatinine ratio (ACR) to detect albuminuria Blood test for serum creatinine to estimate GFR Repeat positive tests over a 3-month period Informational Materials Practical Tools Determine risk or stage of CKD and inform patient Use culturally and linguistically appropriate materials Have information available in various formats (written, visual, video, apps) Address emotional response Consider health literacy levels Informational Materials Practical Tools Measure, track and improve CKD detection rates Examine differences based on race, ethnicity, other risk factors Review with the clinical care team Informational Materials Training Materials Approaches to Treatment and Monitoring of CKD Progression Page 12 of 19 April 2021 Approaches to Treatment and Monitoring of CKD Progression Why Is It Important to Treat and Monitor Progression? Why Is It Important to Treat and Monitor CKD Progression? Although the prevalence of CKD is relatively similar across racial and ethnic groups, minorities are more likely to progress from CKD to ESRD, and progress more rapidly than non-Hispanic whites. Clinical and system-wide interventions for slowing the progression of CKD largely consist of controlling risk factors, developing treatment plans and encouraging lifestyle changes.
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