Adults at elevated risk for kidney damage should be screened earlier and more often than the general population because chronic kidney disease is commonly silent until advanced. Leading nephrology authorities, including Andrew S. Levey at Tufts Medical Center, emphasize measuring both estimated glomerular filtration rate and urine albumin to detect disease that would be missed by symptoms alone. Public health bodies differ on universal screening: the U.S. Preventive Services Task Force concluded current evidence is insufficient to recommend routine screening of all asymptomatic adults, while specialty groups advocate targeted testing for high-risk people.
Who should be screened?
High-risk groups include people with diabetes, hypertension, cardiovascular disease, a family history of kidney failure, age 60 and older, and long-term use of nephrotoxic medications. Diabetes and hypertension are the two most common causes of chronic kidney disease; these upstream conditions damage renal filtration over years, causing progressive decline in kidney function and increased cardiovascular risk. Social and territorial factors matter: Indigenous, Black, Hispanic, and other underserved communities suffer higher rates of diabetes and hypertension and face barriers to timely diagnosis and follow-up care, which increases downstream disparities in outcomes.
How to screen and why it matters
Screening is straightforward: a blood test for eGFR and a urine test for albumin-to-creatinine ratio are the standard, validated measures recommended by international guideline developers such as Kidney Disease: Improving Global Outcomes and clinical experts like Andrew S. Levey at Tufts Medical Center. Early detection enables interventions that slow progression—tight blood pressure and glycemic control, use of renin-angiotensin system blockers or SGLT2 inhibitors in appropriate patients, and attention to lifestyle and medication review. Without detection, CKD can progress to kidney failure requiring dialysis or transplantation and contributes to higher rates of heart attack, stroke, and mortality.
Timing and frequency should reflect risk. For people with diabetes or persistent hypertension, annual testing is common practice under guidance from specialty societies including the American Diabetes Association. For older adults or those with multiple risk factors, clinicians may test at regular intervals tailored to baseline results and comorbidities. Where evidence is incomplete for universal screening, prioritizing high-risk populations and addressing access gaps offers the best balance of benefit and equity.