Screenings if you have kidney disease

Kidney tests: how often

KDIGO says to assess urine albumin (in children, albumin or protein) and GFR at least once a year in people with CKD, and more often for people at higher risk of CKD getting worse when the result will change treatment decisions. (KDIGO, 2024) Its monitoring chart, a guide to the number of checks per year by GFR and albuminuria category, ranges from 1 a year to 4 or more a year at stages G4 and G5. (KDIGO, 2024)

NICE says to agree how often to monitor eGFR and urine albumin-to-creatinine ratio (ACR) with the person, bearing in mind that CKD is not progressive in many people. Its table of the minimum number of eGFR checks per year runs: (NICE NG203)

G1 and G2 (eGFR 60 or over): 0 to 1 a year with normal to mildly increased ACR, 1 with moderately increased ACR, 1 or more with severely increased ACR.
G3a (45 to 59): 1, 1 or 2 a year, by ACR category.
G3b (30 to 44): 1 to 2, 2, or 2 or more a year.
G4 (15 to 29): 2, 2 or 3 a year.
G5 (under 15): 4, 4 or more, or 4 or more a year.

NICE says to tailor this to the cause of CKD, how fast eGFR or ACR is changing, other conditions such as heart failure, diabetes and high blood pressure, treatment changes, illness such as acute kidney injury, and whether conservative management was chosen. (NICE NG203) MedlinePlus says some blood tests, including albumin, calcium, cholesterol, a complete blood count and electrolytes, may be needed as often as every 2 to 3 months when kidney disease gets worse. (MedlinePlus)

Anemia

KDIGO's 2026 anemia guideline says to test for anemia at referral, regularly during follow-up, and when symptoms suggest it, using a complete blood count, reticulocytes, ferritin and transferrin saturation. It suggests hemoglobin testing at least: (KDIGO anemia, 2026)

CKD G3: once a year
CKD G4: twice a year
CKD G5 or on dialysis: every 3 months

It says testing should be more frequent for people whose CKD is progressing quickly or whose hemoglobin is below the target range. (KDIGO anemia, 2026) NICE says to consider investigating anemia if hemoglobin falls to 110 g/litre or less (105 g/litre or less under age 2), or if symptoms such as tiredness, shortness of breath, lethargy or palpitations develop. It says anemia is unlikely to be caused by CKD when eGFR is above 60, and is often caused by CKD when eGFR is below 30. (NICE NG203)

Bone and mineral checks

KDIGO recommends monitoring blood calcium, phosphate, parathyroid hormone (PTH) and alkaline phosphatase starting at CKD G3a in adults, and suggests starting at G2 in children. It describes reasonable intervals: (KDIGO bone, 2017)

G3a to G3b: calcium and phosphate every 6 to 12 months; PTH based on the first level and how CKD is changing.
G4: calcium and phosphate every 3 to 6 months; PTH every 6 to 12 months.
G5, including dialysis: calcium and phosphate every 1 to 3 months; PTH every 3 to 6 months.
G4 to G5, including dialysis: alkaline phosphatase every 12 months, or more often if PTH is raised.

For people at G3a to G5 with signs of mineral and bone disorder or risk factors for osteoporosis, KDIGO suggests a bone mineral density test to assess fracture risk if the result will change treatment decisions. (KDIGO bone, 2017) MedlinePlus lists weakening of the bones and a higher risk of fractures among CKD complications. (MedlinePlus) See how often to have a bone density test.

Heart and blood pressure

MedlinePlus says most people have high blood pressure at all stages of CKD, and lists heart and blood vessel complications among its effects. (MedlinePlus) KDIGO says heart risk prediction in CKD should use tools developed in people with CKD, or that include eGFR and albuminuria. It suggests opportunistic pulse-based screening for atrial fibrillation, for example when blood pressure is measured. For children with CKD, it says to monitor blood pressure once a year with ambulatory monitoring and every 3 to 6 months in the office. (KDIGO, 2024) See heart screenings by age and screenings if you have high blood pressure.

