Referral to sub-specialists: who have the most to gain from early specialist intervention among patients with markers of renal disease?

Chronic kidney disease (CKD) is associated with various consequences to the cardiovascular system and metabolic profile. The classification into stages should be useful for the physician to anticipate and treat early the manifestations of this disease. We have reviewed the current evidence of the potential benefits from screening, monitoring and treating adult patients for CKD stages 1-3 to counter the progression of kidney damage towards end-stage renal disease. In particular, we advocate an integrated vision of kidney and cardiovascular diseases in clinical practice. A Medline/PubMed, Embase and Cochrane Library search from 2001 to 2013 was performed. All articles related to this topic were reviewed. The search strategy was limited to papers on adult patients in English and Italian. The resulting data was organized on the basis of the current guidelines (evidence-based medicine levels of evidence).