The Case for Routine Kidney Screening, With Pranav Garimella, MBBS, MPH

The US Preventive Services Task Force finalized its research plan on chronic kidney disease screening in 2023 and has not yet issued a draft recommendation. As the Task Force considers how kidney disease screening should be approached in primary care, a nephrology perspective can help illustrate the importance of earlier detection and how screening could translate into clinical practice.

"Screening for kidney disease should become a routine part of preventive care for adults, especially those at high risk before symptoms develop," said Pranav Garimella, MBBS, MPH, chief medical officer of the American Kidney Fund.

The question is particularly relevant given ongoing gaps in chronic kidney disease (CKD) detection. Modeling published in 2023 found that screening adults aged 35 to 75 for albuminuria, paired with available treatments, could prevent dialysis or kidney transplant in up to 658,000 people and would be cost-effective.¹ Nearly 1 in 3 adults with severe CKD remain unaware of their disease,² while just 5% of respondents to a 2025 American Kidney Fund survey recalled ever receiving a uACR test.³

In the following interview, Garimella discusses what a USPSTF recommendation on kidney disease screening could look like in practice, including who should be tested and how kidney screening could fit into routine preventive care.

Q&A: How a USPSTF kidney screening recommendation could work

HCPLive: If a recommendation is issued, what should it look like in practice: who is tested, how often, and with which tests?

Pranav Garimella, MBBS, MPH: Screening for kidney disease should become a routine part of preventive care for adults, especially those at high risk before symptoms develop, using both eGFR and uACR. Modeling data published in 2023 found that screening adults aged 35 to 75 with a urine albumin test, paired with today's treatments, would be cost-effective and could keep thousands of people off dialysis.

Testing in people with diabetes and hypertension deserves a specific note. The Task Force guidance treats their kidney testing as part of managing those conditions, noting that guidelines for those groups already exist. While true, these guidelines have not closed the gap: about half of people with type 2 diabetes did not receive a uACR in a year. A recommendation covering other at-risk adults, such as those with cardiovascular disease, a family history of kidney disease, obesity or older age, would be valuable.

Ideally, kidney health becomes part of routine preventive care, monitored the way clinicians already monitor blood pressure, blood sugar and cholesterol, rather than something first addressed after advanced disease appears.

HCPLive: What message would you give the task force about kidney disease prevention, and what impact do you hope it has?

Pranav Garimella, MBBS, MPH: About 1 in 3 adults with severe CKD do not know they have it, and many patients who start dialysis today first learned of their kidney disease when they became ill and needed dialysis urgently.

We have simple blood and urine tests that identify kidney disease, and treatments that slow progression and reduce serious complications. We need to identify people at risk, test them appropriately, confirm the diagnosis and connect patients to treatment and ongoing care. Because kidney disease is intertwined with diabetes, cardiovascular disease and obesity, protecting kidney health should be part of protecting cardiovascular and metabolic health, not treated in isolation.

My hope is that this review gives primary care clinicians and patients a clearer pathway to identify kidney disease when there is still the most opportunity to preserve kidney function and prevent or delay kidney failure.

HCPLive: Is there anything else you would like the task force or nephrology community to know?

Pranav Garimella, MBBS, MPH: The fact that there are specialists serving alongside primary care clinicians on the Task Force is meaningful. Our understanding of the relationship among kidney, cardiovascular and metabolic health has advanced substantially, and we have more tools available to intervene earlier. My hope is that preventive cardiology's embrace of CKM means more high-risk patients will be identified and started on guideline-directed therapy, and that benefits kidney health too.

AKF's 2025 national survey found that although 68% of respondents reported having an annual physical in the prior year, only 51% said their kidneys were checked. Just 5% recalled ever having a uACR test, while more than half were unsure whether they had ever received one.

We have an opportunity to make kidney health a more routine part of preventive care. Clear, evidence-based guidance from the USPSTF could help primary care clinicians identify who should be tested, which tests to use and what should happen after an abnormal result.

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. Cusick M, Owens DK, Goldhaber-Fiebert J, Tisdale R. Population-Wide Screening for Chronic Kidney Disease: A Cost-Effectiveness Analysis. Ann Intern Med. 2023;176(6):788-797. doi:10.7326/M22-3228

2. Centers for Disease Control and Prevention. Trends in Kidney Disease Awareness among U.S. Adults with CKD Stages 3-5. Chronic Kidney Disease Surveillance System. Accessed September 25, 2026. https://nccd.cdc.gov/CKD/detail.aspx?QNum=Q98

3. American Kidney Fund. New survey reveals misconceptions and urgent gaps in public understanding of kidney disease. Published August 27, 2025. Accessed September 25, 2026. https://www.kidneyfund.org/article/new-survey-reveals-misconceptions-and-urgent-gaps-public-understanding-kidney-disease-majority