CV risk: if you aren't testing ACR, you aren't seeing the full picture

Abstract

Chronic kidney disease (CKD) remains a hidden epidemic, under-recognized and under-diagnosed, despite widespread recognition of the benefits of systematic screening of at-risk individuals and early diagnosis. CKD is an important driver of cardiovascular risk, even in the early stages before a diagnosis has been made. An elevated albumin-to-creatinine ratio is an independent cardiovascular (CV) risk factor, and importantly, it is modifiable. Inclusion of urinary albumin-to-creatine ratio testing enables detection of CV risk and CKD before estimated glomerular filtration rate declines and allows for implementation of guideline-directed therapy at the earliest point where it is clinically indicated. Inclusion of urinary albumin-to-creatinine ratio as part of routine testing of at-risk individuals in standard practice would enable early intervention with guideline-directed medical therapies to optimize outcomes and alter disease progression. Individuals at risk of CKD include, but are not limited to, those with type 2 diabetes, CV disease, or hypertension, all conditions that can cause early, often silent, kidney damage. In these populations, measuring the urine albumin-to-creatinine ratio enables early detection of CKD and CV risk, allowing timely initiation of guideline-directed therapies to prevent disease progression. Although this podcast presents expert opinion, rather than original research, all recommendations are guideline-driven and evidence-based, rather than opinion-based.