Advanced kidney disease is one of the quiet drivers of healthcare spending in the United States. Unfortunately, these costs are typically seen only after people are already very sick (for example, when hospitals admit patients with fluid overload, when dialysis has to begin urgently, or when cardiovascular complications escalate). At that point, the medical expense curve is difficult to bend, not because treatment is impossible, but because the disease progressed unnoticed.
According to the U.S. Centers for Disease Control and Prevention (CDC), an estimated one in seven Americans (around 35.5 million people) have chronic kidney disease (CKD) and roughly 9 in 10 are unaware of it. Early CKD typically has no symptoms, meaning patients rarely present with a complaint that would prompt testing. Thus, the disease remains invisible and undiagnosed until it becomes harder (and more expensive) to treat.
Why CKD goes undiagnosed
For many people, kidney disease can be found early with inexpensive testing. However, detectable signals often go unaddressed. Though we have simple diagnostics that can reveal early kidney damage, those tests are not used consistently or are not interpreted properly over time.
For example, in routine care, many people have serum creatinine checked but are not screened for protein in the urine, which is often the earliest sign that the kidneys are under strain. However, even those who are tested for proteinuria are not always retested if an abnormal value appears to determine if it’s a sign of persistent disease. Additionally, people at highest risk (including those with diabetes, high blood pressure, cardiovascular disease, or a history of acute kidney injury) are not always tested at acceptable intervals.
What routine screening actually looks like
When kidney health is evaluated in people at higher risk, two tests are central:
- Estimated glomerular filtration rate (eGFT), a blood test that estimates kidney filtration
- Albumin to creatinine ratio (uACR), a urine test that looks for excess albumin, a type of protein
This combination is the standard approach outlined in the KDIGO Clinical Practice Guideline for the Evaluation and Management of CKD. Together they identify kidney problems long before symptoms drive someone to seek help.
Who should be screened? And how often?
As there is no population-wide recommendation for adults, screening should be risk-based.
Under the American Diabetes Association’s Standards of Care, people with diabetes are expected to have both tests at least once a year. The same annual cadence is reasonable for people with hypertension, cardiovascular disease, or prior kidney injury; who are over age 60; or who have a family history of CKD.
Why earlier detection matters
The sooner CKD is detected, the sooner providers can initiate or modify treatments (e.g., blood-pressure control, addressing high blood sugar, and dietary adjustments) that have been shown to slow the decline in kidney function, lower risk of hospitalization, and reduce the likelihood of developing heart disease. From a value-based care standpoint, this means fewer emergency department visits, fewer unplanned dialysis starts that result in prolonged, avoidable, and costly hospitalizations, and better overall resource utilization.
The Healthmap Solutions perspective
Through our Kidney Population Health Management program, we work with health plans and providers to address these types of opportunities. By encouraging risk-based screening, coordinating timely next steps, and encouraging treatments that slow kidney disease progression, Healthmap helps shift kidney disease identification upstream, before it becomes both clinically and financially more difficult to manage.
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