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Chronic kidney disease detection, staging and treatment in cardiovascular disease prevention
  1. Julio Alejandro Lamprea-Montealegre1,
  2. Michael G Shlipak2,3,
  3. Michelle M Estrella4,5
  1. 1Division of Cardiology and Kidney Health Research Collaborative, University of California, San Francisco, California, USA
  2. 2Division of General Internal Medicine and Kidney Health Research Collaborative, University of California, San Francisco, California, USA
  3. 3San Francisco VA Health Care System, San Francisco, California, USA
  4. 4Division of Nephrology and Kidney Health Research Collaborative, University of California, San Francisco, California, USA
  5. 5San Francisco VA Healthcare System, San Francisco, California, USA
  1. Correspondence to Dr Julio Alejandro Lamprea-Montealegre, University of California San Francisco, San Francisco, California, USA; Julio.LampreaMontealegre{at}ucsf.edu

Abstract

Globally, nearly 10% of the population has chronic kidney disease (CKD), defined as a glomerular filtration rate less than 60 mL/min/1.73 m2 and/or a urinary albumin to creatinine ratio greater than 30 mg/g (3 mg/mmol). Persons with CKD have a substantially high risk of cardiovascular disease. Indeed, most persons with CKD are far more likely to develop a cardiovascular event than to progress to end-stage kidney disease. Although early detection and staging of CKD could help prevent its cardiovascular consequences, current rates of testing for CKD are very low, even among high-risk populations such as persons with diabetes, hypertension and cardiovascular disease. In this review, we first describe the need to test for both estimated glomerular filtration rate and albuminuria among persons at high risk of CKD in order to properly stage CKD and enhance cardiovascular risk stratification. We then discuss how detection and staging for CKD could help prioritise patients at high risk of atherosclerotic cardiovascular disease and heart failure who could derive the largest benefit from cardiovascular preventive interventions. In addition, we discuss the central role of CKD detection and staging in the initiation of cardiorenal preventive therapies, such as the sodium–glucose cotransporter 2 inhibitors, which have shown overwhelming evidence of cardiorenal protection. We conclude by discussing strategies to overcome historical barriers to CKD detection and treatment.

  • epidemiology
  • biomarkers
  • coronary artery disease

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Footnotes

  • Twitter @jlampre

  • Contributors Research idea and study design, data analysis/interpretation, and review of the manuscript and approval of the final version: JALM, MGS and MME; draft of the first version: JALM. Each author contributed important intellectual content during manuscript drafting or revision, accepted personal accountability for the author’s own contributions, and agreed to ensure that questions pertaining to the accuracy or integrity of any portion of the work are appropriately investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests MGS reports receiving consulting fees from Cricket Health and Integra Pharmaceuticals.

  • Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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