NKF-led scientific workshop calls for standardization, equity in how CKD is measured and managed
New York City, NY (May 13, 2025) - A global panel of experts is calling for a shift in how chronic kidney disease (CKD) is detected and monitored, urging health care providers to adopt urinary albumin testing as the standard of care for high-risk adult patients. The recommendations are the result of last month’s Scientific Workshop on the Measurement of Urinary Proteins in Clinical Trials and Clinical Practice convened by the National Kidney Foundation (NKF).
Chaired by Drs. Hiddo Lambers Heerspink, Ron Gansevoort, and Bengt Fellström, the workshop brought together key opinion leaders from academia, laboratory medicine, regulatory agencies (including the U.S. Food and Drug Administration and European Medicines Agency), clinical practice guideline organizations, and industry stakeholders. After two days of presentations and deliberations, the group agreed that measurement of urinary albumin, rather than total urinary protein, offers greater accuracy, equity, and clinical value—and should be the preferred method for CKD screening and monitoring worldwide.
The measurement of urinary proteins—either total protein or albumin—is foundational to diagnosing, monitoring, and predicting outcomes in CKD. However, variation in clinical and research practices has created confusion over which measure offers the most accurate, meaningful insights into disease progression and treatment efficacy.
To help provide clarity, NKF partnered with University Medical Center Groningen to support robust analyses of data from clinical trials and cohort studies. The results of the analyses showed that urinary albumin has a slightly stronger association with clinical outcomes compared to total urinary protein, especially in high risk patients.
The workshop participants also emphasized the urgent need to standardize testing protocols, and remove age, BMI or sex-based thresholds. The recommendations aim to address persistent underdiagnosis and eliminate disparities in kidney care delivery across populations and settings.
Other key findings include:
- Urinary albumin testing is more reproducible, better associated with long-term outcomes, and supported by stronger international standardization than total protein tests.
- The albumin-to-creatinine ratio (ACR) in a spot urine sample is sufficient for initial screening, whereas early morning urine samples are preferred for confirmation and for monitoring high-risk patients.
- Definitions of moderate and severe albuminuria should be consistent across populations and not adjusted based on age, sex, or BMI.
- A transitional approach may be appropriate for glomerular disease patients, where both albumin and total protein are measured to build comparative data and support future conversion.
Despite its clinical advantages, urinary albumin testing remains underused, in part due to lack of awareness and slightly higher costs. NKF and the workshop participants urged policymakers, clinicians, and laboratories to update testing protocols and public health programs to reflect the growing evidence base.
“This workshop, analyzing the evidence for the optimal urine test, is important because urine testing for kidney diseases is often missing in real world practice,” said Dr. Joseph Vassalotti, Chief Medical Officer at NKF. “Building consensus for the preferred test can lead to the right care—and ultimately save lives.”
A full summary of workshop recommendations will be published later this year in the American Journal of Kidney Diseases (AJKD) along with multiple supplemental papers. This initiative reflects NKF’s continued commitment to advancing evidence-based practices in kidney health.
NKF gratefully acknowledges the following sponsors whose support made this initiative possible: Alexion, AstraZeneca, Bayer, Boehringer Ingelheim, Calliditas Therapeutics, CSL Vifor, Dimerix, Novartis, Novo Nordisk, Otsuka, Purespring Therapeutics, Renalytix, and Travere Therapeutics.
About Kidney Disease
In the United States, more than 35 million adults are estimated to have kidney disease, also known as chronic kidney disease (CKD)-and approximately 90 percent don't know they have it. About 1 in 3 adults in the U.S. are at risk for kidney disease. Risk factors for kidney disease include diabetes, high blood pressure, heart disease, obesity, and family history. People of Black or African American, Hispanic or Latino, American Indian or Alaska Native, Asian American, or Native Hawaiian or Other Pacific Islander descent are at increased risk for developing the disease. Black or African American people are about four times as likely as White people to have kidney failure. Hispanic people experience kidney failure at about double the rate of White people.
About the National Kidney Foundation
The National Kidney Foundation is revolutionizing the fight to save lives by eliminating preventable kidney disease, accelerating innovation for the dignity of the patient experience, and dismantling structural inequities in kidney care, dialysis, and transplantation. For more information about NKF, visit www.kidney.org.
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Media Contact:
Paul McGee 716-523-6874 or paul.mcgee@kidney.org