Kidney Week

Abstract: FR-PO1127

Hidden Burden of Early CKD: A Case for Targeted Screening

Session Information

• CKD: Screening, Diagnosis, Serum and Urine Biomarkers, and Scoring Indices
  November 07, 2025 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2301 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

• Selvam, Sri Abirami, Oregon Health & Science University, Portland, Oregon, United States

Sri Abirami Selvam, MD

• Viswanathan, Ajay Prasadh, Microsoft Corporation, Redmond, Washington, United States

Ajay Prasadh Viswanathan

• Shah, Hetvi, Geisinger Health, Danville, Pennsylvania, United States

Hetvi Shah, MD

• Rope, Rob, Oregon Health & Science University, Portland, Oregon, United States

Rob Rope, MD

Background

Early-stage chronic kidney disease (CKD), particularly stages 1 and 2, is often underdiagnosed due to preserved eGFR. Albuminuria-based screening aids early detection, but current screening guidelines are inconsistent. Identifying high-risk populations may inform targeted screening efforts

Methods

Cross-sectional analysis was performed using NHANES 2017-2020 pre-pandemic data (n=15560). Adults aged ≥18 years with available serum creatinine and complete covariate data were included. Exclusions were prior CKD diagnosis, pregnancy and missing data. Final sample had 8,762 participants. CKD stages were defined per KDIGO guidelines. Variables included age, sex, race/ethnicity, income, alcohol use, smoking, BMI, diabetes (DM) status, and hypertension (HTN) category. Analyses were conducted in R software. Chi-square tests assessed associations, multivariable logistic regression identified predictors of CKD stages 1–2, adjusting for all listed covariates

Results

CKD stages 1–2 were present in 106 individuals (1.2%). In this group, 36.8% were Hispanic, 44.3% had DM, 34% had stage 2 HTN, and 2.8% had underweight BMI (<18.5 kg/m²). Significant predictors of CKD 1–2 included Hispanic ethnicity (OR 1.35, 95% CI: 1.07–1.72; p =0.015), DM (OR 2.15, 95% CI: 1.47–3.13; p <0.001), and stage 2 HTN (OR 2.84, 95% CI: 1.35–5.94; p <0.001). Underweight BMI was also associated (OR 2.57, 95% CI: 1.22–5.41; p=0.025), though based on only 3 cases. No significant associations were found with rest of the variables

Conclusion

Unrecognized CKD stages 1–2 affect a small but important proportion of U.S. adults and is associated with Hispanic ethnicity, DM, and stage 2 HTN. The association with underweight BMI was based on only three cases and should be interpreted cautiously. It may reflect frailty, low muscle mass affecting eGFR, or other comorbidities, and warrants further study. Although the number of CKD 1–2 cases was modest, clustering of key risk factors in this group supports the relevance of targeted screening

While nephrology societies advocate for albuminuria testing in patients with hypertension to detect early kidney damage, primary care guidelines have not consistently endorsed it. As the USPSTF re-evaluates its CKD screening recommendations, our findings highlight the importance of including albuminuria testing, even in those with normal eGFR, to detect early kidney damage in high-risk groups

Digital Object Identifier (DOI)

• doi: 10.1681/ASN.2025z8r5g05j