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The asymptomatic nature of chronic kidney disease (CKD) makes explicit screening strategies for individuals at risk as the only means of early detection. This will allow more time for interventions to alter the natural history of the disease by delaying or preventing kidney disease progression and its complications. Patient awareness of CKD remains low. Utilization of CKD tests for patients at risk and interpretation of those tests to detect CKD by primary care physicians remain suboptimal. There is insufficient evidence to support general population screening. Diabetes, hypertension, and age 60 or greater are the primary CKD screening target conditions, based on assessments representative of the general populations in America and Norway. Although cardiovascular disease, family history of CKD, and ethnic and racial minorities are important predictors of CKD risk, they do not contribute significantly beyond the scope of diabetes, hypertension, and older age. Challenges remain to define the roles in the community of the primary physician and nephrologist to implement intensive blood pressure control, use of renin-angiotensin system blockers for proteinuric patients and nephrology referral as indicated. The electronic medical record holds the most promise in CKD screening through improvements in the flow of information and application of clinical decision support.

CKD is a complex comorbid condition with multiple manifestations. It is closely linked with cardiovascular disease and has a very high mortality rate. Currently, it consumes 28% of Medicare expenditures. Complications of CKD include hypertension, diabetes, dyslipidemia, cardiovascular disease, anemia, and bone and mineral disorders. It is underrecognized and underdiagnosed in primary care offices. There is strong evidence that controlling blood pressure, blood glucose, and use of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in albuminuric patients, as well as referral to the nephrologist when glomerular filtration rate is30 mL/min/1.73 m(2), is associated with lower mortality, better access to kidney transplantation, improved management of comorbidities, and less frequent use of catheters for dialysis and to lower mortality.