Should GPs Screen for CKD with Risk Factors?

Early Detection of Chronic Kidney Disease in Primary Care Settings

Kidney failure, more formally known as end-stage kidney disease (ESKD), is the terminal stage of chronic kidney disease (CKD). CKD itself is characterised by gradual loss of kidney function over months or years. When identified early, CKD progression can often be slowed or even halted through timely interventions. However, because early stages of CKD are typically asymptomatic, many individuals remain unaware of their deteriorating kidney function until significant, and sometimes irreversible, damage has occurred. A recent systematic review by Korsa et al., titled “Risk Factor-Based Screening for Early Detection of Chronic Kidney Disease in Primary Care Settings: A Systematic Review,” offers important insights into how targeted screening in general practice might uncover CKD sooner and reduce the burden of kidney failure.

Understanding CKD’s Progression to Kidney Failure

CKD is defined as persistent evidence of kidney damage—often indicated by markers like reduced estimated glomerular filtration rate (eGFR) and/or albuminuria—for at least three months. Globally, CKD affects over 10% of adults, which equates to more than 800 million people. Alarmingly, many of these individuals do not know they have CKD because the disease can remain silent until the advanced stages. When CKD progresses to ESKD (or kidney failure), a person typically requires dialysis or a kidney transplant to survive.

Major risk factors include diabetes mellitus, hypertension, cardiovascular disease (CVD), older age, obesity, smoking, and a family history of kidney disease. Because these conditions often coexist, the likelihood of developing CKD can be substantially higher in people with multiple risk factors. Early identification and management of these risk factors help prevent or delay CKD progression.

The transition from mild to advanced CKD can be slowed when patients receive appropriate interventions. Medications such as angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), and sodium-glucose cotransporter-2 (SGLT2) inhibitors (for certain patient profiles) can protect kidney function. Lifestyle modifications, including improved diet and regular physical activity, also help mitigate progression. Without early diagnosis, these steps are rarely initiated, allowing CKD to advance undetected.

The Socioeconomic Burden of ESKD

The cost of treating advanced CKD and ESKD (dialysis, transplantation, and hospitalisations) is considerably higher than the cost of preventive measures. In many high-income countries, CKD accounts for a significant proportion of total healthcare expenditure, partly because advanced disease incurs substantial resource utilisation. Early detection within primary care, by contrast, is considerably more cost-effective, particularly for high-risk patient groups.

As CKD progresses, patients often experience fatigue, fluid retention, and other complications (for instance, cardiovascular events). Early treatment can alleviate or postpone these symptoms, preserving the patient’s overall quality of life. Additionally, individuals with earlier-stage CKD benefit from timely education about medication adherence, dietary adjustments, and potential warning signs of disease advancement.

Recent Study Highlights Intervention Key

The systematic review by Korsa and colleagues synthesised data from 24 studies across 11 countries, all exploring targeted, risk factor–based CKD screening in primary care. Several important themes emerged.

Almost all of the included studies focused on individuals with at least one recognised risk factor (most commonly diabetes or hypertension). This targeted approach led to higher detection rates than population-wide screenings. In some research cohorts, over half of the participants tested showed evidence of reduced kidney function or kidney damage.

Most programs relied on eGFR (calculated from serum creatinine) and/or the urine albumin-creatinine ratio (ACR). Some used dipstick urinalysis as a simpler, though less specific, tool. A number of studies employed single-time measurements only, whereas others attempted repeat testing to confirm chronicity of changes in kidney function.

While many followed the standard CKD definition (eGFR <60 mL/min/1.73 m² and/or albuminuria), some programs used different thresholds for albuminuria or serum creatinine. Additionally, a variety of formulas—CKD-EPI, MDRD, Cockcroft–Gault—were used to calculate eGFR. This inconsistency contributed to the wide range of CKD prevalence identified (from as low as 2.9% to as high as 56% in at-risk groups).

Despite most guidelines recommending confirmatory tests at intervals of at least one month, many screening programs reported CKD diagnosis based on single measurements of kidney markers. This practice risks misclassifying participants—either falsely diagnosing CKD or missing cases that would have met criteria if persistently abnormal. Of the few studies that did repeat testing, confirmed CKD prevalence ranged from about 4.4% to 17.1%.

Strength of Primary Healthcare Detection

Several studies revealed high patient satisfaction and willingness to pay for accessible testing. Screening programs were also linked to increased physician visits and referrals. These process metrics suggest that targeted screening may enhance patient engagement with their health and foster better care coordination.

Whether carried out in community pharmacies, general practitioner clinics, or other primary care environments, risk factor–based CKD screening is practical. Programs tended to be well-received by patients, especially when results were explained clearly and follow-up pathways were in place.

Point of Care Testing

A recent review highlights several ways in which Australian GPs and medical clinics can enhance CKD detection among at-risk populations, emphasising that consistency in diagnostic criteria, greater use of validated risk tools, timely confirmatory testing, and point-of-care diagnostics may all contribute to improved outcomes. Uniformity in albuminuria and proteinuria thresholds, as well as following established guidelines for repeated kidney function measurements, helps ensure more accurate diagnoses and avoids both under- and over-diagnosis of CKD. Incorporating established risk calculators, such as QKidney or the Kidney Health Australia (KHA) risk test, could help practices systematically identify individuals most likely to develop CKD, rather than relying solely on self-reported risk factors or patient history. Adherence to confirmatory testing at recommended intervals of around three months ensures abnormal findings are repeated before a CKD diagnosis is confirmed, which is essential given that single measurements of kidney markers can be affected by short-term changes in fluid balance or medication use.

Point-of-care testing (POCT) offers an opportunity for quick turnaround of tests in primary care clinics or pharmacies, which can expedite referral and further management, although ongoing research is needed to confirm that POCT results consistently match laboratory standards. Additional Australian-focused randomised controlled trials that compare targeted screening with usual care would help clarify local cost-effectiveness and the impact on specific community groups, particularly Aboriginal and Torres Strait Islander peoples who often bear a greater burden of CKD. While the review concludes that targeted screening effectively identifies significant proportions of people with undiagnosed CKD, early detection will only have a meaningful impact if reinforced by standardised guidelines, reliable follow-up protocols, and better evidence that speaks to the Australian health care context.

Korsa, Ayana et al. (2025) Risk Factor-Based Screening for Early Detection of Chronic Kidney Disease in Primary Care Settings: A Systematic Review, Kidney Medicine, Volume 7, Issue 4, 100979. https://www.kidneymedicinejournal.org/article/S2590-0595(25)00015-9/fulltext