Chronic Kidney Disease: It's Time to Recognize Its Presence in Our Patients With Hypertension

C hronic kidney disease (CKD) is one of the world's major public health problems, and the prevalence of kidney failure is rising steadily.CKD is defined in the Seventh report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure 1 as either (1) an estimated glomerular filtration rate (eGFR) of <60 mL/min/1.73m 2 or (2) the presence of clinical proteinuria (>300 mg/d or 200 mg/g creatinine).In the United States alone, 20 million Americans, or one in nine adults, have CKD and another 20 million more are at increased risk for its development.2 Hypertension is a significant risk factor for CKD.The early stages of CKD are primarily a silent disease.While blood pressure (BP) monitoring occurs at nearly every visit to the doctor, screening for CKD occurs infrequently.The failure to screen for CKD is a missed opportunity for improving patient outcome.How do we recognize CKD?There are two ways to detect this disease.1. Measure for proteinuria (macroalbuminuria), which can be detected on initial urinalysis.Patients with hypertension should have a routine urinalysis. 1 Increased urinary protein excretion is usually a marker of kidney damage and a predictor of disease progression.3 Testing for microalbuminuria is optional if no protein is detected on the initial dipstick, except for patients with diabetes where this should be a routine procedure.3 Microalbuminuria (>30 mg/d and <300 mg/d) is a risk factor for progressive kidney disease and a strong risk factor for cardiovascular (CV) disease, 4 even in nondiabetic and nonhypertensive individuals.5