Providers are urged to test patients at high risk for chronic kidney disease (CKD) for protein in the urine in the revised, global version of the National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF-KDOQI) guideline.
Updated for the first time since it debuted in 2002, “Chronic Kidney Disease: Evaluation, Classification, Stratification” retains the definition of CKD but augments the classification system to include albuminuria and cause of disease as well as glomerular filtration rate (GFR) stage. GFR stage 3 is now subdivided into categories 3a and 3b.
The albuminuria level helps clinicians better stratify risk and evaluate likely outcomes, knowledge that influences management and treatment, noted the NKF in a statement accompanying the release of the document.
“The new staging predicts meaningful outcomes for patients more accurately based on both blood and urine tests instead of one or the other test alone,” affirmed Joseph Vassalotti, MD, Chief Medical Officer of the NKF.
He added that primary-care practitioners could more routinely use inexpensive, readily available albuminuria testing for people at risk for kidney disease. “Our goal is to encourage primary-care [clinicians] to screen those with diabetes, high [BP], and a family history of kidney disease,” Vassalotti commented.
Estimated GFR should be determined using creatinine, but cystatin C can also be used. In addition, risk for overall mortality, cardiovascular disease, end-stage kidney failure, acute kidney injury, and CKD progression should be defined through the relationship between eGFR and albuminuria. Patients with very low GFR (<15 mL/min/1.73 m2) or very high albuminuria (>300 mg) should be referred to a nephrologist.