Hepatitis C around dialysis and transplant

KDIGO recommends hepatitis C screening for everyone: (KDIGO hepatitis C, 2022)

when CKD is first evaluated
when in-center hemodialysis starts, or on transfer from another dialysis facility or type of dialysis
when peritoneal dialysis or home hemodialysis starts (a suggestion rather than a recommendation)
at evaluation for a kidney transplant
every 6 months during in-center hemodialysis

KDIGO says all transplant candidates should be screened for infections including HIV, hepatitis C and hepatitis B. (KDIGO transplant candidates, 2020) What results mean is on hepatitis C test results and hepatitis B test results.

Cancer and skin checks with a transplant

KDIGO says all transplant candidates should have routine cancer screening as per local guidelines for the general population, and that candidates at increased risk of renal cell carcinoma, bladder carcinoma or hepatocellular carcinoma should be screened. (KDIGO transplant candidates, 2020)

For people who have had a kidney transplant, KDIGO suggests: (KDIGO transplant recipients, 2009)

an individual screening plan that weighs past medical and family history, tobacco use, competing risks for death and how well the screening test performs
screening as per local guidelines for the general population: cervical, breast and colon cancer for women; prostate and colon cancer for men
a liver ultrasound and alpha-fetoprotein test every 12 months for people with compensated cirrhosis
for adults, a yearly skin and lip exam by a qualified health professional with experience in diagnosing skin cancer; KDIGO says recipients should be told their risk of skin and lip cancer is very high

KDIGO says cancer screening has both benefits and harms, and that in recipients with several other health conditions the possible harm needs to be weighed against the benefit of finding cancer early. (KDIGO transplant recipients, 2009) See skin checks by age, colorectal cancer screening tests compared and screenings after cancer treatment.

If you also have diabetes

Eye and foot checks for people with diabetes are on screenings if you have diabetes, diabetic eye exam results and diabetic foot exam.

When to contact a provider

The MedlinePlus chronic kidney disease page does not have a "when to contact" list. (MedlinePlus) Ask your care team which of these checks apply to you and when the next one is due.

Where they differ:

Kidney test frequency at mild stages. KDIGO says at least once a year for everyone with CKD, (KDIGO, 2024) while NICE's minimum is 0 to 1 eGFR checks a year at G1 and G2 with normal to mildly increased ACR, and it says ACR monitoring should be individualized. (NICE NG203)
Anemia. KDIGO sets minimum hemoglobin testing intervals by stage, (KDIGO anemia, 2026) while NICE ties investigation to a hemoglobin level or symptoms. (NICE NG203)
USPSTF. Its CKD screening recommendation is being updated and the 2012 version is marked out of date; it is about finding CKD, not the follow-up checks on this page. (USPSTF)

Your doctor decides what your result means for you.

Questions people ask

How often are kidney tests repeated once you have CKD?

KDIGO says to check urine albumin and GFR at least once a year in people with CKD, and more often for people at higher risk of getting worse. Its chart ranges from once a year up to 4 or more times a year at the most advanced stages. NICE gives a minimum number of eGFR checks per year by stage, from 0 to 1 at the mildest to 4 or more at the most advanced. (KDIGO, 2024) (NICE NG203)

How often is anemia checked with CKD?

KDIGO's 2026 anemia guideline suggests testing at least once a year in CKD stage G3, twice a year in G4, and every 3 months in G5 or on dialysis. NICE says to consider looking into anemia if hemoglobin falls to 110 g/litre or less, or if symptoms such as tiredness or shortness of breath appear. (KDIGO anemia, 2026) (NICE NG203)

When do bone and mineral blood tests start with CKD?

KDIGO recommends checking calcium, phosphate, parathyroid hormone (PTH) and alkaline phosphatase from CKD stage G3a in adults, and suggests starting from G2 in children. (KDIGO bone, 2017)

Is hepatitis C testing repeated on dialysis?

KDIGO recommends hepatitis C screening when CKD is first evaluated, when in-center hemodialysis starts, at evaluation for a kidney transplant, and every 6 months for people on in-center hemodialysis. (KDIGO hepatitis C, 2022)

Do usual cancer screenings continue after a kidney transplant?

KDIGO suggests an individual screening plan for each transplant recipient that weighs past and family history, tobacco use and competing risks for death, with cervical, breast, colon and prostate cancer screening as per local guidelines for the general population. It also suggests a yearly skin and lip exam by a qualified health professional for adult recipients. (KDIGO transplant recipients, 2009)