Chronic kidney disease (CKD) is an imminent global health issue. According to the Global Burden of Disease Study 2023, more than 850 million people are affected by kidney disease, twice as many as those living with diabetes and 20 times more than those with human immunodeficiency virus or acquired immunodeficiency syndrome. Worldwide, CKD has shown steady growth, climbing from the 27th leading cause of death in 1990 to the 9th place in 2023.¹ This has prompted the World Health Organization kidney health resolution to prioritise kidney disease within the non-communicable disease programme.² The rising prevalence is associated with ageing populations and an increasing burden of risk factors from non-communicable diseases such as diabetes and hypertension, which together are responsible for over half of CKD-related deaths.^3,4

Diabetes is the primary cause of CKD, including end-stage kidney disease (ESKD). The prevalence of type-2 diabetes among adults continues to increase, mainly as a result of population ageing and the obesity epidemic.⁵ Additionally, an ageing population is a risk factor for CKD, partly because normal ageing-related physiological changes decrease glomerular filtration rate (GFR), especially after age 50. However, there is ongoing debate in the literature about whether to use absolute or age-adjusted cut-off values to detect CKD and assess risk. Because GFR declines with age, a fixed threshold rate can lead to underdiagnosis of CKD in young adults and overdiagnosis among the elderly.⁶

Chronic kidney disease is the seventh leading cause of cardiovascular mortality. Even a moderate decline in kidney function is associated with a significantly increased risk of cardiovascular events and death. While those progressing to ESKD require specialised care, such as transplantation, dialysis or sometimes palliation, these costs have a substantial impact on the healthcare system.⁷ In South Africa, there are approximately two nephrologists per million people, which is below the global standard and inadequate for CKD management.¹

Epidemiological data from South Africa emphasise the importance of prioritising kidney disease on the public health agenda.² The prevalence rates for CKD in South Africa ranged from 6.4% to 8.7%, in sub-Saharan Africa 10.7% – 13.9%, in Africa 4.6% – 10.1% and globally 4.1% – 10.6%. Notably, the burden of CKD is most significant among historically marginalised populations, which often have limited access to optimal management of kidney conditions. This substantially contributes to existing socioeconomic disparities in health outcomes.⁷

Despite the rising burden of CKD, there is no consensus on population- or targeted-screening. Early detection and management in primary care are vital for preventing CKD, delaying progression and avoiding adverse outcomes. An effective strategy involves implementing the 78th World Health Assembly resolution on the prevention and control of kidney diseases,² including ongoing training, and addressing the shortage of human and healthcare resources in primary care, which are crucial for control.⁷

Primary Health Care serves as the entry point for community health needs. Most patients with risk factors or in the early stages of CKD can be managed in primary care settings.⁸ Therefore, primary care providers must identify and treat CKD. This narrative review aims to guide primary care providers on current practices for early detection and management of kidney disease in Primary Health Care. The search strategy used the keyword ‘Chronic Kidney Disease or CKD or Chronic Renal Disease and Primary care or Primary Health Care’ and involved academic databases such as PubMed, Scopus, Web of Science and Google Scholar.

Chronic kidney disease is defined by structural or functional abnormalities in the kidney that last for at least 3 months. The Kidney Disease: Improving Global Outcomes (KDIGO) defines CKD as ‘Decreased GFR < 60 mL/min per 1.73 m² (GFR categories G3a–G5), Albuminuria (albumin to creatinine ratio (ACR) > 3 mg/mmol) and markers of kidney damage (one or more), such as urine sediment abnormalities, persistent haematuria, electrolyte and other abnormalities due to tubular disorders’. These abnormalities can be identified through biochemical tests, urinalysis, histological examination, radiological imaging and a patient’s history of kidney transplantation.⁴

Kidney Disease: Improving Global Outcomes recommends staging of CKD using a validated creatinine-based estimating equation to determine GFR (eGFRcr). In certain circumstances, when the accuracy of creatinine may be questionable, an estimating equation that incorporates creatinine and cystatin C is advised. These situations include patients with a small body habitus, malnutrition, low protein diet, malignancy, cirrhosis, catabolic states and steroid use.^4,6

Staging of CKD is decided by GFR categories (G1–G5), Albuminuria categories (A1–A3) and underlying causes. These elements are vital for assessing CKD severity and associated risks. Staging helps predict patient outcomes and informs treatment strategies. Higher albuminuria levels are associated with worse cardiovascular outcomes. The combination of CKD cause, stage and albuminuria level affects prognosis.^4,9 Figure 1 illustrates CKD staging based on KDIGO diagnostic criteria.

The primary objectives of CKD management are to slow disease progression, lower cardiovascular risk, identify patients needing renal replacement therapy, manage CKD-related complications and modify medications according to GFR. Table 2 presents common strategies for delaying CKD progression, while Table 3 details typical complications in CKD patients and their management.

General lifestyle advice remains important at all stages of CKD. This includes quitting smoking, losing weight, following a low-salt diet (< 2 g/day) and avoiding nephrotoxic substances. Chronic kidney disease patients should be encouraged to participate in suitable physical activity for at least 30 min, five times a week, depending on their cardiovascular health and tolerance. Smoking is linked to faster CKD progression; quitting can help reduce the risk of worsening kidney function and cardiovascular problems. Additionally, adopting a more plant-based diet and limiting animal protein and processed foods can reduce proteinuria and metabolic acidosis. Dietary advice from a qualified dietitian supports managing sodium, phosphate, protein and potassium intake, tailored to CKD stage and comorbidities.^3,10

For the elderly, dietary protein restriction must be individualised. Special attention is needed for frail and sarcopenic older patients to prevent malnutrition. This involves prioritising the most urgent clinical issues. According to Geriatric guidelines, a daily protein intake of 1 g/kg – 1.2 g/kg of body weight may be suitable for patients with stable CKD and other significant age-related concerns. Conversely, in an otherwise stable patient with progressing CKD, a more limited protein intake might be better. Such decisions should involve input from the patient, family and caregivers.^4,8

In conclusion, CKD is a common diagnosis in Primary Health Care. Recently, its prevalence has increased disproportionately among patients in primary care, driven by an ageing population and the rising burden of non-communicable diseases, especially diabetes. Primary care providers play a vital role in early detection and screening, as CKD often exhibits no symptoms in its early stages. Annual screening for blood pressure, urine dipstick tests for proteinuria or albuminuria and serum creatinine is recommended for individuals at high risk of CKD. For established CKD patients, renal protective strategies include a multidisciplinary approach with dietary management, drug stewardship, prompt infection management, optimisation of blood glucose and blood pressure and measures to reduce cardiovascular risk. As the first point of contact for community health needs, primary care providers should effectively manage most at-risk or early-stage CKD patients through an integrated approach to non-communicable disease management.