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Am Fam Physician. 2007;75(2):268

Chronic Kidney Disease Screening Recommended in Patients with CVD

Chronic kidney disease is common in patients with cardiovascular disease (CVD); moreover, it also is a risk factor for developing CVD. Proper management of CVD is much more complex in patients with chronic kidney disease. Therefore, the American Heart Association (AHA) published recommendations for the detection of chronic kidney disease in patients with CVD in the September 5, 2006, issue of Circulation.

The AHA recommends that health care professionals evaluate their patients for chronic kidney disease as part of routine preventive care and treatment. A formal measurement of glomerular filtration rate (GFR) with iothalmate or similar markers and the measurement of cystatin C levels are not consistently accurate. However, several validated estimation equations for GFR use clinical data that are easily obtainable, and these methods allow health care professionals to accurately diagnose chronic kidney disease. A formula developed from the Modification of Diet in Renal Disease study has proved to be the best method for estimating GFR in adults in an office setting.

Calculators to determine the GFR are available online from the National Kidney Foundation (http://www.kidney.org) and the National Kidney Disease Education Program of the National Institutes of Health (http://www.nkdep.nih.gov). However, the formula's accuracy is reduced in patients with normal or only slightly diminished renal function.

The AHA recommends that screening for microalbuminuria, in combination with an estimation of GFR, be performed for all adult patients with CVD, congestive heart failure, or coronary artery disease, as well as patients who have risk factors for CVD such as hypertension or diabetes.

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