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. 2025 Aug 29;40(9):1786-1798.
doi: 10.1093/ndt/gfaf057.

ABCDE to identify and prevent chronic kidney disease: a call to action

Charles J Ferro  1 , Christoph Wanner  2 , Valerie Luyckx  3   4   5   6 , Kate Stevens  7 , Sofia Cerqueira  8 , Rasha Darwish  9 , Beatriz Fernandez Fernandez  10   11 , David Fiel  12 , Rumen Filev  13   14 , Manfred Grieger  15 , Antonia Lopez  16 , Merike Luman  17   18 , Jolanta Malyszko  19 , Milena Krasimirova Nikolova-Vlahova  20 , Fiita Romero  21 , Chrysanthi Skalioti  22 , Carla Alexandra Ribeiro Dos Santos Araújo  23 , Ieva Ziedina  24 , Daniel Gallego  25 , Alberto Ortiz  10   11 , Roser Torra  26 , Raymond Vanholder  27   28
Affiliations

ABCDE to identify and prevent chronic kidney disease: a call to action

Charles J Ferro et al. Nephrol Dial Transplant. .

Abstract

Kidney disease is a global health priority affecting >850 million people worldwide. This number is projected to increase over the coming decades given the increasing prevalence of diabetes, hypertension and obesity and the aging population. Chronic kidney disease (CKD) can reduce both life expectancy and quality of life and is intricately linked with cardiac and metabolic health-the cardiovascular-kidney-metabolic multimorbidity syndrome. With early recognition of risk, CKD can be prevented and with timely case finding, early diagnosis and early intervention, its progression can be halted or slowed. The European Renal Association has established the Strong Kidneys Task Force, with the main purpose of creating awareness about the importance of kidney health for individual and population health. In collaboration with the European Kidney Health Alliance and the European Kidney Patients Federation, the ABCDE campaign will empower communities and individuals to remind their healthcare providers to assess their risk of kidney disease. ABCDE asks five simple questions about health status that only the healthcare system can provide: A) Do I have Albumin in my urine? B) What is my Blood pressure? C) What is my Cholesterol? D) Do I have Diabetes? E) What is my current kidney function (Estimated glomerular filtration rate)? This advocacy text aims to inform individuals, communities and front line healthcare workers that capturing the risk of kidney, cardiac and metabolic health is simple, makes sense, is logical and will save lives. Although making meaningful change will take time and involve major personal and societal changes, the first step really is as easy as ABCDE!

Keywords: albuminuria; chronic kidney disease; diagnosis; mortality; prevention.

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Conflict of interest statement

A.O. has received grants from Sanofi and consultancy or speaker fees or travel support from Adviccene, Alexion, Astellas, AstraZeneca, Amicus, Amgen, Boehringer Ingelheim, Fresenius Medical Care, GSK, Bayer, Sanofi-Genzyme, Sobi, Menarini, Mundipharma, Kyowa Kirin, Lilly, Freeline, Idorsia, Chiesi, Otsuka, Novo Nordisk, Sysmex, Vifor Fresenius Medical Care Renal Pharma and Spafarma and is Director of the Catedra UAM-Astrazeneca of chronic kidney disease and electrolytes. He owns stock in Telara Farma. C.W. has received fees for consultancy and lecturing from Alexion, AstraZeneca, Amgen, Bayer, Boehringer Ingelheim, GSK, Lilly, Novo Nordisk, Sanofi and CSL-Vifor. C.S. has received speaker fees from Astellas Pharmaceuticals, AstraZeneca, Boehringer Ingelheim and Genesis Pharma. M.G. has received consultancy fees from Bayer. K.S. has received consultancy fees from CSL Vifor, Boehringer Ingelheim and Bayer. R.V. is advisor to AstraZeneca, GSK, Fresenius Kabi, Novartis, Baxter, Fresenius Medical Care and Nextkidney. C.S.A. has received speaker fees from AstraZeneca, Boehringer Ingelheim and Bial.

Figures

Figure 1:
Figure 1:
Risk of progression of CKD by GFR and albuminuria. Adapted from Kidney Disease: Improving Global Outcomes CKD Work Group. KDIGO 2024 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int 2024;105(4S):S117–314.
Figure 2:
Figure 2:
Associations of CKD staging by GFR by serum creatinine and UACR categories and risk of all-cause and cardiovascular mortality. Numbers reflect the adjusted hazard ratio compared with the reference cell. Adjustment variables included age, sex, smoking status (current, former or never), systolic BP, total cholesterol, high-density lipoprotein cholesterol, body mass index, use of antihypertensive medications and a medical history of diabetes, coronary heart disease, stroke, heart failure, atrial fibrillation, peripheral artery disease, cancer or chronic obstructive pulmonary disease. Adapted from Kidney Disease: Improving Global Outcomes CKD Work Group. KDIGO 2024 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int 2024;105(4S):S117–314.
Figure 3:
Figure 3:
Hypothetical transformation of chronic eGFR slopes into time to kidney failure, defined as GFR 10 ml/min/1.73 m2, in the EMPA-KIDNEY trial. Time to kidney failure according to baseline GFR was estimated from each baseline eGFR value by applying the chronic eGFR slopes corresponding to participants on placebo and on empagliflozin within the pre-specified GFR subgroups (GFR cut-off points to define subgroups set at 30 and 45 ml/min/1.73 m2) as per reference. The delay in time (years) to kidney failure on empagliflozin versus placebo, according to baseline eGFR, was obtained by subtracting the time to kidney failure on empagliflozin from the time to kidney failure on placebo. This conceptual model assumes that patients will live up to the point where they need kidney replacement therapy and that chronic GFR slopes observed in the clinical trial are maintained stable beyond the duration of the trial. Reproduced from Fernandez-Fernandez B, Sarafidis P, Soler MJ, Ortiz A. EMPA-KIDNEY: expanding the range of kidney protection by SGLT2 inhibitors. Clin Kidney J 2023;16:1187–1198.
Figure 4:
Figure 4:
Infographic for the Strong Kidneys ABCDE campaign.
See this image and copyright information in PMC

References

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