Albuminuria at the Center: The CKM Framework Changes Early CKD Identification

In this National Kidney Foundation (NKF) panel, moderator Andrew Bzowyckyj, PharmD, BCPS, CDCES, senior scientific director and learning consultant at NKF, talks with 3 clinicians from different practice settings:

• Michelle Estrella, MD, a nephrologist, professor of medicine at the University of California, San Francisco, and renal section chief at the San Francisco VA Medical Center;
• Venita Schandorf, DNP, ARNP, a board-certified family nurse practitioner at MultiCare Covington Family Practice in Washington State’s Puget Sound area;
• and Mark Loafman, MD, MPH, a family medicine physician and systems chair for family and community medicine at Cook County Health in Chicago, Illinois.

In the second segment the panelists discuss how the cardio-kidney-metabolic (CKM) framework, which has gained attention alongside the new estimated glomerular filtration rate (eGFR) equations, has made urine albumin-to-creatinine ratio (UACR) a shared marker across cardiology, endocrinology, nephrology, and primary care. They also offer guidance for clinicians who are less familiar with its role in identifying kidney disease early.

Loafman cautioned that albuminuria screening in patients with diabetes has often become a quality-metric exercise, with clinicians credited for ordering the test while patients’ albuminuria and kidney disease continue to progress. He argued that the value lies in acting on a positive result, which can help primary care clinicians identify which patients are most at risk and set the urgency of treatment. Estrella said the framework puts the kidney at the center of care. Busy primary care clinicians previously tended to deprioritize kidney disease while managing diabetes and hypertension, and nephrologists are now more focused on reducing cardiovascular risk in addition to preventing progression to end-stage kidney disease. Schandorf noted that albuminuria testing should not be limited to patients with diabetes but should extend to those with elevated BMI, prehypertension, or hypertension. She added that results can guide decisions on starting sodium-glucose cotransporter 2 (SGLT2)inhibitors, managing patients in the clinic vs referring them to nephrology, and talking with patients about their prognosis.

Loafman pointed out that approximately half of patients with chronic kidney disease (CKD) and cardiometabolic disease die of cardiovascular complications before reaching dialysis. He said that worsening kidney function signals broader vascular damage and should be treated with the same urgency as early heart failure or peripheral artery disease. Estrella said the availability of medications that address several conditions at once helps clinicians persuade patients to start therapy. Loafman compared this to the concept of guideline-directed medical therapy (GDMT) from cardiology, in which patients receive the full package of treatments to gain the benefit. Bzowyckyj closed by noting that most specialties now recognize albuminuria as a measurable, trackable, and treatable target.

Learn more about the National Kidney Foundation at kidney.org and at this link.