Why Early Kidney CKD Testing Matters and How Medicare Quality Programs Can Help

Kidney disease often develops silently over many years, even in people who regularly see a doctor for conditions like high blood pressure or diabetes.

To address this gap, the Coalition for Kidney Health, led by the National Kidney Foundation (NKF), urges the Centers for Medicare & Medicaid Services (CMS) to strengthen how Medicare measures and rewards early kidney disease detection in primary care.

Improving screening through Medicare quality programs could help millions of Americans learn about kidney disease sooner and get treatment earlier.

CKD affects more than 1 in 7 adults in the United States, and more than 1 in 3 adults are at risk.

The leading causes of CKD, diabetes and high blood pressure, are common among older adults. Yet many people with these conditions never receive the two simple tests that can detect kidney disease early:

• A blood test measuring kidney function (eGFR)
• A urine test detecting kidney damage (uACR)

Without early testing, kidney disease can progress unnoticed. Patients may miss opportunities for treatments that can:

• Slow CKD progression
• Protect heart health
• Reduce the risk of kidney failure
• Early detection can dramatically improve long-term outcomes.

Medicare uses quality programs to determine how doctors are evaluated and paid, helping shape what types of care are prioritized.

One key program is MIPS Value Pathways (MVPs), which group together quality measures that clinicians are encouraged to follow when managing certain health conditions.

The Coalition for Kidney Health urges CMS to ensure kidney disease screening is included as a core measure in MVPs focused on:

• Diabetes care
• High blood pressure management
• Primary care prevention

Specifically, the coalition recommended expanding the Kidney Health Evaluation measure, which tracks whether at-risk patients receive both recommended kidney tests.

Read NKF's Recommending a Change to an Existing MVP and MVP Candidate Feedback letters.

Including kidney disease screening in Medicare quality pathways would help ensure that:

• Patients with diabetes and high blood pressure are routinely screened for CKD
• Doctors are encouraged to detect kidney disease earlier
• Care teams can better coordinate treatment across related conditions

Kidney disease also often worsens other chronic illnesses. Once kidney damage occurs, the risk of heart disease, hospitalization, and early death rises significantly, even when blood sugar or blood pressure appears controlled.

Earlier diagnosis gives patients more time, more treatment options, and better chances to prevent kidney failure.

Kidney disease sits at the center of what experts call cardio-kidney-metabolic (CKM) health or the interconnected relationship between the heart, kidneys, and metabolic conditions like diabetes.

Treating these conditions separately often leads to missed opportunities for prevention.

NKF emphasized that primary care teams need:

• Tools that support coordinated care
• Incentives to screen for kidney disease early
• Quality measures that reflect whole-person health

Strengthening kidney testing requirements in Medicare programs could help clinicians address CKD as part of a comprehensive approach to chronic disease management.

NKF supports Medicare’s efforts to improve prevention and quality of care. However, quality programs are most effective when they focus on what patients truly need.

Because kidney disease is common, serious, and often invisible, making early kidney testing a standard part of care for people with diabetes and high blood pressure could save lives.

The Coalition for Kidney Health and NKF will continue advocating for policies that help people learn about kidney disease sooner, access early treatment, and prevent kidney failure.

Help NKF change kidney care for the better. Become a Voices for Kidney Health advocate.