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Chronic kidney disease

Create a complete picture of kidney health

Chronic kidney disease (CKD) affects 37 million people in the US, but most of them are undiagnosed: 9 in 10 adults with CKD don’t know they have it.1 These missed diagnoses drive hospitalizations and costs,2 and risk bad outcomes.

Quest Diagnostics provides the complete testing and expert guidance you need to diagnose CKD, manage progression, establish follow-ups, and initiate nephrology referrals. With combined insights from eGFR, uACR, and other panels, you can feel empowered to get a complete picture of your patient’s kidney health.

Treating the underlying cause can improve patient outcomes

In the early stages of CKD, patients may not have many signs or symptoms, impacting the diagnosis and management of the disease. CKD may not become apparent until kidney function is significantly impaired. However, there are certain signs that people with diabetes may be developing CKD that can help with detection and treatment:

  • Protein in the urine
  • High blood pressure
  • Leg swelling or cramps
  • Increased need to urinate, especially at night
  • Abnormal blood tests (glomerular filtration rate, GFR)
  • Less need for insulin or anti-diabetic agents
  • Nausea and vomiting
  • Weakness
  • Pallor and anemia

Controlling the underlying cause of CKD—such as diabetes and hypertension—can slow the progression of kidney damage that can lead to end-stage renal disease. 

Defining the intersection of chronic conditions: a prevention-focused approach to cardiometabolic disease

With more people at risk for cardiovascular disease than ever before, the Quest Cardiometabolic Center of Excellence™ at Cleveland HeartLab® is advancing a prevention-focused approach for heart disease and associated metabolic conditions.

  • Cardiovascular disease is the leading cause of death for individuals who have T2DM,4 stage 4-5 CKD,5 and NAFLD.6
  • Those who have T2DM have a 2 to 3 times higher risk of fatal coronary heart disease.7
  • Nearly 40% of persons who have diabetes and more than 30% of those who have hypertension also have CKD.8 The leading causes of end-stage renal disease are diabetes and hypertension.9
  • More than 75% of those who have T2DM have NAFLD.10

Cardiovascular disease (CVD) is strongly associated with type 2 diabetes (T2DM), chronic kidney disease (CKD), and nonalcoholic fatty liver disease (NAFLD). Through significant investments in novel technology, Cleveland HeartLab® is fostering innovation to detect these conditions in their early stages, providing the opportunity for stage-targeted intervention and improved clinical outcomes.

Chronic kidney disease testing

Assess kidney function and damage in your at-risk patients with the Kidney Profile

Traditional serum creatinine (eGFR) testing may only reveal one side of the CKD story. For a more complete picture, guidelines recommend both the eGFR blood test and the urine albumin-to-creatinine ratio (uACR) test to assess kidney function and damage.11 This combination enables early detection, essential to managing CKD progression.

The Kidney Profile from Quest includes both tests, enabling earlier detection with just one test code. Quest offers the guideline-based testing you need to help diagnose CKD, manage disease progression, and establish follow-up testing frequency. You’ll also know when a referral to a nephrologist is recommended.

Learn more about the Kidney Profile test

Cystatin C with eGFR is an accurate marker to assess kidney function

Multiple, large studies demonstrate that serum cystatin C (eGFR) identifies a substantial subgroup of individuals with high-risk CKD who may go unrecognized by serum creatinine (eGFR) and provide strong evidence supporting the utility of cystatin C for accurate detection, staging, and risk stratification of patients with CKD.12

While Creatinine (eGFR) sees more use in the Kidney Profile, there are individuals where a Cystatin C (eGFR) may be more reliable, such as in those with12 ,13:
→ Muscle mass extremes
→ High or low meat diets
→ Severe obesity (BMI >40)

Download  the Cystatin C (eGFR) test brochure

Learn more about Cystatin C (eGFR)

It can be challenging to adhere to guidelines-based testing for patients who have progressed to stage 3 or 4 CKD due to the extensive work-ups required for these high-risk cases. However, consolidating all diagnostics within a single test code can help you meet guidelines from both the National Kidney Foundation15 and American Diabetes Association16 for monitoring and managing renal status.

Quest Diagnostics enables a straightforward approach with our comprehensive panel for advanced CKD management. Designed to be used annually in all patients with stage 3 or 4 CKD, the single-code panel assesses:

  • Fasting lipid levels
  • Fasting glucose
  • HbA1c
  • Liver functions (albumin, total and direct bilirubin, alkaline phosphatase, total protein, ALT, AST)
  • Urinary albumin excretion (UAE)
  • Serum creatinine/eGFR

Learn more about the Diabetes and Advancing CKD Management Panel


The power of Quest

Comprehensive, guidelines-based testing

Align your practice with the latest clinical guidelines11 with testing that’s faster, easier, and more affordable. Our complete kidney health panels assess both renal function and damage so you can get a holistic picture of kidney health.

