Bottom Line: Even your doctor may not know to order these tests…
When you see your doctor for a regular check-up, your kidney health may be getting short shrift. You may think your doctor is staying on top of all the tests you need…but not necessarily.
Screening for chronic kidney disease (CKD)—when it’s performed—has traditionally involved a select group of blood and urine tests. But in today’s busy doctors’ offices, it’s common for the urine test to not be ordered. This means that any testing you do receive may be inadequate. Now that’s about to change.
Latest development: To simplify testing, the National Kidney Foundation has collaborated with the American Society for Clinical Pathology and other leading laboratory societies and laboratories to identify a combination of specific tests now called the Kidney Profile. When performed together, these tests—a urine sample for albumin-to-creatinine ratio (ACR) and a blood test for estimated glomerular filtration rate (eGFR)—streamline the testing process. These are the two tests recommended by the National Kidney Foundation and the American Diabetes Association to test individuals at risk for kidney disease.
Pairing the results from these tests makes the Kidney Profile more accurate and comprehensive than receiving just one test. The combination not only detects CKD but also identifies the stage of kidney disease and provides a stronger prediction of one’s risk for kidney failure, heart disease and other chronic conditions.
If CKD is detected, the test results enable doctors to better determine how a patient’s individual case should be managed—typically with medications for those at earlier stages…and with dialysis or even a kidney transplant for people who have later-stage disease.
For example, high blood pressure with high levels of albumin in the urine, or ACR, should be treated with a blood pressure medication that also protects the kidneys—this could be an angiotensin-converting enzyme inhibitor, such as benazepril (Lotensin) or an angiotensin receptor blocker, such as losartan (Cozaar).
The people for whom CKD testing is recommended haven’t changed—they’re the same individuals who should have been getting annual kidney screenings all along. This includes people in specific high-risk groups for CKD, such as…
If you’re wondering whether testing for kidney disease really is that important, the answer is a resounding “Yes!” The condition, which impairs the kidneys’ ability to remove wastes and regulate crucial chemical levels in the blood, such as sodium, potassium and calcium, is far more common than most people realize.
Startling statistic: An estimated 30 million Americans have CKD, but only 3.6 million are aware of it, while the others have no inkling that anything is amiss.
Worse yet, more Americans than ever before are now considered to be at risk of developing CKD due to diabetes or high blood pressure. This escalating number stems, in part, from the aging population and the obesity epidemic, both of which drive high blood pressure and type 2 diabetes.
The real danger: Once your kidneys are damaged, the harm that is done usually cannot be reversed. More than 450,000 Americans are now on kidney dialysis. The only other treatment for late-stage kidney failure is a transplant—an option that is limited by the relative lack of available kidneys.
When it comes to annual screening for CKD, cost has never been an issue for most people. The Kidney Profile’s blood and urine tests cost under $50 and are routinely covered by health insurance. They are easy to get—if your primary care doctor orders both types of tests for the most complete kidney assessment.
Because the Kidney Profile streamlines and simplifies CKD testing for doctors, patients will get the benefit of more complete testing. With leading labs adopting the combination of CKD tests under the heading of “Kidney Profile” on request forms and electronic health records, doctors won’t need to search for and order each test separately…and they also can find the results in one place.
Let’s face it: When one less click of a computer mouse or check mark on a handwritten form is needed to expedite proper care, your doctor’s job gets easier…and the odds of effective care go up.
Important: If you have one of the risk factors (such as diabetes or high blood pressure), be sure to ask your doctor about getting the Kidney Profile. If it’s not yet available in your community, ask for the blood (eGFR) and urine (ACR) tests to be ordered individually.
CKD can be present if one or both tests are abnormal over a period of 90 or more days. Here are the numbers you should look for in the Kidney Profile (or in the following tests if ordered separately)…
• ACR urine test. What’s being measured: Albumin is a type of protein that may signal early kidney disease when it appears in the urine. Creatinine, a product of normal muscle metabolism, is filtered by the kidneys as a waste product.
Target numbers: The ACR is a highly sensitive indicator of kidney damage. If you have ever scrambled an egg, you might notice foam on the surface that represents albumin in the egg. Similarly, individuals with high levels of albumin in the urine may notice foamy urine, but the ACR test is more accurate than looking for foam. The ACR test result should be less than 30 mg/g. Higher levels indicate kidney damage, which in turn increases risk for kidney failure and heart disease.
• eGFR blood test. What’s being measured: Creatinine levels are used in a formula that also incorporates your age, weight, race and gender to calculate your eGFR. The number indicates how well your kidneys are filtering blood to remove natural waste products and excess fluid.
Target numbers: You can think of eGFR readings as a percentage of kidney function. An eGFR reading of 90 or above is considered normal, while a reading below 60 is considered reduced kidney function. People with an eGFR reading between 60 and 89 may not have kidney disease, especially if the ACR is normal. Many people, however, are diagnosed with stage 3 (or moderate) kidney disease when the eGFR result is 30 to 59. A result below 30 is considered severe CKD. The lower the kidney function, the higher the risk for kidney failure and cardiovascular disease.
In general, people who have an eGFR of less than 30 should see a nephrologist (kidney specialist). Patients who have an eGFR of less than 15 usually need to be prepared for dialysis or a kidney transplant.
Note: Low kidney function should be considered when prescriptions are being ordered—some drugs should be avoided, and others need to have the dose adjusted if the drug is eliminated from the body via the kidneys. Approximately half of FDA-approved medications are cleared by the kidneys.
Important: People at risk for kidney disease should be tested at least once every year, but more frequent testing may be advised for more severe kidney disease. Speak to your doctor about the most appropriate testing schedule for you.
For more more information, consult the National Kidney Foundation at Kidney.org/CKDintercept/laboratoryengagement.
