The Brazilian Society of Nephrology published practical recommendations to help primary care managers include chronic kidney disease in routine work, within the structure of the public Unified Health System. The document, which carries a date earlier in 2026, rests on current Brazilian and international guidelines, national law, and the financial and structural resources available.
Its premise is that kidney disease is well suited to prevention: it shares common risk factors with other chronic conditions, can be detected with low-cost, widely available tests, has a known natural history and has treatments with proven cost-effectiveness. It also notes that recent studies still show gaps in implementing the care pathway despite more than two decades of guidelines. The abstract does not list the individual recommendations.
India faces a similar problem, with a large primary care base and under-detected disease. The value of the paper is as a model of how a national society translates guidelines into workflow, and clinicians should read the full recommendations before borrowing any specifics.
- Test for kidney disease in people with diabetes, hypertension, cardiovascular disease or a family history, using eGFR and a urine albumin test together
- Build a recall into the practice register rather than relying on opportunistic testing
- Define who in the team manages monitoring and who refers
- Agree referral criteria with your local nephrology service
- Read the full Brazilian recommendations before adapting any threshold
Why it matters
Kidney disease is cheap to detect and expensive to miss, and the gap is in implementation rather than knowledge.
Don't overread it
A regional society's implementation framework is not a guideline for other countries, and the abstract gives no specific thresholds.
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