Targeted screening and treatment of chronic kidney disease: Lessons learned from the Kidney Early Evaluation Program

The National Kidney Foundation's (NKF) Kidney Early Evaluation Program (KEEP) is a public service program that addresses the gaps in chronic kidney disease (CKD) awareness and care. This free, voluntary, community-based program is designed to screen people at risk of CKD and promote CKD awareness among primary healthcare providers and the public. The primary objective of KEEP is to identify individuals at risk of CKD at a time when appropriate intervention has the potential to markedly slow and potentially prevent progression to kidney failure, as well as to reduce cardiovascular events. The specific opportunities for disease management are improvements in early recognition and treatment to prevent cardiovascular disease (CVD), slow kidney disease progression, treat co-morbidities and complications, and enhance preparation for dialysis and kidney transplantation. Disease management also poses opportunities to improve CKD care by aligning healthcare providers to prevent fragmentation. KEEP involves a health questionnaire and a diagnostic panel of blood and urine tests to establish the diagnosis of CKD and detect CKD complications and co-morbid conditions. Three key tests are blood pressure, spot urine albumin-to-creatinine ratio, and estimated glomerular filtration rate derived from serum creatinine. To date, 75 000 participants aged ≥18 years with a history of diabetes mellitus (25%) or hypertension (52%) or a family history of these diseases and/or kidney disease (24%) have attended KEEP screenings across the US in 49 of 50 states. The 2006 KEEP annual data report notes the prevalence of the five CKD stages to be 3% (stage 1), 5% (stage 2), 20% (stage 3), and 1% (stages 4 and 5), which confirms the ability of this targeted screening program to detect CKD early. Only 2% of KEEP participants are aware of CKD, and 29% meet diagnostic criteria. Low awareness of CKD exists in a high-risk US population. Mass or untargeted screening is anticipated to reveal CKD rates similar to that observed in the National Health and Nutrition Examination Survey (approximately 13%). Targeted screening allows for efficient and cost-effective disease management to improve patient outcomes.