Risk Prediction for Chronic Kidney Disease: Considerations for Primary Care

Chronic Kidney Disease (CKD) affects more than one in ten Canadians and is largely managed in primary care. Diabetes is the leading cause of CKD, and primary care providers often manage the underlying causes and comorbid conditions related to kidney disease, as well as the adverse consequences of CKD itself. It is important to recognize that CKD has a variable course. While most adults lose approximately 1 mL/min of kidney function every year after the age of 40, some patients lose kidney function rapidly, leading to hospitalizations due to heart failure and progression to kidney failure, whereas others remain stable for decades, requiring minimal additional intervention. Recent advances in risk prediction for CKD allows all providers to accurately identify high risk individuals. These innovations enable the use of highly effective therapies that slow down, and in many cases, normalize the rate of kidney function loss, leading to potential lifetime risk reduction for kidney failure. (Figure 1). This review will cover key considerations in screening, risk stratification, and treatment of CKD in primary care, with an emphasis on tools that are readily available in clinical settings. We believe that a screen-triage-treat paradigm for CKD can lead to optimal outcomes for patients and health systems.