Chronic Kidney Disease: How Early Detection Stops Progression

Most people with chronic kidney disease (CKD) don’t know they have it-until it’s too late. By the time symptoms like fatigue, swelling, or trouble sleeping show up, the kidneys have already lost a lot of function. But here’s the truth: chronic kidney disease can be caught early, and when it is, progression can often be stopped-or at least slowed down significantly. This isn’t theory. It’s what happens in clinics where doctors use the right tests at the right time.

What Chronic Kidney Disease Really Means

Chronic kidney disease isn’t just about high creatinine or a single blood test. It’s a long-term condition where the kidneys don’t work the way they should for at least three months. The damage might be from diabetes, high blood pressure, or something else entirely. But the key is this: it’s not sudden. It creeps in. And that’s why so many people miss it.

The official definition from KDIGO and KDOQI guidelines is clear: CKD means either a reduced estimated glomerular filtration rate (eGFR) below 60 mL/min/1.73 m², or signs of kidney damage-like protein in the urine-lasting three months or longer. You need both pieces of evidence to confirm it. One test alone isn’t enough.

The Two Tests That Change Everything

If your doctor only checks your serum creatinine, you’re not getting the full picture. Creatinine levels can look normal even when your kidneys are starting to fail-especially if you’re older, have low muscle mass, or are African American. That’s why relying on creatinine alone misses up to 40% of early cases.

The real game-changer is combining two tests:

• eGFR: This estimates how well your kidneys filter waste. It’s calculated using your creatinine level, age, sex, and race. The CKD-EPI equation is the current standard, but even this has limits.
• uACR: This measures albumin (a type of protein) in your urine. A value of 30 mg/g or higher means your kidneys are leaking protein-a clear red flag. The best sample is the first morning urine.

You need both. If your eGFR is 65 (which looks fine) but your uACR is 85, you have stage 2 CKD. That’s early. That’s treatable.

Staging: Knowing Where You Stand

CKD is broken into five stages. But stages 1 and 2 are where the fight begins:

• Stage 1: eGFR ≥90, but uACR ≥30. Kidneys are still working well, but damage is present.
• Stage 2: eGFR 60-89, uACR ≥30. Slight decline, but still early.
• Stage 3a: eGFR 45-59. Mild to moderate loss.
• Stage 3b: eGFR 30-44. Moderate to severe.
• Stage 4: eGFR 15-29. Severe damage.
• Stage 5: eGFR under 15. Kidney failure. Dialysis or transplant needed.

Most people don’t realize that stage 1 and 2 are still kidney disease-even if they feel fine. That’s the danger. And that’s why testing matters.

Who Should Be Tested-and How Often

Not everyone needs annual screening. But if you fall into one of these groups, you’re at risk:

• People with type 1 or type 2 diabetes (screen annually after diagnosis)
• People with high blood pressure (screen at every visit, full test yearly)
• Those with a family history of kidney failure
• African Americans, Native Americans, and Hispanic individuals (3.7x higher risk for African Americans)
• People on long-term NSAIDs, certain antibiotics, or other kidney-toxic drugs
• Anyone over 60

The American Diabetes Association, the National Kidney Foundation, and the CDC all agree: if you’re in one of these groups, get both tests every year. Don’t wait for symptoms. They won’t come until it’s advanced.

What Happens When You Catch It Early

This isn’t just about avoiding dialysis. It’s about living longer, healthier, and with fewer heart problems-because CKD isn’t just a kidney issue. It’s a cardiovascular risk factor.

Studies show that when CKD is caught in stages 1 or 2 and managed properly:

• Blood pressure control below 130/80 mmHg reduces progression risk by 27% (SPRINT trial data).
• SGLT2 inhibitors (like dapagliflozin or empagliflozin) cut the risk of kidney failure by 32% in people with albuminuria (CREDENCE trial).
• Comprehensive care-including diet, medication, and education-slows eGFR decline from 3.5 mL/year to just 1.2 mL/year.

One patient, u/KidneyWarrior2022, shared on Reddit: “My doctor only checked creatinine for 10 years. By the time they did uACR, I was stage 3.” That’s the norm. But another user said: “Caught at stage 1 during a routine physical. Five years later? Still stage 1. Medication and diet kept it stable.” That’s the outcome early detection makes possible.

Why So Many Cases Are Still Missed

Despite the guidelines, most primary care providers don’t order both tests. A 2022 study found only 52.7% of doctors consistently order eGFR and uACR together. In rural clinics, that number drops to under 32%. Why?

• Electronic health records don’t prompt for both tests.
• Doctors think “normal creatinine” means normal kidneys.
• Patients don’t ask for the test because they don’t know it exists.

There’s also a problem with overdiagnosis in older adults. A 2023 editorial in Kidney News warned that for people over 85 with an eGFR of 45-59 but no protein in their urine, aggressive treatment might do more harm than good. Context matters. Not every low eGFR is disease.

What’s Changing Right Now

The tide is turning. In 2023, the FDA cleared the first AI tool-NephroSight by Renalytix-that analyzes 32 clinical factors to predict CKD risk before eGFR drops. It’s already being used in some VA hospitals.

The Biden administration’s 2023 Executive Order on Kidney Health is funding $150 million to roll out dual-testing in Federally Qualified Health Centers by 2026. That’s 1.2 million more people who could be diagnosed early.

And soon, point-of-care uACR tests-devices that give results in minutes instead of days-could be available in doctor’s offices. The Kidney Health Initiative predicts this could boost screening rates by 40%.

What You Can Do Today

If you’re at risk, here’s your action plan:

1. Ask your doctor for an eGFR and uACR test-don’t accept just creatinine.
2. If you have diabetes or high blood pressure, make sure you’re getting both tests every year.
3. Request your results. Know your numbers. Don’t let them just say “everything’s fine.”
4. If your uACR is over 30, ask about SGLT2 inhibitors or ACE inhibitors-they’re proven to protect your kidneys.
5. Reduce salt, avoid NSAIDs like ibuprofen long-term, and control your blood sugar and blood pressure.

And if your doctor says, “Your creatinine is normal, so you’re fine”? Say: “I’d like both eGFR and uACR. That’s what the guidelines recommend.”

Why This Matters Beyond the Kidneys

CKD doesn’t just affect your kidneys. It increases your risk of heart attack, stroke, and early death. The annual cost of kidney disease in the U.S. is $120 billion-mostly from treating late-stage disease. But studies show early detection saves $1,850 per patient per year by preventing complications.

That’s not just money. That’s time. That’s mobility. That’s avoiding dialysis. That’s staying alive longer, healthier, and on your own terms.

The science is clear. The tools exist. The guidelines are in place. What’s missing is action-from doctors, from patients, from the system.

You can’t fix what you don’t know. But if you know, you can stop it. Before it’s too late.