Screening for CKD

The Red Book recommends a risk-based approach to screening for chronic kidney disease (CKD). This means that not everyone needs to be screened, but only those individuals who are considered at higher risk of developing the disease.

  1. Stage 1 (eGFR ≥ 90 mL/min/1.73 m^2)
    1. Kidney damage with normal or increased eGFR.
    2. Kidney damage is usually determined by the presence of albuminuria, abnormal urine sediment, electrolyte and other imbalances, or abnormalities in imaging tests.
  2. Stage 2 (eGFR 60-89 mL/min/1.73 m^2)
    1. Kidney damage with mildly decreased eGFR.
    2. Again, evidence of kidney damage is necessary to diagnose CKD at this stage.
  3. Stage 3 (eGFR 30-59 mL/min/1.73 m^2)
    1. Moderately decreased eGFR.
    2. This stage is further divided into two sub-stages:
      1. 3a: eGFR 45-59 mL/min/1.73 m^2
      2. 3b: eGFR 30-44 mL/min/1.73 m^2
    3. Many patients start to manifest clinical symptoms related to reduced kidney function at this stage.
  4. Stage 4 (eGFR 15-29 mL/min/1.73 m^2)
    1. Severely decreased eGFR.
    2. This stage is a preparation phase for end-stage renal disease (ESRD), and discussions about renal replacement therapy (like dialysis or transplantation) usually begin.
  5. Stage 5 (eGFR < 15 mL/min/1.73 m^2 or on dialysis)
    1. Also referred to as end-stage renal disease (ESRD) or kidney failure.
    2. At this stage, the kidneys have almost stopped functioning, and renal replacement therapy (dialysis or kidney transplantation) is necessary for survival.

This advice conflicts with other RACGP advice that says to screen

  • All people aged ≥30 years
  • People aged 18–29 years with one or more of the CKD risk factors listed below.

Risk Factors: Key risk factors for CKD include:

  • ATSI-> annual screen BP/UEC/ACR from 18 years
  • Diabetes
  • Hypertension
  • Smoking
  • Obesity
  • Established cardiovascular disease (e.g., heart attack, stroke)
  • Family history of kidney failure
  • History of acute kidney injury
  • Low socio-economic status

Screening Tests: For those at high risk, the Red Book recommends regular testing of kidney function. This can include:

  • Blood pressure measurement: High blood pressure can be both a cause and a consequence of CKD.
  • Serum creatinine test: This blood test helps estimate the glomerular filtration rate (eGFR), which reflects how well the kidneys are filtering wastes from the blood.
  • Urine albumin/creatinine ratio (ACR): This test checks for albumin in the urine, which can indicate kidney damage.

Frequency of Screening: For those at high risk, screening might be recommended every 2 years, but this can vary depending on the individual’s specific risk factors and overall health.

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