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 significant portion of their 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 dramatically.

What Chronic Kidney Disease Really Means

Chronic kidney disease isn’t just about high creatinine levels or a single blood test. It’s defined by lasting damage to the kidneys that lasts three months or longer. This damage shows up in two ways: either your kidneys aren’t filtering blood well (measured by eGFR), or they’re leaking protein into your urine (measured by uACR). You need both signs to confirm CKD, not just one.

The old way of checking kidney health? Just measuring creatinine. That’s like checking your car’s oil light without looking at the engine. Many people with early kidney damage had normal creatinine because their muscles were still strong, or they were older, or they were Black-factors that artificially raise creatinine levels and hide real damage. That’s why so many cases slipped through the cracks.

The Two Tests That Save Kidneys

If you’re at risk, you need two tests, every time:

• eGFR (estimated glomerular filtration rate): This tells you how well your kidneys filter waste. It’s calculated from your blood creatinine, age, sex, and race. The current standard uses the CKD-EPI equation, which is more accurate than older formulas.
• uACR (urine albumin-to-creatinine ratio): This checks for protein in your urine. A value of 30 mg/g or higher means your kidneys are leaking-early damage. The best sample? First-morning urine. It’s the most reliable.

Here’s the key: if your eGFR is above 60 but your uACR is 30 or higher, you still have CKD-Stage 1 or 2. Many doctors miss this. They see ‘normal’ creatinine and think everything’s fine. It’s not. Protein in the urine is often the first warning sign.

For some people-especially those over 65, with low muscle mass, or without clear risk factors-creatinine can be misleading. In those cases, cystatin C is a better marker. It’s not used as often, but it’s more accurate when creatinine doesn’t tell the full story.

Stages of CKD: Why Early Matters

CKD is split into five stages based on eGFR and whether damage is present:

• Stage 1: eGFR ≥90, but uACR ≥30 → kidneys look normal but are leaking protein.
• Stage 2: eGFR 60-89, uACR ≥30 → mild damage, still early.
• Stage 3a: eGFR 45-59 → mild to moderate loss.
• Stage 3b: eGFR 30-44 → moderate to severe loss.
• Stage 4: eGFR 15-29 → severe loss.
• Stage 5: eGFR <15 → kidney failure.

Stages 1 and 2 are where you have the most power. If you act now, you can prevent your kidneys from slipping into Stage 3 or worse. Once you hit Stage 4, options shrink. By Stage 5, you’re looking at dialysis or a transplant.

Who Should Be Screened-and How Often

Not everyone needs yearly testing. But if you have any of these, you’re at high risk and need regular checks:

• Diabetes (type 1 or 2)
• High blood pressure
• Heart disease
• Family history of kidney failure
• Being Black, Native American, or Hispanic (higher risk groups)
• Obesity
• Chronic use of NSAIDs like ibuprofen or naproxen

The American Diabetes Association says: test at diagnosis for type 2, and five years after diagnosis for type 1-then every year after. For high blood pressure? Test at every visit, with full eGFR and uACR at least once a year.

And don’t assume you’re safe just because you feel fine. CKD is silent. That’s why screening is so critical. A 2022 study found that over half of primary care doctors still don’t order both tests together. That’s a dangerous gap.

How to Stop It From Getting Worse

If you’re diagnosed with early CKD, you’re not helpless. Here’s what works:

• Control blood pressure. Shoot for under 130/80. Studies show this cuts progression risk by 27% compared to letting it stay at 140/90.
• Use SGLT2 inhibitors. These diabetes drugs (like empagliflozin or dapagliflozin) are now first-line for CKD-even if you don’t have diabetes. The CREDENCE trial showed they reduce progression to kidney failure by 32% in people with albuminuria.
• Reduce sodium. Less than 2,300 mg a day. Salt makes blood pressure worse and strains the kidneys.
• Avoid NSAIDs. Ibuprofen, naproxen, and even high-dose aspirin can damage kidneys over time. Use acetaminophen instead for pain.
• Quit smoking. Smoking speeds up kidney damage and increases heart disease risk, which is already high in CKD patients.
• Work with a dietitian. Protein intake needs to be balanced-not too high, not too low. Too much protein can stress damaged kidneys.

One 2022 meta-analysis found that people who got full support-medication, diet, education-slowed their kidney decline from 3.5 mL/min/year to just 1.2 mL/min/year. That’s the difference between reaching kidney failure in 10 years versus 30.

What’s Changing Right Now

The field is moving fast. In 2023, the FDA cleared the first AI tool-NephroSight-that analyzes 32 data points (blood pressure, lab values, meds, age, etc.) to predict who’s at risk for CKD before their eGFR drops. It’s already being tested in VA hospitals.

Also, the debate around race adjustment in eGFR calculations is heating up. For decades, labs added a multiplier for Black patients, assuming they had more muscle mass. But new data shows that removes 12% of early CKD cases from detection in Black populations. Many labs are now removing the adjustment. This could mean more people get diagnosed earlier.

The Biden administration’s 2023 kidney health order is funding $150 million to push dual-testing in federally funded clinics by 2026. That could uncover over a million undiagnosed cases.

The Big Miss: Overdiagnosis in the Elderly

Not every low eGFR means disease. In people over 85, eGFR naturally drops with age. If they have no protein in their urine and no other risk factors, they may not need treatment. Forcing medication on them can cause more harm than good. That’s why experts like Dr. Ronald Perrone warn against blanket screening in the very old without checking for albuminuria.

It’s not about testing everyone. It’s about testing the right people-and interpreting results correctly.

Why This Matters for You

CKD isn’t just about kidneys. It’s a major risk factor for heart attacks, strokes, and early death. In fact, most people with CKD die from heart disease before they ever reach dialysis.

And the cost? The U.S. spends $120 billion a year on kidney disease. Early detection could cut that by $27 billion annually. But money isn’t the only reason. It’s about quality of life. People who catch CKD early live longer, feel better, and avoid dialysis.

One Reddit user wrote: ‘My doctor only checked creatinine for 10 years. When they finally did uACR, I was already stage 3.’ Another said: ‘Caught at stage 1. Five years later? Still stage 1. Medication and diet saved me.’

That’s the difference.

What to Do Next

If you’re at risk:

1. Ask your doctor for both eGFR and uACR-don’t accept just one.
2. If you have diabetes or high blood pressure, insist on annual testing-even if you feel fine.
3. Ask if your lab still uses race adjustment in eGFR. If yes, ask if they can recalculate without it.
4. Get a copy of your results. Know your numbers. Don’t let them hide behind ‘normal’.
5. If you’re diagnosed with early CKD, ask about SGLT2 inhibitors and a kidney-friendly diet.

Early detection isn’t glamorous. It’s just two simple tests. But for millions of people, it’s the only thing standing between them and a lifetime on dialysis.