An estimated 37 million US adults, or 14% of the adult population, have chronic kidney disease (CKD), and about 87% of adults with CKD do not know they have it.¹

On September 17, 2026, the US Department of Health and Human Services announced 8 new members of the US Preventive Services Task Force (USPSTF).² The USPSTF previously published its final research plan for CKD screening in July 2023 but has not yet released a draft recommendation.³

In a statement released September 17, the American Kidney Fund noted that the new USPSTF roster does not include a nephrologist and said preventive care recommendations should reflect current evidence on kidney disease detection and treatment.⁴

Testing gaps persist even among patients with established risk factors. In a study of 513,165 adults with type 2 diabetes receiving primary care across 24 US health care organizations, the 1-year median testing rate was 89.5% for estimated glomerular filtration rate (eGFR) but just 52.9% for urinary albumin-to-creatinine ratio (uACR).⁵ Albuminuria can signal kidney damage even when eGFR remains relatively preserved, making uACR an important part of kidney assessment.

CKD is defined by abnormalities of kidney structure or function that persist for more than 3 months, helping distinguish chronic disease from a single abnormal test result.³ Earlier identification can create opportunities to initiate treatment and address cardiovascular and metabolic risk before more advanced kidney disease develops.

HCPLive spoke with Pranav Garimella, MBBS, MPH, chief medical officer of the American Kidney Fund, about the current state of CKD detection and the evidence he believes should inform the USPSTF’s ongoing review of kidney disease screening.

Q&A: Improving chronic kidney disease detection and screening

HCPLive: Where does kidney disease stand in the US today, and what does that mean for people at risk?

Pranav Garimella, MBBS, MPH: Kidney disease is both common and significantly underdiagnosed. About 14% of US adults, roughly 37 million people, are living with chronic kidney disease, and nearly 9 in 10 do not know they have it. Kidney disease can progress for years without noticeable symptoms, and by the time someone feels sick, significant damage may already have occurred.

We also increasingly understand kidney disease as part of a broader health picture. Cardiovascular-kidney-metabolic, or CKM, syndrome recognizes the interconnected nature of heart disease, kidney disease, diabetes and obesity. Nearly 90% of US adults meet criteria for at least early-stage CKM syndrome. Identifying kidney disease earlier is therefore an opportunity to protect kidney function and to address a patient's broader cardiovascular and metabolic risk.

For people at risk, that means we cannot wait for symptoms. Earlier identification creates an opportunity for treatment that can slow CKD progression and reduce the risk of heart attack, stroke and kidney failure.

HCPLive: From a nephrology perspective, what should the task force keep in mind about how kidney disease is detected and who is at greatest risk?

Pranav Garimella, MBBS, MPH: Kidney health should be assessed with two tests in everyone: an estimated glomerular filtration rate, or eGFR, which measures how well the kidneys filter the blood, and a urine albumin-to-creatinine ratio, or uACR, which detects albumin in the urine as a sign of kidney damage.

CKD can be diagnosed from albuminuria even when eGFR is normal, so the urine test can detect early disease the blood test misses. Yet the urine test is the one most often skipped. A 2021 study in Diabetes Care of more than 500,000 primary care patients with type 2 diabetes found that about 9 in 10 had an eGFR in a year, but only about half had a uACR. That means disease is being missed at the stage when patients have the greatest opportunity to protect their kidney health.

An abnormal result should be repeated to confirm CKD rather than diagnosed from a single test, because CKD requires abnormalities lasting more than three months. That confirmation step also guards against overdiagnosis and labeling, and the Task Force's plan appropriately includes the potential harms of screening.

The groups at highest risk are people with diabetes and high blood pressure, which we have long recognized. In addition, those with obesity, cardiovascular disease, older adults and people with a family history of kidney disease are at high risk for CKD. Importantly, risk is also not shared equally, with Black Americans being more than four times as likely as white Americans to develop kidney failure, and Hispanic and Native American people being more than twice as likely.

HCPLive: What do you hope the task force's evidence review captures, and how can the nephrology community contribute?

Pranav Garimella, MBBS, MPH: When the Task Force last reviewed CKD screening in 2012, it found the evidence insufficient to make a recommendation in asymptomatic adults. The landscape has changed considerably since, both in our understanding of kidney disease and in the treatments available. Drugs such as SGLT2 inhibitors, finerenone and GLP-1 receptor agonists have shown in large trials that they can slow kidney disease progression and reduce cardiovascular events even in early stages.

The evidence review should examine whether screening accurately identifies CKD, what happens after identification, and whether earlier detection lets clinicians start treatments that improve outcomes. Since kidney disease does not affect every community equally, evaluation of screening should account for populations that bear a disproportionate burden of CKD and kidney failure.

The nephrology community can contribute by continuing to provide current research, clinical experience and implementation data. As the Task Force resumes its work, the public comment period on the draft evidence review and recommendation will be an important opportunity for kidney experts to identify gaps and add clinical context.

Editor's Note: This transcript has been edited for grammar and clarity using artificial intelligence tools. Garimella has relevant disclosures with Otsuka and the PKD Foundation.

References

1. Centers for Disease Control and Prevention. Chronic Kidney Disease in the United States, 2026. Updated March 31, 2026.

2. US Department of Health and Human Services. Secretary Kennedy Announces New Appointments to US Preventive Services Task Force. Published September 17, 2026.

3. US Preventive Services Task Force. Chronic Kidney Disease: Screening. Final Research Plan. Published July 13, 2023.

4. American Kidney Fund. American Kidney Fund Statement on USPSTF Roster Updates. Published September 17, 2026.

5. Bailey RA, Wang Y, Marcovina S, et al. Chronic kidney disease testing among primary care patients with type 2 diabetes across 24 US health care organizations. Diabetes Care. 2021;44(9):2009-2016. doi:10.2337/dc20-2715.