Why is chronic kidney disease now on my medical problem list?

At our primary care practice, a woman in her mid-50s with diabetes and high blood pressure recently shared an observation during an office visit: “I noticed my chart now says that I have ‘stage 3a chronic kidney disease.’ I don’t recall us talking about that before.”

Many doctor’s offices, including ours, share full access to electronic medical records with our patients.

Our patient had no reason to be alarmed over her new diagnosis: “It’s there so I remember to monitor your kidney function and am sure to provide you with the best care to minimize kidney damage. Mostly, that means keeping your sugar and blood pressure under good control,” Dr. Millstein told her.

She is among many patients now asking why, with no apparent change in their blood test results, chronic kidney disease (CKD) is suddenly appearing as a problem on their medical charts. The answer is we now have more evidence-based protocols to treat early stage kidney disease to keep it from worsening.

Identifying patients who have CKD, and placing the diagnosis on the chart’s problem list, is an important way to encourage your doctor to monitor and address this regularly.

CKD is a common condition affecting about one in seven U.S. adults in which the kidneys filter the blood and make urine at a lower speed than normal. The majority of people who have CKD are not aware of it.

The good news is that it’s simple to find out about your kidney health through two tests that your primary care provider can order. The first is a blood test called a metabolic panel, which can report on the estimated glomerular filtration rate (eGFR), or how fast the kidneys can filter the blood. And the second test, called the urine albumin to creatinine ratio, reports on the level of protein in the urine.

We have known for some time that controlling blood pressure and blood sugar helps prevent kidney disease. In recent years though, medicine has grown the list of ways to help patients slow the worsening of CKD to prevent the need for dialysis or a kidney transplant.

Blood pressure medicines like angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs), as well as a newer class of diabetes and kidney disease medicines called SGLT-2 inhibitors are highly effective at preventing decline in kidney function. In addition, we use cholesterol-lowering STATIN drugs to lower the risk of death.

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Beyond medications, lifestyle actions are very impactful, such as eating a diet higher in plant-based, unprocessed foods and exercising regularly. Avoiding medicines that can damage the kidneys — like nonsteroidal anti-inflammatories (NSAIDs), such as ibuprofen and naproxen — is also important.

In addition to high quality care, doctors have another reason for more consistently documenting CKD. Payment for primary care services is shifting away from paying for each medical visit to rewarding offices that help patients achieve care quality goals and improve their health. When done with honesty and integrity, listing all of the medical conditions, including CKD, provides payment that supports the time and attention primary care providers should take to care for patients with the most medical needs.

Make sure to take a look at your chart’s medical problem list. If you notice any new conditions named, we encourage you to ask about them.

As primary care physicians, we are looking to partner with patients to identify risk factors for chronic diseases like CKD, treat high blood pressure and diabetes, look for signs of early CKD, and offer the best care to help patients with CKD live healthy, full lives.

Renée Betancourt is a family physician and vice chair for education at the University of Pennsylvania Perelman School of Medicine Department of Family Medicine and Community Health. Jeffrey Millstein is an internist and regional medical director for Penn Primary Care.