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Primary Care and Chronic Kidney Disease
Screening, Diagnosis, and Management of CKD in Primary Care Settings

Released: October 16, 2025

Chuck Vega
Chuck Vega, MD, FAAFP
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Key Takeaways
  • Primary care healthcare professionals (HCPs) should proactively participate in chronic kidney disease (CKD) screening, management, and collaborative care to slow disease progression and reduce the risk of complications.
  • CKD screening is recommended for people at high risk, such as those with diabetes, hypertension, cardiovascular disease, history of acute kidney injury, obesity, or a family history of kidney disease.
  • According to current guidelines, HCPs should use both estimated glomerular filtration rate and urinary albumin–to-creatinine ratio to screen for CKD, and if results are abnormal, tests should be repeated to confirm that they are persistent.

Chronic kidney disease (CKD) affects approximately 1 in 10 adults worldwide and approximately 1 in 7 adults in the United States. Early recognition and consistent follow-up in settings where patients at high risk for CKD receive care (eg, primary care) have the potential to significantly improve health outcomes, optimize resource use, and potentially control costs. As frontline healthcare professionals (HCPs), primary care HCPs are in a strong position to detect CKD early, slow its progression, and protect our patients from serious complications like cardiovascular disease and kidney failure. Kidney Disease: Improving Global Outcomes (KDIGO) recommendations, including the 2024 KDIGO guidelines, identify key roles for primary care HCPs in identifying patients at high risk for CKD, screening for and diagnosing CKD, starting treatment in a timely manner, and coordinating long-term care.

Step up Early: Screen for CKD
CKD often goes unnoticed until it is advanced; symptoms are often not recognized until kidney function has dropped significantly. Screening for CKD in high-risk patients is an effective tool for identifying individuals who should receive treatment. Primary care HCPs should prioritize CKD screening in high-risk individuals, particularly those with diabetes, hypertension, cardiovascular disease, a history of acute kidney injury, obesity, or a family history of kidney disease.

The KDIGO 2024 guidance recommends using 2 simple tests to screen people at high risk for CKD: estimated glomerular filtration rate (eGFR), to measure how well the kidneys filter waste, and urinary albumin–to-creatinine ratio (UACR), to check for kidney damage by measuring protein leakage into the urine. If either result is abnormal, the tests should be repeated after a few months to confirm persistence. Even small, consistent changes matter—they can signal early kidney damage that can be treated to slow or prevent further damage. Per guideline recommendations, adults with diabetes should be rescreened annually following a negative eGFR/UACR test result. Evidence also indicates benefits of annual screening for individuals with hypertension.

Diagnosis and Monitoring
CKD is defined by persistent abnormalities for at least 3 months. Assess CKD using both eGFR and UACR to guide your assessment, and when possible, combine creatinine with cystatin C to improve accuracy. This extra step can help to identify at-risk patients earlier, especially those whose lab results might otherwise look “borderline.”

Albuminuria is not just a warning sign—it is a call to act. Even mild elevations increase cardiovascular risk and predict faster kidney decline. Use tools like the Kidney Failure Risk Equation to determine which patients need closer follow-up or a nephrology referral. A clear understanding of risk will help in identifying appropriate next steps.

Manage Proactively: Take the Lead in CKD Care
Primary care teams can dramatically reduce CKD progression and its complications by working with their patients to make changes consistent with evidence-based care, including lifestyle modification, blood pressure and metabolic control, and cardiovascular risk management. Talk with your patients about important lifestyle changes like smoking cessation, staying active, and adopting a mostly plant-based diet. Aim for a systolic blood pressure <120 mm Hg when safe, and use angiotensin-converting enzyme inhibitors or angiotensin receptor blockers as first-line therapy. Do not wait for diabetes to add SGLT2 inhibitors; they benefit almost everyone with CKD, protecting both the kidneys and the heart. Prescribe statins, assess cardiovascular risk regularly, and consider GLP-1 receptor agonists or nonsteroidal mineralocorticoid receptor antagonists when appropriate. Managing cardiovascular risk is not optional; it is  central to kidney health, and it is important that patients receive life-changing medications that are now available. Do not forget to review all medications, including over-the-counter drugs and supplements, to avoid nephrotoxic interactions. If treatment is paused during acute illness, set clear plans for when to restart it. Consistent follow-up prevents setbacks and keeps patients safe.

Know When to Collaborate: Refer Strategically
Although CKD can often be managed in primary care, timely referral ensures patients get the right support when needed. Situations where referral to specialty care is recommended include eGFR <30 mL/min/1.73 m², rapid decline in kidney function, consistent significant albuminuria, hypertension that does not respond to treatment, and/or >5% predicted chance of kidney failure within 5 years. Shared-care models where primary and specialty teams work together lead to the best outcomes. Think of nephrologists as partners, not replacements. Collaborative care gives patients continuity, clarity, and confidence.

Conclusion
By integrating CKD screening of individuals at high risk for CKD during cardiovascular risk assessments and wellness visits, primary care HCPs can identify disease earlier and close care gaps. To learn more about CKD screening and management, join us for a live virtual session during the 2025 MEDX Primary Care Conference.

Your Thoughts
As a primary care HCP, what do you do in the management of patients with CKD? Do you screen high-risk patients? Manage CKD? Refer to nephrology specialists? Coordinate care? Answer the polling question and leave a comment to join the discussion.

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What do you routinely use to screen at-risk patients for CKD?

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