Insightful reporting

Make care planning and referrals easier with advanced reporting enriched with clinical algorithms, educational resources, and expertise on kidney health. With the Kidney Profile, you and your patients get a complete analysis that maps follow-up testing to National Kidney Foundation guidelines.

Quanum® electronic health record

Spend more time with patients and less time clicking with our cloud-based EHR that offers dynamic and secure access to patient information anytime, anywhere. This powerful and fully mobile solution lets you easily manage labs, prescribe electronically, submit prior authorizations, and do so much more—right from the record.

Access to our network of experts

You can be confident you’re picking the right tests and interpreting results correctly with our team of more than 600 MDs, PhDs, toxicologists, genetic counselors, and other experts available for consulting at any time.

 

 

 

This information is provided for informational purposes only and is not intended as medical advice. A physician’s test selection and interpretation, diagnosis, and patient management decisions should be based on his/her education, clinical expertise, and assessment of the patient.

 

References

1. CDC. Chronic kidney disease in the United States, 2021. Updated March 4, 2021. Accessed April 2, 2021. https://www.cdc.gov/kidneydisease/publications-resources/2019-national-facts.html

2. Vassalotti JA, DeVinney R, Lukasik S, et al. CKD quality improvement intervention with PCMH integration: health plan results. Am J Manag Care. 2019;25(11):e326-e333.

3. Molnar AO, Hiremath S, Brown PA, et al. Risk factors for unplanned and crash dialysis starts: a protocol for a systematic review and meta-analysis. Syst Rev. 2016;5:117. doi:10.1186/s13643-016-0297-2

4. Lamarche B, Tchernof A, Moorjani S, et al. Small, dense low-density lipoprotein particles as a predictor of the risk of ischemic heart disease in men. Prospective results from the Québec Cardiovascular Study. Circulation. 1997;95(1):69-75. doi:10.1161/01.cir.95.1.69

5. National Cholesterol Education Panel. Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation. 2002;106(25):3143-3421.

6. Davidson MH, Corson MA, Alberts MJ, et al. Consensus panel recommendation for incorporating lipoprotein-associated phospholipase A2 testing into cardiovascular disease risk assessment guidelines. Am J Cardiol. 2008;101(12A):51F-57F. doi:10.1016/j.amjcard.2008.04.019 

7. Fox CS, Sullivan L, D’Agostino R, et al. The significant effect of diabetes duration on coronary heart disease mortality: the Framingham Heart Study. Diabetes Care. 2004;27(3):704-708. doi:10.2337/diacare.27.3.704 

8. Penn MS, Klemes AB. Multimarker approach for identifying and documenting mitigation of cardiovascular risk. Future Cardiol. 2013;9(4):497-506. doi:10.2217/fca.13.27 

9. Ikonomidis I, Mihalakeas CA, Lekakis J, et al. Multimarker approach in cardiovascular risk prediction. Dis Markers. 2009;26(5-6):273-285. doi:10.3233/DMA-2009-0633 

10. Richard J, Lingvay I. Hepatic steatosis and Type 2 diabetes: current and future treatment considerations. Expert Rev Cardiovasc Ther. 2011; 9(3): 321–328. doi:10.1586/erc.11.15 

11. National Kidney Foundation. Quick reference guide on kidney disease screening. Accessed April 2, 2021. https://www.kidney.org/kidneydisease/siemens_hcp_quickreference#

12. Chen DC, Potok OA, Rifkin D, Estrella, MM. Advantages, limitations, and clinical considerations in using cystatin C to estimate GFR. Kidney360 3(10):p 1807-1814, 2022. doi: 10.34067/KID.0003202022

13. Gounden V, Bhatt H, Jialal I. Renal function tests. In: StatPearls [Internet]. StatPearls Publishing; 2022. https://www.ncbi.nlm.nih.gov/books/NBK507821

14. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl. 2013;3(1):1-150. doi:10.1038/kisup.2012.73

15. Levey AS, Coresh J, Balk E, et al. National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Ann Intern Med. 2003;139(2):137-147. doi:10.7326/0003-4819-139-2-200307150-00013

16. Marathe PH, Gao HX, Close KL. American Diabetes Association standards of medical care in diabetes 2017. Diabetes Care. 2017; Standards of medical care in diabetes—2017. Diabetes Care. 2017;40(Suppl 1):S1-S2. doi:10.2337/dc17-S001

Questions?

Please talk to your Quest account representative for ordering information on our CKD testing solutions

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Chronic kidney disease

Resources

Getting Ahead of CKD with Cystatin C: The Podcast

The continuum of kidney disease care: from identification to referral

Chronic kidney disease: laboratory support of diagnosis and management

Laboratory testing for chronic kidney disease diagnosis and management

Kidney Profile test summary

Cystatin C (eGFR) test summary

Sample CardioIQ® Requisition Form

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