Prediabetes, Prehypertension … Is It Time for Pre-CKD?

There is no doubt that chronic kidney disease (CKD) is common in the United States (1) and is associated with important adverse outcomes, such as cardiovascular disease and mortality (2). Factors that are associated with higher risk for CKD include hypertension, diabetes, obesity, and African ancestry. The currently accepted definitions of hypertension and diabetes are somewhat arbitrary; in fact, previous definitions of hypertension and diabetes were revised on the basis of the recognition that values lower than the prevailing acceptable thresholds for BP or blood glucose were associated with higher risk for adverse outcomes. The new designations “prediabetes” (also known as impaired glucose tolerance or impaired fasting glucose) and “prehypertension” were recently introduced, yet these terms are somewhat awkward because the risks associated with blood glucose and BP are continuous rather than dichotomous. Nonetheless, individuals with prediabetes are at high risk for the development of diabetes and at increased risk for cardiovascular disease (3). As we continue to refine our understanding of the relations between risk factors and adverse outcomes, we must also evaluate the criteria we use to assess disease and revise our definitions accordingly. Considerations such as whether individuals in the “predisease” phase are at higher risk for relevant outcomes and the availability of effective interventions that can reduce the likelihood of developing the adverse outcome will inform the establishment of guidelines for screening and treatment. Guidelines for screening for diabetes already exist (4). High-risk individuals should be screened regardless of age. For others, screening is recommended beginning at age 45. Effective interventions are available for individuals who meet the criteria for prediabetes to reduce the risk for progression to diabetes and the associated morbidities. Screening for albuminuria and measurement of serum creatinine (and calculation of estimated GFR [eGFR]) are currently recommended by the American Diabetes Association …